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Employers work with their pharmacy benefit managers to customize formularies for their injured workers, but they tend to be most heavily involved when they have staff with medical expertise or are trying to address the overuse of a drug in their workers compensation programs.
In states such as Texas that have adopted workers comp formularies, employers generally are more likely to incorporate additional limits for narcotics, antidepressants, muscle relaxants and other drugs, said Brigette Nelson, senior vice president of workers compensation clinical management at Express Scripts Holding Co. in Cave Creek, Arizona.
“Most of our clients will customize to some degree,” Ms. Nelson said.
While many will ask pharmacists to advise them on what the formularies should look like, employers with nurses or medical directors tend to be more vocal about whether or not specific drugs should be in the formularies, she said.
And most employers will tell their PBMs to exclude drugs such as cancer medications not intended for workers comp pain management, or limit drugs such as sleep aids not meant for long-term use, she said.
Employers also are concerned about injured workers using opioids in combination with skeletal muscle relaxants because of the potentially serious safety risks, with Express Scripts data indicating that nearly half of injured workers took such combinations in 2014, Ms. Nelson said.
Employers are also working with their PBMs to create formularies that address pricey compound drugs, said Donald Lipsy, manager of regulatory, communications and compliance at First Script Network Services in Tucson, Arizona, a unit of Coventry Workers' Comp Services.
Compounds accounted for 7.7% of all managed drug spending in 2014, up from 4.5% in 2013, and 28.1% of all unmanaged drug spending, up from 20.1% in 2013, according to a Coventry First Script report in June.
“I think that's one of the reasons people are paying attention, because it's difficult to control for those,” he said.
Third-party administrators are leveraging pharmacy and claims data to develop red flags used to alert adjusters when injured worker cases need more attention.