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.”
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 firstname.lastname@example.org have been representing injured workers and their families who have suffered occupational accidents and illnesses.