More states are looking to create closed formularies for medications prescribed in workers compensation to change prescribing behaviors and stop opioid addiction before it starts.

Following in the footsteps of Tennessee, where a formulary is expected to take effect in August, and California, which has been tasked with creating a formulary by July 2017, Nebraska is the latest state to consider an evidence-based formulary for drugs prescribed to injured workers.

L.B. 1005, introduced last month by Nebraska Sen. Burke Harr, D-Omaha, would require prior authorization by workers comp payers before controlled substances that aren't included in the formulary — or those that are included but not recommended — could be prescribed to injured workers.

An evidence-based formulary can help change prescribing patterns, since opioid painkillers, benzodiazepine psychoactive drugs, soma muscle relaxants and other medications are sometimes used inappropriately in workers comp, experts say.

“If we're really ever going to get our arms around the opioid issue in this country, we have to change the prescribing culture when it comes to treating pain,” said Brian Allen, vice president of government affairs for pharmacy benefit manager Helios in Westerville, Ohio. “A formulary does that because it provides guidelines at the prescribing level about which drugs are appropriate for the work comp systems versus which ones they want to see weeded out.”

Logistics questions

However, discussions about L.B. 1005 at the state Legislature's Business and Labor Committee meeting last week prompted questions about how the formulary would be managed on an ongoing basis and how it would affect injured workers.

“The idea of a formulary is feasible for every state, but how it gets done or what standard,” such as the American College of Occupational and Environmental Medicine Practice Guidelines or the Work Loss Data Institute's Official Disability Guidelines, “they adopt has to be right for their state,” Mr. Allen said.

One issue discussed during the committee meeting, which “is a concern raised by all opponents of drug formularies in every state,” was whether new claims and legacy claims would be treated differently in Nebraska, Mark Pew, senior vice president at Duluth, Georgia-based medical management company Prium, said in a blog post Tuesday.

Rather than abruptly stopping an injured worker's opioids, “a remediation period is required to help wean those on inappropriate drug regimens,” Mr. Pew said, adding that addressing this issue “is a no-brainer.”

Texas' formulary, for example, went into effect in September 2011 for new injuries and in September 2013 for all injuries.

Other formularies can be found in Oklahoma as of February 2014, and monopolistic workers comp states Washington and Ohio as of 2004 and 2011, respectively.

Mr. Allen said other states considering a closed drug formulary include Arizona, Georgia, Louisiana, Maine, Michigan, North Carolina and South Carolina.