Pennsylvania Gov. Tom Wolf (D) last week vetoed a bill that would have required changes in how opioids are prescribed for construction workers and others in the state workers' compensation system, along with additional alterations to existing law. He said the so-called "formulary proposal" introduced by Republican lawmakers would have saved money for businesses and insurers but would not have helped fight abuse of the painkillers.

Pennsylvania is one of the states hardest hit by the opioid addiction crisis, according to recent data from the Centers for Disease Control. 

Several states are considering or working on enacting drug formularies, which detail the type and quantity of medication that may be prescribed and monitor prescriptions. A 2017 report by pharmacy benefit manager myMatrixx says 2016 was a turning point for legislation and regulations to control opioid pain prescriptions. 

Pennsylvania's failure to enact the workers' compensation changes follows a similar outcome in Louisiana. California passed a formulary for its workers' compensation system in 2015 that went into effect on Jan. 1, and New York has been considering one. 

Construction workers are among the most affected employees across all industries because of injuries they sustain and work-related chronic health problems.  

Formulary programs effectively limit opioid prescriptions, require doctors and pharmacies to report what is being prescribed and dispensed, and prevent an injured party from obtaining opioid prescriptions from multiple doctors. They also help state pharmacy boards review which doctors are prescribing unusually high amounts of opioids so these practitioners can be counseled on proper opioid prescription methods.

The formulary proposed in SB 936 "will not improve overall health outcomes for Pennsylvania's injured workers and will not stem the tide of the opioid crisis that is ravaging every area of our society," Wolf wrote in a letter to state senators. "Many opioid medications are among the least costly prescription medications available on the market. Since the bill's drug formulary is designed to steer physicians toward prescribing less costly drugs, it will not likely accomplish the often-stated objective of the bill's promoters."

Separately, Wolf said the bill "threatens health care for millions of workers who could be injured on the job, including police, corrections officers and firefighters ... whose injuries can be unique, debilitating and severe. It is wrong to sacrifice health care for our first responders to protect the bottom line for insurance companies and corporations."

The Governor's Opioid Action Plan

In announcing the veto, Wolf provided an action plan to combat the opioid epidemic, as well as his administration's guide to learning how to treat and prevent addiction to the drugs. The plan includes creating prescription guidelines for opioids in worker's compensation, training workers' compensation judges and providers, encouraging the passage of legislative measures regulating prescribing guidelines, instituting a seven-day limit on opioid prescriptions, and reviewing to identify overprescribing. Wolf also called for curbing "overly expensive" opioid treatments by restricting topical opioid compound prescriptions.

Supporters of the vetoed measure had cited an article in the Philadelphia Daily News that described how a Philadelphia law firm specializing in workers' compensation has been able to refer clients approved for that cost coverage to doctors who had drug-buying agreements with a pharmacy the law firm owned.