HLS 17RS-886 ORIGINAL
2017 Regular Session
HOUSE BILL NO. 529
BY REPRESENTATIVE BROADWATER
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
WORKERS COMPENSATION: Provides for a workers' compensation closed pharmacy
formulary
1 AN ACT
2To amend and reenact R.S. 23:1203.1(B), (D)(introductory paragraph), (H), (I), (J)(1), (L),
3 and (M), relative to workers' compensation; to provide for the creation of a closed
4 pharmacy formulary; to provide for the criteria for the creation and content of the
5 formulary; to provide for variances; and to provide for related matters.
6Be it enacted by the Legislature of Louisiana:
7 Section 1. R.S. 23:1203.1(B), (D)(introductory paragraph), (H), (I), (J)(1), (L), and
8(M) hereby amended and reenacted to read as follows:
9 ยง1203.1. Definitions; medical treatment schedule; medical advisory council; closed
10 pharmacy formulary
11 * * *
12 B. The director shall, through the office of workers' compensation
13 administration, promulgate rules in accordance with the Administrative Procedure
14 Act, R.S. 49:950 et seq., to establish a medical treatment schedule and a closed
15 pharmacy formulary within the medical treatment guidelines.
16 (1) Such rules shall be promulgated.
17 (2) (1) The medical treatment schedule and the closed pharmacy formulary
18 within the medical treatment guidelines shall meet the criteria established in this
19 Section and shall be organized in an interdisciplinary manner by particular regions
20 of the body and organ systems.
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1 (2)(a) The director shall promulgate rules necessary to implement the closed
2 pharmacy formulary, which shall be promulgated and placed within the medical
3 treatment guidelines. The rules shall be promulgated and the formulary shall be
4 adopted by July 1, 2018.
5 (b) The closed pharmacy formulary shall include rules to address legacy
6 claims to ensure the safe transition of patients from any ongoing use of opioid drugs.
7 (c) Prior to the adoption of the closed pharmacy formulary, the director shall
8 engage with employers, insurers, private sector employee representatives, public
9 sector employee representatives, treating physicians actively practicing medicine,
10 pharmacists, pharmacy benefit managers, attorneys who represent applicants, injured
11 workers, and any other stakeholder the director deems appropriate to facilitate the
12 development of the formulary.
13 * * *
14 D. The medical treatment schedule and the closed pharmacy formulary shall
15 be based on guidelines which shall meet all of the following criteria:
16 * * *
17 H.(1) The director, with the assistance of the medical advisory council, is
18 authorized to review and update the medical treatment schedule no less often than
19 once every two years. Such updates shall be made by rules promulgated in
20 accordance with the Administrative Procedure Act, R.S. 49:950 et seq. In no event
21 shall the schedule contain multiple guidelines covering the same aspects of the same
22 medical condition which are simultaneously in force.
23 (2) The medical advisory council may recommend to the director that the
24 formulary be updated or revised upon a showing by the medical advisory council of
25 high ranking scientific medical evidence. The director may, upon that
26 recommendation, promulgate any rules necessary for an update.
27 I. After the promulgation of the medical treatment schedule and the closed
28 pharmacy formulary, throughout this Chapter, and notwithstanding any provision of
29 law to the contrary, medical care, services, and treatment due, pursuant to R.S.
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HB NO. 529
1 23:1203 et seq., by the employer to the employee shall mean care, services, and
2 treatment in accordance with the medical treatment schedule and the closed
3 pharmacy formulary. Medical care, services, and treatment that varies from the
4 promulgated medical treatment schedule or the closed pharmacy formulary shall also
5 be due by the employer when it is demonstrated to the medical director of the office
6 by a preponderance of the scientific medical evidence, that a variance from the
7 medical treatment schedule or the closed pharmacy formulary is reasonably required
8 to cure or relieve the injured worker from the effects of the injury or occupational
9 disease given the circumstances.
10 J.(1) After a medical provider has submitted to the payor the request for
11 authorization and the information required by the Louisiana Administrative Code,
12 Title 40, Chapter 27, the payor shall notify the medical provider of their action on
13 the request within five business days of receipt of the request. If any dispute arises
14 after January 1, 2011, as to whether the recommended care, services, or treatment is
15 in accordance with the medical treatment schedule or the closed pharmacy
16 formulary, or whether a variance from the medical treatment schedule or the closed
17 pharmacy formulary is reasonably required as contemplated in Subsection I of this
18 Section, any aggrieved party shall file, within fifteen calendar days, an appeal with
19 the office of workers' compensation administration medical director or associate
20 medical director on a form promulgated by the director. The medical director or
21 associate medical director shall render a decision as soon as is practicable, but in no
22 event, not more than thirty calendar days from the date of filing.
23 * * *
24 L. It is the intent of the legislature that, with the establishment and
25 enforcement of the medical treatment schedule and the closed pharmacy formulary,
26 medical and surgical treatment, hospital care, and other health care healthcare
27 provider services shall be delivered in an efficient and timely manner to injured
28 employees an injured worker.
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1 M.(1) With regard to all treatment not covered by the medical treatment
2 schedule or the closed pharmacy formulary promulgated in accordance with this
3 Section, all medical care, services, and treatment shall be in accordance with
4 Subsection D of this Section.
5 (2) Notwithstanding any other provision of this Chapter, all treatment not
6 specified in the medical treatment schedule and not found in Subsection D of this
7 Section shall be due by the employer when it is demonstrated to the medical director,
8 in accordance with the principles of Subsection C of this Section, that a
9 preponderance of the scientific medical evidence supports approval of the treatment
10 that is not covered.
11 * * *
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 529 Original 2017 Regular Session Broadwater
Abstract: Provides for the creation of a closed pharmacy formulary for the treatment of
injured workers in workers' compensation claims.
Proposed law requires that rules shall be promulgated and the closed pharmacy formulary
be adopted by July 1, 2018.
Present law created the medical treatment guidelines.
Proposed law retains present law and provides a procedure for the creation of a closed
pharmacy formulary subject.
Proposed law requires that in the development of a pharmacy formulary, the director consult
with workers' compensation stakeholders for specialized input.
Proposed law requires that in the promulgation of the closed pharmacy formulary, rules shall
be promulgated to address legacy claims to ensure the same transition to patients using
opiods.
Present law requires that the director update the medical treatment guidelines every two
years.
Proposed law retains present law and provides that the pharmacy formulary may be updated
if an update is recommended by the medical advisory council pursuant to high ranking
medical evidence.
Present law provides that if the treatment needed by the injured worker is not sufficiently
addressed by the medical treatment guidelines, that the employer may demonstrate by
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HB NO. 529
preponderance of the scientific medical evidence that a variance is necessary. Proposed law
retains present law and adds to this exception, along with the medical treatment guidelines,
that the pharmacy formulary will also be subject to a variance pursuant to the procedures in
present law.
(Amends R.S. 23:1203.1(B), (D)(intro. para.), (H), (I), (J)(1), (L), and (M))
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