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Posted by Jeffrey A. Jacobs, M.D., M.P.H., Associate Medical Director
Last week I testified before the Pennsylvania House Labor and Industry Committee on the use of drug formularies in the workers’ compensation system.
It was the first time I have had the opportunity to testify before a government body and express my opinion about an issue I feel strongly about – the need for legislation to control over-prescribing of opioids and curb misuse and abuse.
In a memorandum, Rep. Ryan E. Mackenzie, author of the bill under consideration (HB 18), said the intent is to “reduce instances of opioid abuse and addiction stemming from our workers’ compensation system.” The proposed legislation would require the Pennsylvania Department of Labor and Industry to adopt an evidence-based drug formulary and establish certain standards for utilization review.
I was only allowed five minutes to speak, but my written testimony, which features a detailed analysis of the opioid epidemic, also became part of the record. I was able to touch on the three key points that I wanted the committee members to understand:
First, opioids have a role in the treatment of pain, but they are not the first-line medication in most situations.
Second, no one ever became a chronic pain patient without first going through the acute and sub-acute treatment phases.
Third, there are non-pharmacologic tools available to the primary care provider that optimize the well-being of their patients with acute or chronic musculoskeletal pain.
A number of states have adopted workers’ compensation drug formularies or have them in development. In a 2016 position paper on Drug Formularies in Workers’ Compensation Systems, the American College of Occupational and Environmental Medicine suggests that “a decision to include, exclude or otherwise restrict certain medications in a formulary should optimally follow principles of evidence-based medicine, including a ranking of the strength of medical evidence about a drug’s efficacy and safety.” The college also recommends that states include specific provisions to measure a broad range of outcome variables in order to assess the impact, efficacy and cost of formulary adoption. Outcome measures may include total claim costs, rates of delayed return to work or delayed claim closure, utilization review costs, and patient and provider satisfaction.
My remarks appeared to be well-received by the committee – after all, who could be against reducing death and disability from opioids? However, I observed powerful constituencies represented in the room that vociferously disagreed with the vehicle for achieving this reduction (evidence-based drug formularies).
I am not sure whether the Pennsylvania bill will make it out of committee, but as an introduction to the legislative process, I consider the Labor and Industry Committee hearing a small but positive step.
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