1

Get started today

Schedule Your Free Consultation Today!

Fill out the form and someone from our team will contact you. 

Free Consultation

Drug Formularies – Lower Costs at the Expense of Injured Workers? 

by FranksKoenig NeuweltJan 7, 2020

Drug Formularies – Lower Costs at the Expense of Injured Workers? 

Depending on the state involved, the cost of prescription drugs for injured workers make up 11%–17% of the overall cost of the average workers compensation claim. The overall cost includes all medical expenses as well as indemnity benefits for lost time from work. Nationally, drug costs per claim have gone down in recent years, but prescription drugs remain the target of the insurance industry and state workers compensation agencies, for further cost reduction.

Although pursuing the goal of cost reduction may have an added benefit of reducing the overuse of certain medication, most notably, opioids, the long-term effect is to reduce the treatment options for medical providers who are treating injured workers.

workers compensation lawyer

Many state agencies, often spurred on by insurance companies, have instituted, or are in the process of developing drug formularies. Generally, these formularies are composed of rigid rules that direct medical providers on the specific drugs that can be prescribed to treat certain injuries and conditions. More expensive medications, such as brand name drugs or compound topical pain creams which are formulated by individual pharmacies, may be completely prohibited. These rules also define the dosage and the number of refills which will be allowed for certain medications. If the treating medical provider wants the medication to be continued for a longer duration, there is often an elaborate process the provider must navigate in order to get authorization for continued use of the medication. In many states, the process may be especially onerous and convoluted and beyond the capabilities of many medical providers to contend with. This may produce the unwanted effect of driving some providers out of the system, thereby further reducing the quality of care for the injured worker.

The development of drug formularies is often promoted by the insurance industry as a device to provide better and more consistent care for injured workers. The purpose may be described as a need to safeguard patients by curbing the misuse of prescription medication and preventing dangerous drug interactions. Supposedly, the newly developed formularies are built on evidence-based medicine and therefore, will provide the best care for the patient. Rarely stated though is the obvious fact that the use of prescription medication under the formularies, will be severely limited. The ability of the attending physician to treat his or her patient and to meet that patient’s individual needs, will be curtailed. The restriction on the availability of various prescription medications may prevent or deter the recovery of the injured worker.

Because of these concerns, some lawmakers have been hesitant to implement formularies in their states. They may be coming to the realization that the quality of care for injured workers may be sacrificed in a primarily cost based system such as a formulary. Adoption of formularies is certainly not assured in such states. However, not all states would require legislation. In New York for instance, a formulary was adopted through a simple administrative rulemaking process by the agency overseeing the state’s workers’ compensation system.  Given these factors, it remains to be seen whether drug formularies will become the dominant system nationwide for handling prescription medication in workers compensation cases. Injured workers and their Workers Compensation attorneys hope not. 

Thanks to our friends from Hurwitz, Whitcher & Molloy for their insight into workers’ compensation law.

Palm Beach car accident lawyer

We have offices in Florida, Georgia and Illinois. It is not only important to talk to an experienced workers’ compensation lawyer when you have been hurt on the job, it is also the best way to make sure that you receive proper medical services and lost wages you are entitled to under the law. After all, the Workers’ Compensation law was created to protect you – the employee.

See what Our Clients Have To Say

Florida’s Most Trusted Workers’ Comp Attorneys

Devin Major
Devin Major
August 9, 2022.
Verified
Best team I had ever working for me I really hope anybody who needs legal advise call them
Gregory Diggs
Gregory Diggs
August 4, 2022.
Verified
I recommend this law firm to anyone with a worker's compensation case. The staff does a great job and they treat you like family. Judd Koenig was my attorney and went the extra mile and then some more securing my a nice settlement of my case.
Cynthia Murray
Cynthia Murray
August 3, 2022.
Verified
Great Attorney thank you Eric Lakind and staff Attentive, friendly, answered ever questions got results when I could not do it myself Cynthia
Naisha Dorvilus
Naisha Dorvilus
August 2, 2022.
Verified
Lisa was my lawyer she asked me questions and was very helpful. She and her team communicated with me about my cause and I'm super happy with her service.i will definitely recommend her and her company
Jaime Ieli
Jaime Ieli
July 29, 2022.
Verified
My husband was hurt and never dealt with an attorney before. He looked up attorneys online & thru the grace of God got Lissa Dorsey as his attorney & she was truly amazing! She was very involved, always returned our phone calls & made the whole process as easy for us as she possibly could while my husband treated with Dr's and started his healing process. I would recommend her to any & everyone without a doubt.
Evelin Hernandez
Evelin Hernandez
July 21, 2022.
Verified
Best law firm in Palm Beach County, Lisa and Kim were the best. I recommend this law firm to everyone.
Tammy Dault
Tammy Dault
July 20, 2022.
Verified
Wasn't sure how it would work with me being in one town and lawyer in another but it all worked out in the end thank you for all your hard work.
Brandon moore
Brandon moore
July 19, 2022.
Verified
Great understanding lawyers! They were great in getting me a fair settlement and quick to respond to any questions I had. Thanks Kim and Lisa!
john heller
john heller
July 12, 2022.
Verified
They were always responsive to my calls did an excellent job of getting everything I needed. When it came time To settle my case Andy and J did an excellent job I’m very happy with the outcome and very happy with this law firm I would highly recommend them!!!!