Medical Board Urges State Fund to Reconsider Restrictions on Prescription of Opioids for Intractable Pain

The California State Compensation Insurance Fund (SCIF), the state's largest workers' compensation insurer, recently notified the physicians in its medical provider network (MPN) that they must agree to refrain from prescribing opioids for a period longer than two months and not prescribe compounded medications without prior authorization from the insurance adjuster or by order of a workers' comp judge. The new rules, detailed in SCIF's "General Provisions and Criteria" document, also stipulate that MPN physicians cannot even prescribe certain medications at all, regardless of medical necessity.

The California Medical Association (CMA) believes that these new provisions are an attempt by SCIF to exert control over physicians' practice of medicine and clinical judgment, require physicians to treat injured workers' differently than other patients and violate state law, which allows for prescribing, dispensing, furnishing or administering controlled substances for the treatment of a condition causing pain, including but not limited to intractable pain. The restrictions also violate the Medical Board of California's Guidelines for Prescribing Controlled Substances for Pain.

In addition to the concerns above, SCIF's notice required physicians to agree to the new preauthorization rules within two weeks or be kicked out of the MPN. State law requires insurers to provide physicians with at least 45 business days' notice of a material change to a contract. The law also gives physicians the right to terminate the contract prior to implementation of the change.

At CMA's request, the California Medical Board reviewed SCIF's preauthorization requirements for opioid prescriptions and has informed CMA that it shares the association's concerns. The board recently sent a letter to SCIF, urging the fund to review the board's guidelines for the treatment of intractable pain and to reconsider whether the preauthorization requirements are "a necessary component of effective treatment provided in the workers' compensation arena."

If SCIF doesn't voluntarily withdraw the provisions, the medical board has told CMA that it will take further action.