BWC Reports to Legislature on Difficulty of Implementing a Drug Formulary
Tuesday, July 11, 2017
* State: Tennessee
* Topic: SOUTH
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Implementing a drug formulary has been more difficult than creating the accompanying medical treatment guidelines, the Bureau of Workers’ Compensation says in an annual report (https://www.tn.gov/assets/entities/labor/attachments/Workers_Compensation_Annual_Report.pdf) to legislators on the impact of the 2013 Workers’ Compensation Reform Act.
Among the difficulties of implementing a formulary are its complexities, resistance from patients taking high doses of opioids and approving prescriptions in emergencies, the report states.
“Several factors contributed to the difficulty. One is the apparent lack of understanding of the process of filling a prescription when there is a formulary. The process includes multiple players (physician prescribers, pharmacists, pharmacy benefits managers, claims adjusters, utilization review organizations, insurance companies and other payers),” the report says.
“This complexity makes it difficult for injured workers and sometimes their physicians to understand this new process,” it states.
To reduce friction points, the Medical Advisory Committee has formed a subcommittee to develop alternative language governing certain situations.
The report also notes positive developments with the new alternative dispute resolution process. Three-quarters of the 3,950 cases that went to mediation in fiscal 2017 were settled, the report states, compared to 63% the year before.
The agency continues to grapple with questions raised by the medical community on the reform act’s new definitions of injury and causation. Under the old standard, workers could be compensated if a work accident “could be” the cause of the worker’s condition, along with the worker’s corroborating testimony.
The new standard says injuries must arise “primarily” out of employment and be shown “to a reasonable degree of medical certainty” that the job contributed to “more than” 50% of the injury or death.
The reform act created the Court of Workers’ Compensation Claims and a Workers’ Compensation Appeals Board, moving Tennessee from a state court system to an administrative court system and leaving Alabama as the only state to use state courts.
Businesses and employers have lauded the reform act, while workers’ advocates have denounced it.
“The devastating effects visited on Tennesseans through the passage and implementation of the Reform Act cannot be understated,” according to a quote in the report from claimants’ attorney Bruce Fox, a voting member on the Advisory Council on Workers’ Compensation.