The door hinges creaked slightly as the young teenage boy opened the door to his mother’s bedroom and peered into the darkness. It wasn’t an unusual occurrence. His mom had been enduring the pain of a back surgery performed nearly two years earlier. Most mornings she needed some encouragement to wake up from a drug-induced sleep. But, on this morning, the room was eerily quiet as the boy entered. He touched her arm and, instead of the soft warmth he expected, he confronted the cold and lifeless body of his 42 year old mother. After battling addiction to opioids for more than 20 months, she surrendered to her pain by accidentally ingesting a toxic overdose of the medications that had been prescribed by her physician.
Sadly, this young man was confronted with nearly the same scenario two years later, as he found his father dead from a medical episode brought about by an over use of opioids. These tragedies are one of the fabrics weaving my family’s story—the teen’s mother was my younger sister. Tens of thousands of other families face the fear of this becoming their story every day as they witness loved ones struggle with addiction.
The use of opioid analgesics to treat pain is a significant issue in our country, to the point that, in 2011, the Centers for Disease Control (CDC) declared overdose deaths from prescription opioids a national epidemic. The latest figures from the CDC indicate that 16,500 people died from a narcotic painkiller overdose in 2010. In workers’ compensation, there has been a lot of talk about opioid analgesics and their accessibility, use, and impact when treating injured workers with chronic pain. Many states have taken steps to control the use of opioid analgesics in their workers’ compensation systems using a variety of methods ranging from treatment guidelines, drug testing, prescription drug monitoring programs, weaning programs, and pre-authorization requirements. A standout approach adopted by Texas in 2011, with others more recently following suit, is the closed formulary.
The Texas Closed Formulary
In 2005, when the Texas legislature was debating a significant overhaul of their workers’ compensation system, House Bill (HB) 7 was passed, requiring the newly created Division of Workers’ Compensation to develop a “closed formulary.” At the time, none of the stakeholders really knew what a closed formulary would look like or how it would be implemented, but there was a consensus that the use of opioid analgesics and other potentially addictive medications needed to be controlled. HB 7 contained a host of new provisions that required rulemaking and many of those provisions, including medical treatment guidelines, needed to be implemented before rules for a closed formulary could be adopted.
As early as 2008, the Division began having informal discussions with various individuals and groups about what a closed formulary might look like. More formal discussions and hearings followed. The natural fit, after much discussion, was to adopt a closed formulary based on the drug list contained in the previously mandated treatment guidelines from the Official Disability Guidelines (ODG) and to phase it in over time.
In January 2011, Texas formally adopted the closed formulary rule1, which included all drugs and over-the-counter medications that did not have an “N” designation in the ODG drug list. Medications indicated as “N” drugs, which include most opioid analgesics, could be prescribed but required the prescribing physician to engage in an involved prior authorization process. Additionally, the Division designed the rule such that it would be phased in over a two year period, making it effective for all new claims occurring on or after September 1, 2011, and then effective on September 1, 2103, for all “legacy claims,” claims that had occurred prior to September 1, 2011. The additional two year time frame was intentionally designed to allow payers and prescribing doctors to work together to determine if the currently prescribed “N” drug was appropriate or if another medication might be more beneficial to the injured worker.
continue to read here
Sadly, this young man was confronted with nearly the same scenario two years later, as he found his father dead from a medical episode brought about by an over use of opioids. These tragedies are one of the fabrics weaving my family’s story—the teen’s mother was my younger sister. Tens of thousands of other families face the fear of this becoming their story every day as they witness loved ones struggle with addiction.
The use of opioid analgesics to treat pain is a significant issue in our country, to the point that, in 2011, the Centers for Disease Control (CDC) declared overdose deaths from prescription opioids a national epidemic. The latest figures from the CDC indicate that 16,500 people died from a narcotic painkiller overdose in 2010. In workers’ compensation, there has been a lot of talk about opioid analgesics and their accessibility, use, and impact when treating injured workers with chronic pain. Many states have taken steps to control the use of opioid analgesics in their workers’ compensation systems using a variety of methods ranging from treatment guidelines, drug testing, prescription drug monitoring programs, weaning programs, and pre-authorization requirements. A standout approach adopted by Texas in 2011, with others more recently following suit, is the closed formulary.
The Texas Closed Formulary
In 2005, when the Texas legislature was debating a significant overhaul of their workers’ compensation system, House Bill (HB) 7 was passed, requiring the newly created Division of Workers’ Compensation to develop a “closed formulary.” At the time, none of the stakeholders really knew what a closed formulary would look like or how it would be implemented, but there was a consensus that the use of opioid analgesics and other potentially addictive medications needed to be controlled. HB 7 contained a host of new provisions that required rulemaking and many of those provisions, including medical treatment guidelines, needed to be implemented before rules for a closed formulary could be adopted.
As early as 2008, the Division began having informal discussions with various individuals and groups about what a closed formulary might look like. More formal discussions and hearings followed. The natural fit, after much discussion, was to adopt a closed formulary based on the drug list contained in the previously mandated treatment guidelines from the Official Disability Guidelines (ODG) and to phase it in over time.
In January 2011, Texas formally adopted the closed formulary rule1, which included all drugs and over-the-counter medications that did not have an “N” designation in the ODG drug list. Medications indicated as “N” drugs, which include most opioid analgesics, could be prescribed but required the prescribing physician to engage in an involved prior authorization process. Additionally, the Division designed the rule such that it would be phased in over a two year period, making it effective for all new claims occurring on or after September 1, 2011, and then effective on September 1, 2103, for all “legacy claims,” claims that had occurred prior to September 1, 2011. The additional two year time frame was intentionally designed to allow payers and prescribing doctors to work together to determine if the currently prescribed “N” drug was appropriate or if another medication might be more beneficial to the injured worker.
continue to read here
No comments:
Post a Comment