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Industry praises New York’s move toward comp drug formulary

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The proposed workers comp drug formulary in New York is key to curbing dangers to injured workers caused by inappropriate pharmaceutical prescriptions, according to insurance trade associations.

In April 2017, New York Gov. Andrew Cuomo signed legislation into law that required the New York State Workers Compensation Board to establish a comprehensive drug formulary, which is due to become effective July 1, 2018.

The proposed drug formulary will limit new opioid prescription to seven days for injured workers and ensure that refills for opioids are subject to prior authorization.

The board began seeking public comments on a proposed drug formulary in December with a Feb. 26 deadline.

“We’ve commenced the usual 60-day period of public comment in compliance with the New York State Administrative Procedures Act. This ensures that the formulary that is ultimately adopted is fully vetted prior to final adoption,” a spokesman for board said in an emailed statement.

Insurance trade associations have voiced their support for the New York drug formulary.

“Though we are still reviewing the draft regulations, we are very thankful New York policymakers agreed with us on the need to establish a drug formulary,” said Alison Cooper, Albany, New York-based vice president of state affairs for the Northeast region with the American Insurance Association. “Formularies play a critical role in reducing the dangers to injured workers caused by inappropriate pharmaceutical prescriptions. They also have proven to be effective in reining in prescription drug costs overall. We believe New York will end up being just the latest state to see the advantages to the treatment of injured workers and the workers’ compensation system broadly when such policies are enacted.”

Evidence-based drug formularies work best when they are used in conjunction with evidence-based treatment guidelines, according to Trey Gillespie, Austin, Texas-based assistant vice president of workers compensation with the Property Casualty Insurers Association of America.

“The proposed formulary in New York certainly appears to be an evidence-based drug formulary,” Mr. Gillespie said. “When you look at some of the early studies on how best to address the opioid crisis, many studies recommend a multipronged approach to fighting opioid overutilization including drug formularies, treatment guidelines, and strong pharmacy drug monitoring programs.”

Mr. Gillespie cites Texas as an early adopter of a drug formulary and a model for a possible outcome for New York, stating that the number of injured employees receiving nonpreferred drugs in Texas decreased by 83% during a three-year period following the implementation of its formulary in 2011.

“The number of open claims in Texas where nonpreferred strong opioids were being received and utilized by injured workers decreased from almost 15,000 injured workers in 2009 to less than 500 injured workers in 2015,” said Mr. Gillespie.

Mr. Gillespie said PCI would possibly submit comments on New York’s proposed drug formulary, adding that the organization believes the formulary has a “strong chance of improving health outcomes for injured workers in New York.”