UR Nation End of Month Regulatory News Summary

| | Technology & Integration, Utilization Review

FL Considering Creating a Drug Formulary

On January 5, the Florida DWC will ask its 3-member governing panel to seek legislative approval to create a workers’ comp drug formulary.  If adopted, Florida would be the 9th state to mandate a formulary, following Texas, Washington State, North Dakota, Ohio, Delaware, Oklahoma, Tennessee and Nevada, with California implementing a formulary to take effect July 1, 2017 and Arizona looking to adopt a formulary by fall 2017.

David Langham, chief deputy judge of the Florida Office of Judges of Compensation Claims, said, “I think this would simplify the Florida process for the vast majority of injured workers, physicians and carriers. The efficiency would be beneficial. If that also results in costs savings, it’s an added bonus.”

Mark Pew, senior vice president at Prium, said “The key is a strong dispute-resolution process and medical treatment guidelines, the latter of which do not exist in Florida.” Pew went on to say, “The goal is to create better clinical outcomes and change prescribing behavior so that workers get better results and less dangerous care. It will be interesting to see how it proceeds in Florida. Adopting a drug formulary sounds easy, but the actual flesh, muscle and ligaments around the bones is where it becomes complicated.”

Donald Trump Nominated Andrew Pudzer as Head of DOL

President Elect Donald Trump has nominated Andrew Puzder, the CEO of CKE Restaurants, as head of the U.S. Dept. of Labor. As you may know, CKE Restaurants owns Carl’s Jr. Hardee’s and Green Burrito, with 3,664 franchised or company-operated restaurants in 44 states. A Washington outsider and multi-millionaire, Puzder has been critical of minimum wage hikes and the new overtime rules and is predicted to take a “pro-business” anti-labor approach to the new position. Joe Paduda, in his recent blog, said that any reformation or oversight by DOL of the workers’ comp system is history.

Investigation Reveals 780 Million Opioid Pills Shipped to WV 2007-2012

A recent investigation by the Charleston Gazette-Mail found that McKesson, Cardinal Health and AmerisourceBergen shipped 780 million hydrocodone and oxycodone pills to W. Virginia from 2007 to 2012. That amount equates to 433 pills for every man, woman and child in the state. This information was previously confidential as part of the list of drug shipping sales held by the U.S. DEA and the West Virginia Attorney General’s office. The drug companies and the wholesalers fought vigorously to keep the records secret.

Specifically, it appears from the records that drug distributors, who were required to report suspicious drug orders for controlled substances to the West Virgina Board of Pharmacy, simply disregarded that requirement as small-town pharmacies ordered more pills than could possibly be taken by people who really needed medicine. And the fatalities mounted. From 2007 to 2012 hydrocodone and oxycodone deaths increased 67%.

Keep in mind that West Virginia now has a prescription drug monitoring program (PDMP) in place, and doctor shopping is now on the decline. 

New TX TDI Report Shows Number of Non-Subscribers Dropped 50 Percent in 2016

TX TDI issued a new report that shows the number of private-sector employers who did not subscribe to the Texas workers’ comp system dropped 50 percent in the past two years. The percentage of non-subscibers is the lowest ever recorded in the state of Texas, and most industry participants view this as a very encouraging sign.

The highest percentage of non-subscribers were companies that had four employees or fewer. So we’re talking about very small businesses. Also, the top reasons stated for not buying workers’ comp coverage were too few employees (26%), not being required to carry coverage (24%), few if any workplace injuries (18%) and high workers’ comp premiums (18%).

The report also says that the primary reasons businesses buy workers’ comp coverage in Texas is the ability to provide medical care to injured employees, the mistaken belief that it’s required by law, and concerns about civil suits (businesses with workers’ comp coverage are immune from negligence suits from employee injuries as work comp is the sole remedy for the injured worker). Another factor is that many business require other business to have the coverage in order to do business. 

Yahoo Discloses New Data Breach Affecting One Billion Accounts

Yahoo recently announced that it has identified a new breach that occurred back in August 2013 and involved data associated with more than one billion user accounts. This is double the number affected in a different 2014 security breach disclosed by Yahoo this past September.

Yahoo said it has not been able to identify the intrusion associated with the theft. However, Yahoo can say that the stolen user information may have included names, email addresses, telephone numbers, dates of birth, hashed passwords and, in some cases, encrypted and unencrypted security questions and answers. Payment card data and bank account information was not stolen as that information was not stored on the system affected by the breach.

One billion accounts represents the largest security breach in history.

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.