Friday, May 4, 2012

Tennessee Steps Up: UR and Narcotics Contracts

The Tennessee General Assembly passed a bill late Tuesday that will apply the utilization review process to any schedule II, III, or IV drug prescribed for more than 90 days.  Further, the bill creates stiff penalties for patients that violate narcotics contracts with treating providers. 

Let's look at some of the specifics.  I find the following to be particularly encouraging:

1) Employers can leverage UR for drugs - excellent step.  Here at PRIUM, we still believe the best path to fixing a lot of these claims is through collegial, voluntary peer-to-peer engagement... but if that doesn't work, having UR as a statutorily recognized option is very beneficial.

2) Interestingly, if a doctor refuses to prescribe a certain drug, the claimant can (on no more than one occasion) trigger the UR process on his own behalf to essentially secure a third party's view of the appropriateness of the medication therapy.  I wonder how often this will be used...

3) If an injured employee violates the narcotics contract more than once (I guess everyone deserves a mulligan), the patient's "right to pain management through prescription [drugs]... shall be terminated."  Tough, but appropriate. 

A few concerns:

1) The UR option appears to be off the table if there is "an initial evaluation of an injured or disabled employee by a physician specializing in pain management."  I see the fingerprints of the Tennessee Medical Association here.  In our experience, exempting pain management specialists from oversight rests on a set of flawed and dangerous assumptions. 

2) The bill doesn't require a narcotics contract.  The employee "may" sign a formal written agreement.  If the employee does sign such an agreement and then violates it (more than once), the penalties are clear.  But the employee doesn't have to sign one... I would have liked to have seen the word "shall" here instead of "may," but these things are a negotiation and you get what you can get. 

I saw an earlier draft of the bill that did say "shall" and applied the same penalties described earlier for violators to those that refused to sign a contract.  That would have been interesting.  That earlier version also included mandated urinary drug monitoring... that also disappeared from the final version. 

Those minor concerns notwithstanding, this is an example of appropriate legislative response to a major public health issue.  One particularly good sign - Rocky McElhaney from the TN Association for Justice (representing trial lawyers) said that his organization had little choice but to accept the bill.  "With the governor being a Republican and Republican majorities in the House and Senate, we don't have a lot of say in legislation these days," he said.

Sad, but true, fact: When the trial lawyers don't like it, it's usually a good sign that the legislation has a chance of making a difference.

On Twitter @PRIUM1

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