UR Nation End of Month Regulatory News Summary

| | Evidence Based Medicine, Utilization Review

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As the month draws to a close, here’s a summary of some of the more important regulatory news stories from May.

CA DWC Announces Appointment of Dr. Raymond Meister as Medical Director

CA DWC announced the appointment of a new medical director. The medical director’s role is critical, managing all medical and health-related programs in the DWC. The medical director provides guidance for the division and develops education and training for treating physicians. Having a great medical director is vital to the division’s mission to provide quality care to injured workers. Acting Administrative Director George Parisotto announced that “Dr. Meister brings a wealth of knowledge and experience that will enable us to fulfill that mission and ensure the workers’ compensation system is working for all parties.” Dr. Meister has served as an associate medical director for DWC since 2014. Prior to joining DWC, Dr. Meister served as a public health medical officer at the California Department of Public Health (from 2000 to 2014). The position does not require Senate confirmation.

CA DWC Launches Search Tool for IMR Decisions

The California DWC has launched a search tool that allows workers’ comp professionals to find independent medical review decisions online. The DWC said information for each IMR case is posted on its website following a determination by a physician reviewer. Users can search for decisions by case number, date of injury, specialty of reviewer, or category of treatment request. George Parisotto, Acting Administrative Director, said “The DWC IMR search tool allows the public to easily research the database of IMR decisions. Increased knowledge about the program’s past performance will ultimately lead to a more effective IMR process.”

FDA Clarifies Limits on Compounding Pharmacies

The FDA has released draft guidance to clarify regulations for compounding drugs. The rules were developed to prevent a similar situation that occurred in 2012 when tainted drugs caused meningitis and killed 60 people. Pursuant to the draft guidance, open to public review through July 18, pharmacies are restricted to compounding drugs when they’ve received a prescription for an identified individual patient. They may produce a 30 day supply. However, a pharmacist may compound a drug before receipt of a prescription for an identified individual patient in anticipation of receiving a prescription, based on knowledge of what prescriptions the pharmacist has historically been asked to fill.

Compounded drugs exist most often in workers’ comp as topical pain creams containing a long list of ingredients with high price tags. Phil Walls, chief clinical officer at MyMatrixx, a pharmacy benefit management company (PBM), said that enterprising pharmacies have been creating compounds and actively marketing to physicians, thereby creating demand for their products. Walls said that if everyone followed the FDA guidance we wouldn’t have the problems you see in workers’ comp. While there is a legitimate need for compounded drugs in some situations, Walls said that compounds are being used excessively.

LA Passes Resolution 113 to Establish Opioid Addiction Task Force

The Louisiana House of Representatives has passed HRC 113, a resolution that would establish a task force to measure and reduce opioid addiction. The measure would use evidence-based strategies for opioid prevention, treatment and enforcement. Department of Health and Hospitals Secretary Rebekah Gee said, “From improving the general health of our citizens to helping to prevent injured workers from succumbing to a destructive addition while trying to get healthy enough to return to work, both of our agencies are committed to pioneering innovative strategies to combat this problem.” If passed by the Senate and signed into law, the bill would create a panel with representatives from state agencies, medical boards and associations who would meet bimonthly and make recommendations to the governor and Legislature not later than Feb. 1, 2017.

Maine Workers’ Comp Board Approved Reimbursement for Medical Marijuana

In the past year, Maine has reviewed five cases and approved three of them for reimbursement of medical marijuana. One claim involved a 53 year old worker who slipped and injured his shoulder. He underwent 5 surgeries and tried injections and PT for his intractable shoulder pain. After receiving a physician’s certification for candy containing medical marijuana he slept for 5 hours (up until that time he was unable to sleep for more than 30 minutes). His dosage of Vicodin declined from 10 to 12 pills a day to one a day. One claim that was denied was a woman who suffered from depression. Her claim was denied because depression is not on Maine’s list of “debilitating medical conditions” for which marijuana is approved as a treatment. Conditions that are on the list are intractable pain and persistent, severe muscle spasms.

Mark Pew, senior vice president with Prium, said the thinking on medical marijuana in workers’ comp may be changing. “I think that is a foretaste of what is to come. If it increases function, increases quality of life and gets rid of dangerous prescription drugs… carriers would make that switch.” Another potential game changer is that the US DEA is considering whether or not to change the designation of marijuana from Schedule I to Schedule II or III. The Washington Post reported that the DEA may reschedule marijuana by July of this year.

TX DWC Moved Forward with Audit of Compounding Medications Prescribers

DWC will select up to 10 physicians for the audit based on who wrote the largest number of prescriptions for compounds and who accounted for the highest amount billed for compound medications. The audit will look at prescriptions for compounds that were filled between Sept. 1, 2014, and August 31, 2015. Compounds in which the only ingredient was a laxative will not be included in the audit. Even though Texas has had a drug formulary since 2011, the formulary does not include compounds. That means that the often pricey compound formulations can be prescribed without preauthorization.

Tom Swiatek

Tom Swiatek

As Assistant Vice President of Regulatory Services, General Counsel, and Editor in Chief of UR Nation, Tom Swiatek draws on his experience as an insurance attorney on both the general liability side, as well as on workers’ compensation matters. As a California Workers’ Compensation Section Member, Tom is leading the discussion with respect to the regulatory challenges and opportunities facing the workers’ compensation system.