PA Formulary in the Works? The Trials and Tribulations of HB 18

LeHeigh Valley, PA (WorkersCompensation.com) – HB 18 has been met with some positive feedback, and some challenges. 

The Pennsylvania bill adds to recent WorkersCompensation.com coverage of drug formularies in Louisiana and California.

Sponsored by Rep. Ryan MacKenzie (R-LeHigh), vice chair of the House Labor and Industry Committee, he said he ardently supports the bill that protects workers “at all stages in their professional lives — including when they are out of work due to a work-related injury.”

Discussing the bill, which has seen both love and hate in recent press letters to the editors, Rep. MacKenzie told WorkersCompensation.com that statistics show 13 Pennsylvanians are dying everyday due to an opioid or heroin overdose.

“In 2016, 4,642 Pennsylvanians died from a drug overdose, which is a 37 percent increase over the previous year, according to the federal Drug Enforcement Administration (DEA). And, of the 4,642 fatalities, prescription or illicit opioids such as heroin were implicated in 85 percent of deaths. Furthermore, a report from the Centers for Disease Control and Prevention (CDC) found that 27 percent of people who abuse prescription pain medications receive them from a prescription from a doctor,” Rep. MacKenzie said.

In Pennsylvania specifically, a June 2016 study by the Workers’ Compensation Research Institute (WCRI) brought to light the significant overprescribing of drugs in Pennsylvania’s Workers’ Compensation system, said the Representative.

“The results were stunning. The study found that, of the 25 states reviewed, Pennsylvania had the third highest number of opioids prescribed per injured worker, and the second highest number of opioid pills prescribed per claim in non-surgical cases,” he said.

“There is no silver bullet to solve this problem. Communities, families, educators, service providers, and the government can all play a role in tackling this issue. We in the state Legislature have been diligently working to enact measures to help curb opioid abuse,” Rep. MacKenzie said.

HB 18 would implement a doctor-created drug formulary in the state’s Workers’ Compensation Program, noted the Representative, who added the adoption of a drug formulary is designed to reduce the over-prescription of opioid painkillers by setting standards for the medication that can be prescribed for a Workers’ Compensation patient.

While pushing his legislation, love and hate for the bill has been respectively reported first in the Lehigh Valley Live Letter to the Editor from June 11. “It is encouraging to see one of our local legislators take action to help address this crisis as it relates to injured workers,” according to the letter, further noting Rep. MacKenzie’s bill is a no-brainer. “It's hard to understand how anyone could oppose implementing a prescription drug formulary for Pennsylvania's workers’ compensation program — particularly as formularies are standard in hospitals, regular healthcare, Medicare and other public programs to help ensure appropriate patient care and address overuse of prescription drugs,” it continues.

The Pennsylvania Federation of Injured Workers (PFIW) wrote in to the Morning Call on May 12 as a Letter to the Editor authored by John Weiss, of Nazareth.

“It heightens the already adversarial and litigious atmosphere that the workers’ compensation system has become. The workers’ compensation law was enacted to fairly balance the rights of both the worker and the employer in a non-fault environment and not to become one-sided. HB 18 should not see the light of day. Call your state representatives and ask them to oppose it,” per Weiss’s writing.

Saying the bill “should be opposed by all workers in that it interjects a new legal obstacle between the injured workers and their doctors, where decisions like the choice of medicine belong,” Weiss denies any good coming out of the legislation. The PFIW did not respond to comment by press time.

Love nor hate has stopped Rep. MacKenzie from pushing the bill and drafting a successful formulary as seen in other states. “For example, Texas was an early adopter of a Workers’ Compensation drug formulary and its results show the dramatic impact such legislation can have. In the six months after implementation, non-formulary drugs and the injured workers who received them fell by over 60 percent.”

“In addition to Texas, many other states across the country also have been implementing drug formularies for Workers’ Compensation systems.  Most recently, Governors Jerry Brown in California and Andrew Cuomo in New York have both recognized the positive impact of such legislation and signed drug formularies into law to limit the overprescribing and help injured workers,” he said.

Rising fatality rates means immediate resistance, according to Rep. MacKenzie, who added legislators “need to attack this problem from all fronts, including addiction and abuse of opioids that may stem from our Workers’ Compensation system.”

“The Pennsylvania Medical Society recommends the use of guidelines in many instances. In addition, Pennsylvania Governor Tom Wolf has implemented the use of guidelines in the state’s Medicaid program when it comes to prescribing opioids,” he said.

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