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Committee Passes Formulary Bill, Opposition Offers Support if Amended

  • State: California
  • Topic: Top
  • - Popular with: Legal
  • -  0 shares
A bill that would make California the fifth state in the nation to implement a prescription drug for…

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Garry Crosby Nov 3, 2016 a 2:58 pm PDT

here is a chance to eliminate UR or make it independent of the Ins Company so that appropriate care can be given to the IW per LC 4600 and UR does not have a financial obligation to the ins company and deny all treatment as the UR gets paid directly by the ins company and thus has a vested interest.

JAMES BADER Nov 3, 2016 a 2:58 pm PDT

Agree with the comments by SSK. Why cant the UR doctors be any independent group of physicians appointed by the DWC. Their identities can be concealed just like the IMR doctors. In that manner the insurance carriers will not have undue influence over the doctors which are on the UR panel. Wouldn't that be much fairer to the injured worker ?

Anonymous Nov 21, 2016 a 6:49 pm PST

AB1124 is vague, and I did not see in the language that formula medications would not be subject to UR. This is a hope for those on the applicant side. I am very surprised CAAA and others are not fighting against this, as this bill limits requested treatment to injured workers. It is only be done as a cost containment tool for insurance companies.

Forwarded article from LEXISNEXIS

"An Inconvenient Truth: Cook Book Medicine Creates False Savings and Shifts Costs to Another Source

Leading the charge against any treatment that is founded upon evidence-based medicine (EBM) is Robert G. Rassp, a long-time workers’ advocate and author of The Lawyers Guide to the AMA Guides and California Workers’ Compensation (LexisNexis). According to Rassp, selectively chosen data gives a false impression of a formulary’s effectiveness:

“Any medical treatment that is based on EBM is a disguise for cost containment and may not be best medical practices. EBM relies on studies that exclude many patients who we see in our cases and who the effect of medication and treatment modalities have not been adequately tested scientifically. This is especially true for women of child bearing potential, the obese, the aged, and diabetics. Also, utilization reviews seem to cherry pick only the studies that say a given treatment (or medication) has not shown to be effective even though in real medicine, that treatment is a community standard of care, e.g., epidural steroid injections for spinal disorders, properly prescribed opioids for chronic pain where the patient is functional, on a stable dosage, not diverting medication, not hoarding it, and not addicted.”

Rassp also explains another impact that formularies can have—namely the shifting of costs outside the workers’ compensation system.

“Experience has already shown that cook-book medicine in workers' compensation cases in California results in injured workers seeking treatment outside the WC system that creates the false impression that all of this is cost saving for the workers' compensation payer community. A drug formulary like the one in Texas will have the same effect—shifting payments for standard of care treatment to outside the WC system entirely. For patients who do not have access to treatment outside the WC system, access to MediCal (California's Medicaid program) will allow patients to obtain medications the same way as those who can obtain them through health insurance. This creates a false savings by shifting the costs to another source.”

Oh Doctor, doctor, is this love, I’m feeling?

The most damaging formulary impact that Rassp underscores is the weakening of a physician’s ability to provide an injured worker with optimal medical care."

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