Why Gov. John Edwards Should Sign Louisiana Formulary Bill HB 592

| | Evidence Based Medicine, Technology & Integration, UR Software

Kara May 2016 Article on Louisiana Drug Formulary
Louisiana Rep. Kirk Talbot, R-River Ridge, has been promoting the formulary bill HB 592, which recently passed the Labor and Industrial Relations Committee. HB 592 would adopt the ODG drug formulary effective 1/1/2018 for dates of injury that occur on or after that date. The bill would also require the ODG formulary to be used by 7/1/2018 for new drugs dispensed for dates of injury prior to 1/1/2018. The committee vote was 8-5 along party lines, with republicans supporting the bill and democrats opposing it. The bill will next go to the floor of the state House of Representatives for debate on 5/18/2017. But even if HB 592 passes the House and Senate it still faces Democratic Gov. John Bel Edwards.

Mark Pew, senior vice president at Prium, was recently quoted in a WorkCompCentral article by J. Todd Foster as saying “The more relevant point is that Gov. Edwards is a plaintiff’s attorney. So will he vote with his peers who have demonstrated a desire to maintain the status quo in Louisiana, or will he look at the evidence and decide that HB 592 should be the law of the land because we need to utilize all the potential tools at our disposal?” In his recent article, Mark Pew talks about HB 592 as being part of the “The Louisiana Trifecta” of bills pending to fight the opioid crisis.

After HB 592 passed the Labor and Industrial Relations Committee, Rep. Talbot was noted in the same WorkCompCentral article as stating, “I think we’ve demonstrated to the majority of the committee that we’re going after a nationwide formulary that has data and results, and proven results, behind this. We’re not the first one trailblazing this formulary. There are other states that have done it.”

One issue is that Louisiana’s 2017 legislative session ends June 8. This doesn’t give the Louisiana Legislature much time. But if it passes both the House and Senate, the bill will land on Gov. Edwards’ desk. Below are my top three reasons why UR Nation staff believe Gov. Edwards should sign the bill.

  1. Louisiana has a big opioid problem. A news article posted on LAISE.org noted that a recent WCRI Study shows that patients in Louisiana received twice as many opioid prescriptions as the median state in the study. The study also found that of all the workers who had claims involving pain and who were prescribed pain medication, 85 percent received opioids, many on a long term basis.
  1. The formulary based on ODG has already been successful in other states. While there was another formulary bill in the form of HB 529, which sought adoption of a custom state-created formulary, HB 592 (based on ODG) has several advantages. It can be implemented relatively quickly. This is because the formulary based on ODG already exists. It also has a strong track record.  Looking at Texas as an example, we can see that Texas adopted the ODG formulary in 2011 for new claims and in 2013 for legacy claims.  The LAISE article cited a TDI-DWC Research and Evaluation Group report that pointed to a striking number – in 2009 in Texas there were 15,000 claims where an opioid painkiller was prescribed with at least a 90 morphine milligram equivalent (MME) dose. By 2015 that number had shrunk to less than 500. That’s about a 97 percent reduction.
  1. Even though Louisiana has its own treatment guidelines, the ODG formulary would still work. It should be noted that ODG guidelines are used at times when the Louisiana state-created guidelines, which are based on the Colorado guidelines, need to be supplemented. But even more to the point, the formulary based on ODG is really a list, or binary indicator, of drugs that are designated “Y” for preferred and “N” for non-preferred. This means a treating physician could look up whether a drug is “Y” or “N” and have that help him, along with the guidelines, decide whether or not to issue the prescription. If a prescriber strongly believes an N drug opioid is needed, they can request a variance through utilization review. The guideline creates a pause to consider if an “N” drug is the best option for the injured worker and to ensure that option is supported by the Louisiana state guidelines, which already influences prescribing decisions.

In February, our Medical Director, Dr. Zenia Cortes, wrote an article titled The Rise of ODG. In it, she highlights how ODG has been adopted by Texas, Oklahoma, Kansas, New Mexico, North Dakota, Tennessee and Arizona (for chronic pain and opioids). While she by no means claims that ODG is perfect, there are specific reasons why ODG has had so much success. Some of her points are that ODG is comprehensive, easy to navigate, continuously updated, and is independent of any specialty group. To sum up another way, ODG simply works. If adopted (at least the formulary portion) by Louisiana, we believe this would be a significant upgrade over the current system, which is essentially allows a high level of opioid prescribing as a quick fix for injured worker pain, which leads to addiction, abuse, and unfortunately, in some cases, death.

Kara Larson, Regulatory Manager at UniMed Direct and Guest Contributor to UR Nation