by Karl Voigt
The Pennsylvania House of Representatives on Tuesday, June 20 will likely be voting on its House Bill 18, which seeks to further control medications taken by Workers’ Compensation claimants. Some consider this a “foot in the door” piece of legislation that is designed to start the process of more severely limiting medications, particularly opioids.
HB18, which originates from Berks/Lehigh Counties, is being sold as a way to control opioid addiction. And that’s clearly a noble goal; Pennsylvania and perhaps even the nation is suffering from a genuine crisis. However, that’s not the actual goal of this proposal. This new legislative proposal would simply adopt one of several national “evidence-based drug formularies” that would in essence decide if a medication – or it’s dosage – is reasonable and necessary.
What HB18 seeks to do is to change the utilization review process where medications are involved. Under the present system, a carrier can challenge reasonableness and necessity of a prescription medication and it goes through a process where the medication is reviewed by a certified reviewer. He or she reviews medical records specific to the injured worker and he makes an initial decision as to whether or not the care is indeed reasonable and necessary. This, again, is based on an individual’s response to the treatment. If the treatment is found to be unreasonable and unnecessary, the injured worker can file an appeal to be heard by a judge. During that appeal, the burden of proof to convince the judge actually rests with the insurance company, no matter who filed the appeal. Regardless, the judge examines the individual’s response to the challenged care and decides accordingly.
This new legislative proposal aims to remove consideration of an individual patient’s circumstances and would simply allow or disallow medications based on a “one size fits all” table. This could in essence take your own individual medical care out of the hands of your doctors and replace their judgment with a flowchart.
Naturally, we encourage our readers to voice their opposition to this proposed bill to their elected officials.