Workers’ Comp Lawyers’ Blog

Lawyers Discuss Opioid Prescriptions in California Workers Comp Cases

In October 2015, then Governor Jerry Brown signed California Assembly Bill 1124 into law which required the state’s Division of Workers’ Compensation to institute a “drug formulary” for injured workers.

Drug Formulary in Workers Comp

A drug formulary is essentially a list of brand-name and generic prescription drugs that have been approved by a specific health system.  Formularies are based on the drug’s ability to produce the intended result, its safety and cost.

The formulary instituted by AB 1124 was compiled by a committee of medical professionals and is consistent with the Medical Treatment Utilization Schedule guidelines that set forth medically appropriate care for those receiving worker’s comp in California.

The intention of A.B. 1124 was to make sure that any medication prescribed to a worker’s comp recipient would meet evidence-based standards.  It would also reduce delays and costs associated with pharmaceutical utilization and independent medical review.

Workers Comp Formulary Addresses Opioid Usage

A key goal of AB 1124 was to address the growing problem of Opioid usage for pain management in worker’s comp cases.  As a result, the formulary includes a revamped approach to dealing with pain.  The new system should reduce disputes between a claimant and the insurer with respect to a particular treatment, and whether or not it is appropriate.

The formulary streamlines the process for prescribing medications and treatments.  It also offers protections against prescribing errors and specifically, the overprescribing of opioids.  While opioid drugs remain on the formulary, a pre-authorization is now necessary to ensure there is medical necessity and that other drug therapies have proven to be ineffective.

In response to a nationwide concern regarding inappropriate use of opioids, there has been a concerted effort by the California Workers’ Compensation Institute to put stronger guidelines in place, such as tighter scrutiny through the utilization review process and independent medical review, as well as the restrictions placed within the formulary.

Study Shows Positive Results of Worker’s Comp Efforts

Various studies seem to indicate that these policies are having the desired effect.  For instance, a study was performed by the CWCI, using data from 5.75 million prescriptions dispensed to California injured workers from 2009 to June of 2018.

A preliminary analysis of the CWCI study indicated that efforts to quell the overuse of opioids are working.  Opioid prescriptions have fallen to 18% of the prescriptions filled in the first six months of 2018, as compared to 20.2% in 2017, and 30.5% a decade ago.  CWCI published its study in a research update report entitled “California Workers’ Comp Prescription Drug Utilization and Payment Distributions, 2009 – 2018,” which is available in its entirety on the CWCI website www.cwci.org.

New Workers Comp Formulary Lessens but Doesn’t Eliminate Disputes

The new system should lessen the need for disputes between the injured worker and insurance companies over whether or not a recommended treatment is appropriate.  The formulary will be updated quarterly, to keep it as current with the state of medical knowledge as possible.

The goal of the revised formulary system is to improve the quality of medical care that an injured employee will receive.  However, there will almost certainly continue to be situations where disputes arise, especially in the beginning phases of the program.

Long Beach Workers Comp Lawyers

Our experienced workers comp attorneys are available to assist you if you have questions about how the new law may affect you.  We are here to ensure that you are receiving the medical treatment you need and are available to answer whatever questions you may have.

Your consultation with our workers’ comp lawyers is 100% confidential, and neither your employer nor your insurance company will be notified that you requested a consultation with us. Our lawyers will help you understand your rights and work tirelessly to ensure that you receive the maximum workers’ comp benefits for which you qualify.

Call our Long Beach Workers Comp lawyers: 800-964-8047