Back in the days when the
workers’ compensation statutes were initially crafted in the US, probably the
most common drugs used to treat injured workers were aspirin and Mercurochrome ™ (a/k/a Merbromin,
now banned by the FDA). Things were sure simpler then.
Now
workers comp pharmaceutical sales is a big business: The drug companies hire
sales reps on commission to sell products to doctor; doctors are paid by the
drug companies with gifts, trips and free lunches; and pharmacies and a new
cottage industry of pharmacy benefit coordinators will even help injured
workers “find an attorney.”
 |
| Mercurochrome™ |
Compounding
(no pun intended) is yet another problem as specialty drugs are crafted to
prescribing physician specifications. Recently that has led to a major contamination
issue as governmental regulations were lacking.
If
things weren’t bad enough in the pharmaceutical sector, there is also an
element of both prescription fraud and abuse. Sometimes even the dispenser will
attempt to also cut costs by selling a generic, almost but not quite, look
alike product as a substitute.
The
breakfast table discussion topic in injured workers’ homes concentrates on
boasting, “how many pills do you take?” It is not if, it is now how much.
Understandably,
California employers and insurance carriers are grabbing the opportunity of
using the IMR (Independent Medical Review) process to delay and deny benefits.
The problem is that is NOT what the process was intended to be used for. It you
want to kill the workers’ compensation system using, the pill by pill technique,
the strategy will obviously work.
It is
bad medicine for an ill system. It will only increase costs and litigation and all the parties will suffer.
While
some very knowledgeable people have endorsed a “formulary system,” that is a
doubtful solution to the complicated issue. The Part D system embraced under
the Medicare Program is a nightmare of confusion. You need a crystal ball, and
a lot of luck, on picking the best selection. The odds at the Mega-Million
jackpot are better.
What
workers’ compensation needs is not to re-invent the wheel yet again for pharmaceutical care. It cannot cure the
corrupted practices of big pharma. The compensation system was intended to be a
simple and cost effective system for providing summary benefits for injured
workers. California needs to take a step back, and just specifically exclude
drugs from the IMR process altogether.
….
Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 decades the Law Offices of Jon L Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.
