Tuesday, October 13, 2015

No one in Florida is Talking About it?

WorkCompCentral (WCC) reported this week that the Push for Formularies is Gaining Momentum. It appears that the concept is here to stay. With "here" meaning workers' compensation generally. Some wonder if "here" should or even could mean Florida. A formulary is essentially a list of medications that are approved for the treatment of conditions or symptoms. Texas started the idea, implementing a formulary in 2011. It has reportedly resulted in significant cost savings for the workers' compensation marketplace.

We know California will join the list of states with a formulary for workers' compensation claims. That story broke about two weeks ago. The WCC story this week says that Maine, Georgia, and Louisiana may beat California to deployment because they are working on regulation already. North Carolina is on the path, and Arkansas has worked on exploring the idea. What do all of these states have in common? None of them are among the largest state workers' compensation systems. 

Joe Paduda of CompPharma is quoted in the WCC article. He says "a growing number of states are taking up the question" of a formulary. He sees this as a method to reduce spending and to "ensure injured workers are receiving appropriate care." Mr. Paduda predicts that 30 or more states will have a formulary within the next ten years. He says that the enthusiasm is driven by the fact that formularies have been deployed and "are working." I guess nothing spurs expansion like succcess?

Mark Pew of Prium was also quoted. He said that "New York and Florida have the infrastructure in place for a successful formulary," and New York is making some noise about the process. However, he noted that he "hasn't heard anyone talking about it for the Sunshine State." New York and Florida, on the contrary are among the ten largest workers' compensation systems in the country, along with Texas, California, Washington, and Ohio (which have each adopted the formulary concept). 

Eighteen months ago, the Workers' Compensation Research Institute (WCRI) published a report that suggested Florida could benefit from a Formulary. WCRI concluded that a Texas-style formulary could save significant expense in Florida and New York. 

A year ago, I noted that Formularies were in the news. That was when California was reacting to a study by the California Workers' Compensation Institute (CWCI). The CWCI study was an inspiration for California. Its findings likely drove the legislative effort that concluded last month with Governor Brown signing the law to instigate California's formulary. That forumulary will now be in place in 2017. As I type that, I note that we are coming to the close of the second decade of the century. Time is ticking by. Last October, I questioned whether Florida should consider a forumulary. 

In April of this year, I asked some questions about formularies. The benefits are being touted. The concept is spreading across the country. There are those who contend that a forumlary will make medications less expensive. Others claim that additional savings will result from improved prescription behavior, essentially the prescriptions that won't be written if there is a formulary in place. Still others contend that formularies are harmful to injured workers. That has to be part of any conversation; at its heart, this system is in place for injured workers and their employers.

From a variety of articles and posts, formularies are a reality already in Texas, Ohio, Washington and Oklahoma. They are now mandated by statute and under development in North Carolina and California. Arkansas has discussed one, and we hear that Georgia, Louisiana, Maine, Montana and Tennessee are in the process. It appears that by 2017 it is likely there will already be at least 10 of the 30 states Mr. Paduda predicts will adopt formularies before 2025.

Workers' compensation was born about 100 years ago. A small group of 10 states adopted workers' compensation statutes in 1911 according to EH.net. These leaders were New York, California, Illinois, Kansas, Massachusetts, New Hampshire, New Jersey, Ohio, Washington, and Wisconsin. Thereafter, programs were "originally adopted by most states between 1911 and 1920. The concept spread across the country rapidly. In ten years, by 1920 there were 44 American jurisdictions with a workers' compensation law. 

Florida was not among the innovators or leaders. Florida adopted workers' compensation in 1935, about 25 years after the first. Mississippi was last to embrace Comp, in 1948. Will Florida be among the first to adopt a prescription formulary? Will Florida adopt the concept within the first ten years of Texas' innovation? Texas began the movement in 2011. Will Florida be in the 3/5 (30) the Mr. Paduda predicts will adopt formularies in the next ten years? 

When the first decade of formularies concludes, will Florida be in the number? Or will Florida wait 25 years and again be among the last? Will anyone be interested in even discussing it?

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