UR Nation End of Month Regulatory News Summary

| | Technology & Integration, Utilization Review

CA DWC Announces Formulary Pharmacy and Therapeutics Advisory Committee

The California Division of Workers’ Compensation (CA DWC) gave notice that they have formally selected members to serve on the Pharmacy and Therapeutics (P&T) Committee. The P&T Committee was established pursuant to AB 1124, which created California’s first workers’ compensation drug formulary. The P&T Committee consists of three medical doctors and three pharmacists and will consult with A.D. George Parisotto on updates to the MTUS drug formulary.

The P&T Committee is chaired by DWC Executive Medical Director Raymond Meister, M.D. The committee’s medical doctors are Basil R. Besh, M.D., Rajiv P. Das, M.D., and Steven Feinberg, M.D., and the pharmacists are Lori A. Reisner, Todd Shinohara and Raymond Tan.

The P&T Committee will meet for the first time on September 26, at 12:30 PST, at the Elihu Harris state building in Oakland, CA. The agenda will be posted here at least 10 days prior to the meeting. Most system participants are excited that this committee has been formed and will start meeting. A.D. George Parisotto, with quarterly input from this committee, should be able to make needed changes to the formulary drug list in an intelligent and efficient manner.

Pennsylvania Governor Tom Wolf Introduces New Prescribing Guidelines

At the end of April, Gov. Tom Wolf came up with his own alternative plan to the SB 936 formulary bill. He did this as he vetoed SB 936 just hours before it would have become law without his signature. In a statement Gov. Wolf said, “Make no mistake, Senate Bill 936 is not a bill designed to fight the opioid crisis. Senate Bill 936 threatens health care for millions of workers who could be injured on the job, including police, corrections officers and firefighters, who put their lives on the line every day.”

In furtherance of his alternative plan, Gov. Wolf introduced his new opioid prescribing guidelines. Gov. Wolf said, “These prescribing guidelines will help to ensure that health care providers who treat patients with work-related injuries have the guidance they need. I thank the members of the Prescribing Guidelines Task Force for all of their hard work in developing this essential guidance.”

Secretary of Health Dr. Rachel Levine said, “These prescribing guidelines add to the 10 others we have developed for health care practitioners like dentists, OB/GYN and emergency room physicians. The workers’ compensation guidelines are intended to supplement, not replace, clinical judgment.”

Industrial Commission of Arizona Considering Reimbursement Guidelines for Physician Dispensing

Pursuant to SB 1111, the Industrial Commission of Arizona is required to consult with system users about setting appropriate reimbursement rates for drugs doctors dispense from their office. To this end, the Commission gave notice that a public hearing will be held August 23, 2018, at the Commission’s first floor auditorium at 800 W. Washington Street, in Phoenix AZ at 1:00 p.m. (MST). Written comments may be submitted prior to the August 23, 2018 public hearing. Those wishing to do so should submit written comments to Jacqueline Kurth in the Medical Resource Office, by fax: (602) 542-4747 or email: mro@azica.gov.

New Report Questions Effectiveness of Gabapentin for Back Pain

A new report in the Canadian Medical Association Journal (CMAJ) questions the effectiveness of anti-seizure anticonvulsants used to treat nerve pain, specifically gabapentin (most common brand: Neurontin) and pregabalin (most common brand: Lyrica) for chronic low back pain.

One of the study’s authors, Oliver Enke, University of Australia, said, “We have shown, with mostly high and moderate quality evidence, that common anticonvulsants are ineffective for chronic low back pain and lumbar radicular pain, and are accompanied by increased risk of adverse events.”

Dr. Gary Franklin, medical director for the Washington State Department of Labor and Industries, said the Department had problems with the use of gabapentin to treat pain that is not neuropathic. “There has never been evidence that gabapentin improves somatic as opposed to neuropathic pain. Yet the vast majority of our use in workers’ comp in the past has been for things for which the drugs don’t work, like low back pain.”

Ohio Proposed Formulary Updates to Take Effect Jan. 1 2019

The Ohio Bureau of Workers’ Compensation has a proposed formulary update that would take effect January 1, 2019. The proposed rules would eliminate migraine drug Treximent and generic equivalents from the formulary. In addition, Relistor, a drug used to treat opioid-induced constipation, would be eliminated and replaced with Symproic. However, Symproic would only be eligible for reimbursement if the injured worker had been taking opioids at a 40 MME or higher dosage, along with documentation of at least two failed attempts at relieving constipation with stool softener/stimulant laxatives. Reimbursement would also be limited to one Symproic tablet per day. Lastly, there are rules limiting reimbursement for benzodiazepine medications (drugs such as Valium which are used to treat anxiety and sometimes muscle spasms).

Virginia Opioid Prescribing Rules to Take Effect August 8, 2018

The State of Virginia gave notice in the Register of Regulations that starting August 8, 2018, doctors will be required to check Virginia’s prescription drug monitoring program (PDMP) before prescribing opioids. The rules also set an initial 7-day script limit on opioids for acute pain. With respect to chronic pain, the regulation sets forth a 9-step evaluation process to follow before writing an opioid prescription. The nine steps include the nature and intensity of the pain, past pain treatments, an analysis of comorbidities, and an analysis of potential addiction including any family history of addiction. In addition, doctors must discuss with the patient known risks of opioid therapy as well as the patient’s responsibilities, and an exit strategy. Lastly, the regulation states that for acute or chronic pain treatment non-drug and non-opioid therapy must be considered before resorting to opioid treatment.

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.