WHAT IS A DRUG FORMULARY?
Jan. 28, 2022
Many legislatures in the US have been influenced by the companies who handle workers’ compensation cases who want to establish a “Drug Formulary”. What this means is that the insurance companies seek to have a set regimen for every injured person that is in chronic pain and is need of chronic pain management. This is absolutely a horrible idea. One size fits all. They clearly want to limit treatment for everyone to a set formulary.
Fortunately, Georgia has refused to move forward with the drug formularies for the injured worker, even though the SBWC seemingly was behind this idea a few years ago.
A federal task force released a report in January 2021, that is critical of these drug formularies or guidelines. They state that these decisions should be made by the patient’s doctor.
The task force also calls for a multi-pronged treatment of pain which means whatever the doctor feels is appropriate. The task force also questions the CDC guidelines because the guidelines seem to emphasize the danger of opioid while minimizing the benefits of medication when this medication is properly managed. The authors of these studies state that many states “Have used legislatures for what should be medical decision making by healthcare professionals,”. “The CDC guideline was not intended to me model legislation for State Legislators to enact.”
The 29 member task force that prepared the report is called The Pain Management Best Practices Inter Management Task Force. This report also discusses behavioral health approaches to pain management including cognitive behavioral therapy and mindfulness (I do not know what that means), two concepts that have been gaining attention in workers’ compensation claims.
The task force recommends increasing access to evidence-based psychological interventions and seems to emphasize psychological treatment for managing pain.
It has been my experience that anytime one of my injured clients need psychological treatment, the insurance companies do everything they can to resist this treatment that actually could be very beneficial for my clients. There are many types of treatment to address pain like epidural injections, nerve ablations, pain pumps that can deliver pain medication directly to the spinal cord, spinal cord stimulators are a rather risky proposition but can help in some cases.
As a representative of the insured worker here in Suwanee Georgia, I am very pleased that this report is further evidence that the drug formularies and guidelines are not going to be part of my client’s treatment, which would mean very little treatment.
It is most interesting that the insurance companies love to state that they genuinely care about the injured worker, and they want formularies to protect them since the injured worker is not doing this to manage his-her pain responsibly. To make the matters worse, there is the panel of doctors (list of 6) who invariably overprescribe and they do not know what is best for their patients! And lastly and most cynically, the insurance companies and their paid pain management doctors, (and I use that term loosely) state that pain management is not needed because things like practicing yoga will effectively kill pain. This is so frustrating.