Manasquan, NJ – During the 2019 NCOIL Annual Meeting in Austin, TX, the organization adopted the NCOIL Workers’ Compensation Drug Formulary Model Act sponsored by Indiana Representative Matt Lehman, 2020 NCOIL President. The Model passed without objection on a voice vote by both the Workers Compensation and the NCOIL Executive Committees.
The Workers’ Compensation Committee had been working on this Model since its introduction at the NCOIL Spring Meeting in Nashville, TN in March 2019. The initial discussion draft of the Model was based on Indiana SB 369 which Rep. Lehman sponsored and was signed into law in March 2018. Essentially, the IN law requires the adoption of the Official Disability Guidelines (ODG) Workers’ Compensation Drug Formulary Appendix A published by MCG Health, and prohibits workers’ compensation reimbursement for drugs specified in said formulary as “N” drugs, except during a medical emergency.
However, in order to provide states with flexibility, the Model does not require the selection of a specific formulary but rather provides states the option of either selecting a nationally recognized, evidence-based drug formulary, or developing such a formulary, by rule.
“I am proud to sponsor this Model for NCOIL, and I commend the Committee for acting promptly on this issue. In efforts to combat the opioid crisis and lower drug costs, it is our duty as State legislators to ensure that the treatment provided to injured workers is related to and most appropriate for their work-related injury,” stated Rep. Matt Lehman, NCOIL President. “My goal when developing NCOIL Models is always to develop a framework for states to consider, knowing that states may need to make certain changes to reflect the market and other realities. I am pleased we were successful in ultimately ending up in a good place with this Model,” he concluded.
During the drafting discussions, NCOIL legislators and staff heard from a wide array of interested parties such as: the Tennessee Bureau of Workers’ Compensation; Mitchell, ODG by MCG Health; ReedGroup; MAXIMUS; the California Workers’ Compensation Institute (CWCI); Baker & Welsh LLC; the American Medical Association Advocacy Center (AMA); the California Labor Federation; the American Association of Payors, Administrators, and Networks (AAPAN); the Maryland State Medical Society (MedChi); the Physicians Research Institute (PRI); the American Property Casualty Insurance Association (APCIA); and Medtronic.
The purpose of the Model is “to require the establishment of a drug formulary for use in a states’ workers’ compensation system in order to facilitate the safe and appropriate use of prescription drugs in the treatment of work-related injury and occupational disease.”
Highlights of the Model include the requirement for the appropriate state agency/department to select a nationally recognized, evidence-based drug formulary or to develop such a formulary by rule; setting forth factors the appropriate state agency/department must consider while selecting or developing a drug formulary for adoption; solicitation of public comments and holding a public hearing regarding the selection of a formulary;; requiring the appropriate state agency/department to review updates by the publisher of a selected formulary; ensuring the formulary is available through the department/state agency’s publicly accessible Internet website; requirements for operation of a formulary, including the process by which an employee can obtain a drug that is listed but no approved on the formulary; and third party conflict of interest requirements. The Model also requires the state department/agency to promulgate rules necessary for the implementation of the formulary.
Commissioner Tom Considine, NCOIL CEO, stated, “I am confident that the NCOIL Workers’ Compensation Drug Formulary Model Act will serve its purpose and provide states options so that they can determine what is best for their state. NCOIL Models are developed to better equip the states to act in the best interest of the public. In this instance of the Workers’ Compensation Drug Formulary Act, NCOIL provides the framework for states to make their workers’ compensation system safer and more efficient, while having the opportunity to expand provisions as they deem appropriate.”
View the full Model Act: NCOIL Workers’ Compensation Drug Formulary Model Act (PDF)