Legislature to Take on Opioids in the Work Comp System

Posted by Dean Blackaby | Feb 09, 2015 | 1 Comment

Matthew Rosendale (R-Glendive)

Picking up on a national trend, the Montana Legislature is jumping in the fray regarding the opioid issue relative to the workers' compensation system.  It's no secret that prescription drugs are one of the most significant cost drivers in the system but more disconcerting is the social and health impact the prevalence of opioid medication has among the workers' compensation population.

SB 292, introduced by Matthew Rosendale (R-Glendive) seeks to introduce a drug formulary into the Montana work comp system for the first time.  The proposal provides authority to the Montana Department of Labor and Industry to establish rules implementing an outpatient drug formulary that lists drugs that are payable for the treatment of compensable injuries.  The department may also establish rules for the maximum morphine equivalent dosage (MED) that is payable.

The legislation excuses insurers from payment absent documentation from a treating physician as to why it is medically necessary prior to authorization.  The rules also establish an independent medical review process for denials and subjects the dispute to the jurisdiction of the Workers' Compensation Court.

Such legislation is not unusual given the recent national trend toward curbing what the Insurance Journal calls an epidemic based on studies by the Workers' Compensation Research Institute.   States like Ohio have established fairly tight MED requirements - 60 MEDs while physicians routinely exceed that daily dosage when prescribing such medication.  The studies focus not only on the daily amounts but also the long durations that are frequently encountered in a work comp setting.

The bill, though well intentioned, is sure to spark debate.  Anytime elected officials beginning "legislating" medical treatment and supplanting the judgment of a treating physician, there are philosophical differences.  Such conflict is inherent in social insurance programs and merits discussion.  As with the Utilization and Treatment Guidelines, there is an uneasy tension between managing the system and dictating treatment.  Given Montana's penchant for privacy, the formulary may pass but its implementation is sure to present a challenge.

Of note, unlike most workers' compensation legislation, the proposed effective date is NOT July 1, 2015 but rather delayed until July 1, 2016 to allow time for the department to quilt the formulary together.

About the Author

Dean Blackaby

Attorney representing individuals hurt at work; mediation of workers' compensation disputes; settlement consultant focusing on Medicare Secondary Payer compliance and Medicare set-asides.


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