Today's Toledo Blade reports that
link workman's comp program is cutting the drug benefits of the disabled receiving assistance from the program. They seriously deserve a second Pulitzer Prize for investigative reporting for breaking and following this story. Local southern Ohioans are starting to hear about it finally. More below the fold.
The bureau - wracked with about $300 million in investment losses and at the center of a widening political scandal - has decided to cut drug benefits to save an estimated $4 million or more a year.
Starting yesterday, injured workers no longer had automatic access to a number of drugs deemed to have cheaper alternatives - including OxyContin and Celebrex, among others.
This isn't about switching to generic brands - some of the drugs do not have that cheaper equivalent, and such a program is already in effect.
The new "preferred drug" program is focused on pushing injured workers to try cheaper alternatives, meaning different medications.
Under the new program, a doctor must justify the need for the more expensive medication by filling out a form and gaining approval from a bureau pharmacist.
Mr. Adams - a 50-year-old Toledo man who has received a stipend and drug coverage from the bureau since a 1979 work-related back injury and seven subsequent surgeries - will have withdrawal symptoms, he said.
He said legions of injured workers across the state, who have been using certain painkillers for years, are in the same uncomfortable straits."
Others in state government do not connect this change to the recent Coingate financial woes. Evidently the program has been in the works since 2003 and was designed to make the insurance be more like that of an HMO- "more competitive" is the phrasing used.
Although heavy duty prescription narcotics have been used for years by some of the clients of workman's comp, some pharmacists and physicians are worried about the consequences of too rapid withdrawal to comply with these regulations.
Few would support state-sponsored addiction or chemical dependency, but Ernest Boyd, a pharmacist and the executive director of the Ohio Pharmacists Association, said the bureau and some in the medical field have created a mess by indulging the desire for strong painkillers over the years.
Adding to the problem for the bureau is that the pool of injured workers covered by the agency's $14.3 billion fund tends to have back and other muscular and skeletal injuries, which many times call for managing pain, said Tina Kielmeyer, bureau interim administrator.
The bureau has covered too much in terms of strong painkillers over the years and now might have a problem weaning people in such a dramatic, cold-turkey fashion, Mr. Boyd said.
"That would be my concern. It's not a bad thing to get on Darvon, [less addictive than OxyContin], and then get off quickly. But this is a different deal because we have people already on these drugs for years. What's going to happen is it's going to be tough for the pharmacist and it's going to be tough for the patient," he said.
"What do you do with a patient who's been on this stuff and is chemically dependent and he gets off the stuff and goes into seizures? Then you'd have to admit there's been a dependency problem [created]," Mr. Boyd said.
Once again, the physician's advice on what to prescribe is questioned by the accountants. If we are going over to being that "competitive" with private health care plans, then why can't we have a single payer plan? These sounds like the "worst case" of the Republicans ads during the Clinton health care fiasco- "Your doctor can't prescribe the medicine you have been taking- why don't you try the following cheaper alternatives." Or will they say that it is these Workers fault they lost private insurance when they lost their jobs- assuming they ever had a job with insurance.
Easy to make this program look like the pain killers are "drugs of abuse" and the folks on workman's comp are somehow "druggies". But people who wind up on Workman's Comp long enough to get the drug benefits often are disabled because of back pain.
Maybe I am just ranting on, but I am concerned that the folks taking these painkillers may find it hard to defend themselves. Will the "Workman's comp guy on Oxycontin become the next "Welfare Cadillac" unwed mom? Or the next vet taking viagra (and having to embarassing justify to the feds why they need it?) And the stress of having to go through a bureaucracy and justify the medications you are using is high.
Limbaugh Watch: With all his "pain" will he understand the need for many to get these prescriptions?
Finally, the everyday people getting this news aren't buying it that this is a moneysaving effort predating the Coingate scandal.
Mr. Adams, and other injured workers who did not want to be identified, do not buy the assurances. They said it feels like a program that is supposed to be serving them will hurt them.
Those injured workers include a 45-year-old Toledo woman with a herniated disk and arthritis in her back, she said. Since receiving the letter, she has worried the bureau will no longer pay for her pain medication. She did not want to be identified, fearing retribution from the bureau, she said.
"This is really irking me, and I'm sure the people of Ohio don't know what's happening. Workers' compensation is not paying for my education, they are not giving me a stipend. My husband and I are just eking by, and the only thing they are giving us is the medical. And now they're going to cut back," she said.
She's upset by the investment losses because that money could easily cover the cost of the prescription drugs she and others have been taking. She says the timing seems suspicious to her.
She and Mr. Adams do not believe the issues are unrelated.
"All those little scandals that are unfolding through the governor's office ... It would be the most unbelievable coincidence that they come back with the huge losses, and the next week they're looking to cut costs. If you don't put those two things together ... This is a cost-cutting measure," she said. "[My doctor] may fill that form out for me, and it may not be a problem. But I can't imagine they would go though all of that and still approve you."
I believe Coingate and prescription cutbacks may have been unrelated in the beginning- bureaucracies move very slowly.
But, the same adminstrators and governor that brought you Coingate are responsible for this effort. And Workman's Comp in Ohio hasn't the funds to back off of this policy now if it doesn't work out. I sense the "Coingate Blues" may bring back some of the voters back to the Democratic party that cares about a citizen's freedom to follow their physician's advice.