Should Old Acquaintance Be Forgot?
Dec 23, 2015

DRUG FORMULARY BACK IN THE NEWS

The Tennessee Bureau of Workers' Compensation (Bureau) published its final rules establishing an evidenced based closed drug formulary. The Bureau based the formulary on the Official Disability Guidelines (ODG). The Tennessee formulary will now list "N drugs," generally opioid in nature, that will require prior approval from insurance carrier. The Bureau will publish the complete formulary by February 2016. Tennessee becomes the seventh state to adopt rigorous pre-authorization formulary procedures for opioid treatment in workers' compensation claims.

MOMENTUM THROUGHOUT 2015

Earlier this fall, California Governor Jerry Brown signed into law Assembly Bill 1124, which instructs the Division of Workers' Compensation to implement a closed drug formulary by July 2017. Studies estimatethe California formulary could save employers and carriers $124 million to $420 million in prescription drug costs annually.

NEXT UP?

North Carolina. Passed as an amendment to the North Carolina budget bill, the North Carolina legislature directed the state's Industrial Commission to study the impact of a drug formulary on workers' compensation claims filed by State employees. The Commission will report its findings to the legislature by April 1, 2016. The report will detail pharmacy‑related expenses incurred by the state of North Carolina annually and the opportunities to save cost and generate better health outcomes through the use of a closed drug formulary in the state.

A FEDERAL BUDGET BILL ON THE MOVE

INSIDE THE BELTWAY

This week the Congress passed a $1.1 trillion spending bill, narrowly avoiding a government shutdown.

ANY RISK MANAGEMENT ISSUES ALONG FOR THE RIDE?

The controversial Cybersecurity Information Sharing Act (CISA), for one. Along with the spending provisions in the budget, the Congress passed the CISA, which had been debated in the House and Senate all year. This cybersecurity measure provides mechanisms for private entities to transmit credible evidence of cybersecurity threats to federal law enforcement agencies through electronic portal systems. Critics of the CISA, including large technology firms like Apple, have voiced concerns that the CISA compromises consumer privacy.

AND…

Opioid reduction. The budget bill includes a $91 million allocation to the National Institutes of Health to underwrite state opioid reduction programs. This represents a 300% increase in federal funding to support such programs. This issue remains a significant part of the national conversation as we look ahead to the 2016 election.

NEXT UP?

The budget bill now goes to President Obama for signature.

MAKING OUR WAY AROUND THE COUNTRY

CENTERS FOR DISEASE CONTROL

The CDC announced its long-awaited guidance on prescription practices for opioid medication is open for public review and comment through January 16, 2016. Previously, the CDC planned to craft the guidelines privately through a select stakeholder group. It would appear that pressure from various sources, including the US Senate, prompted the CDC to open the guidelines to public comment.

FLORIDA

The Florida Division of Workers' Compensation announced proposed regulations to govern medical fee disputes between insurers and health care providers. The DWC's proposed rules address the form, content and supporting materials necessary to file or respond to a medical fee petition. The changes would also extend the response time for employer/carrier from 10 to 30 days. The DWC will accept comments through January 12, 2016, when it will hold a hearing on these proposals.

THANK YOU

We thank you for your participation as an "early adopter" of The Way this year. We greatly appreciate your feedback and support. You have helped us refine our writing and hone in on the critical governmental affairs affecting our industry each week. We will be off next week, and will hold our next edition until Wednesday, January 6th. 

Again, thank you for your valued assistance this fall. Please accept our best wishes for a joyous holiday season and most prosperous New Year.

Greg McKenna & Cari Miller

Tags:

Share This
Subscribe
 
* Required Fields