LEGISLATIVE ALERT: Major Potential Change in Prescription/Medication Allowance in Pennsylvania Workers’ Compensation Cases
A new bill sponsored by the Chairman of the Senate Insurance Committee, Don White, R-Indiana, (SB 936) would have a significant impact on the way medication is prescribed to injured workers under the Pennsylvania workers’ compensation system. Under this bill, only medications on an approved list could be approved and prescribed by your healthcare provider. This prohibition in prescribing other, non-listed prescription drugs, would apply across the board to not only treating doctors but to panel/company physicians regardless of the legal or medical status of an injured worker.
Currently, in a case where an injured worker has an accepted Pennsylvania workers’ compensation claim, as long as a doctor states a prescription is “reasonable, necessary and related” to a work injury, there is a presumption that the medication should be paid for by the workers’ compensation insurance carrier. Under the proposed law, all medications prescribed in a Pennsylvania workers’ compensation case, would have to be on a list or a “formulary.” If the medication is not on the list, the injured worker would be prohibited from obtaining that medication and treating with it even if the treating doctor believes it is reasonable, necessary and related to the work injury. Likewise, that medication would be denied even if it would provide the injured worker with the best pain relief available. It is anticipated that many of these drugs will be eliminated based solely on their cost, i.e., the more expensive the drug the less likely it will be included in the formulary. The proponents of this bill claim that it will help address the opioid addiction epidemic. Opponents of bill, including most attorneys representing injured workers, believe it will negatively impact the ability of injured workers, under the guidance of their doctor, to make medically necessary decisions regarding their treatment. It’s unclear as to whether the passage of this bill would have any impact on the opioid addition problem since it’s possible, if not likely, that the bill could apply to medications that are not necessarily opioid based, but excluded from the formulary list, nonetheless, based solely their cost.
If you are currently receiving Pennsylvania workers’ compensation benefits and are concerned about how this could impact your medical treatment, you should speak with an experienced Pennsylvania workers’ compensation attorney.