I was able to speak with someone at TDOL regarding my post this week on SB 3315. While TDOL acknowledges that the interpretation of the statute as I outlined was at one time accurate, the current TDOL interpretation is now much more in line with the legislative intent of the bill.
Any Schedule II, III, or IV drug prescribed for pain management for more than 90 days will be subject to utilization review.
Several pieces of good news here:
1) TDOL is listening. I was very pleased with the transparent and candid nature of my discussion with my contact there. TDOL is really trying to get this right and wants to be a resource not just to injured workers, but to employers and carriers doing business in Tennessee.
2) The state has, in fact, created a statutory framework for addressing opioid dependence. That doesn't mean this is simple (a single adverse UR determination for someone on oxycodone for the past five years doesn't fix the issue), but it does mean progress is possible if employers and carriers are prepared to offer a clinically responsible path to weaning these medications.
3) My contact at TDOL has no direct knowledge of any impending rule-making process; doesn't mean there won't be one at some point, but for now we all need to operate on the basis of the language in SB 3315. So let's get to work.
One note: despite this strengthened UR statute in TN, I'm still a believer in UR as a "Plan B". Plan A ought to be a voluntary, collegial, evidence-based engagement with the treating physician to explore alternative treatment. The time frames and technicalities of UR should only be deployed when attempts at real clinical engagement have failed.
And for those that have heard rumors (or had specific experience) with regard to adverse UR determinations being overturned by TDOL, my understanding is that this has been driven largely by the date range issue (the 90-day clock starting ticking on July 1 even if the patient had been on opioids for years previous to July 1). Some payors apparently jumped in too early.
Progress in Tennessee.
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