The Ohio Bureau of Workers’ Compensation (BWC) will be reviewing at its January 27 meeting of directors a pharmacy “lock-in” rule, called the Coordinated Services Program, aimed at combating prescription drug abuse.
The program will allow BWC to require an injured worker to use a single pharmacy to dispense all non-emergency prescriptions that are reimbursed under the bureau’s prescription benefit plan.
House Bill 93, which took effect last May 20, requires that the bureau adopt such a program and rule by July 1, 2012. The legislation also provides that the bureau’s effort be developed in cooperation with the Department of Job and Family Services.
Under the proposed rule, the bureau could place an injured worker in the “lock-in” program based on the injured worker meeting one or more of the following criteria in a three-month time frame:
--Use of three or more different prescribers to obtain prescriptions of the same or comparable medications.
--Receipt of prescription drugs from more than two different pharmacies.
--Monthly receipt of three or more prescriptions, including refills for drugs identified as narcotic analgesics.
--Monthly receipt of more than two concurrent narcotic analgesics in the same therapeutic drug class.
--Monthly receipt of more than two narcotic analgesics in the same therapeutic drug class, more than one benzodiazepine, and more than one sedative-hypnotic.
The proposed rule also would allow the bureau to restrict an injured worker convicted of a drug offense to the use of a single prescribing physician, selected by the injured worker from bureau-certified physicians, in order to receive reimbursement from the agency for non-emergency prescriptions.
Ernie Boyd, executive director of the Ohio Pharmacists Association, told WorkCompCentral on Friday that he thinks the rule will help deter abuse of prescription drugs. Boyd said the only concern raised by pharmacists on the rule was that when an injured worker is required to select a single pharmacy, "it has to be the worker's choice."
Compare Ohio's plan with Washington's pharmaceutical controls.
Washington requires medical practitioners to perform a full evaluation to document a patient's health history for past treatment of pain and substance abuse problems. Practitioners must also review any available information about past prescriptions and current prescriptions through prescription drug monitoring programs before prescribing opioids.
Doctors are required to prepare a treatment plan, discuss the risks associated with opioids with patients and have the patient sign an agreement for treatment that outlines how the drugs should be taken. The contract can also include language saying the patient could be cut off from medication for violating the contract.
Other provisions in Washington's rules say whenever possible, a single prescriber and single pharmacy should dispense opioids, and that treating doctors should review the treatment plan and patient's progress at least every six months.
Doctors in Washington are required to seek a consultation for any prescription in excess of the equivalent of a 120 mg dose of orally administered morphine per day. Exceptions to the consultation requirement apply when a patient is being tapered off opioids, a patient requires only a temporary increase in dosage for acute pain, the doctor documents reasonable attempts to obtain a consultation with a pain management specialist or the doctor documents that the patient's pain and function is stable and the patient is on a non-escalating dosage of opioids.
Ohio is one of the few completely state-run systems. This allows the state to implement rules, such as the Coordinated Services Program, much more easily than a competitive open market state, because coordination of state agency services is more consolidated and streamlined.
Because Washington is also a state-run system, the effectiveness of the Coordinated Services Program can be measured directly against Washington's program for controlling prescription drugs providing the rest of the nation with valuable insight into better ways to manage this current source of abuse and concern. I assume at some point one of the workers' compensation research organizations will do this comparison and also compare against other states with, and without, adopted pharmaceutical control guidelines.workers compensation, work comp, injured worker