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Stakeholders called for more tweaks to California’s proposed workers compensation drug formulary, which is slated to go into effect in January 2018 and still needs refining of provisions for weaning injured workers off drugs that would be exempt from prescribing under the new rules, according to several commentators.
In its latest call for public comments on the proposed drug formulary for injured workers, the California Department of Industrial Relations received insight from 17 separate organizations and individuals by the Aug. 2 deadline.
Closed drug formularies are the latest trend in state workers comp systems, praised as an answer to opioid overprescribing. Many of the public commentators praised California for tackling the issue that has plagued the system that guides care for injured workers, but not without calling for refinements.
Under California’s proposed formulary, long-term opioid prescribing will no longer be allowed without a review process.
In the latest round of comments, organizations said the weaning rules need to be clarified and that doctors may need more time to put patients on an alternative treatment plan. The new rules call for doctors to issue progress reports no later than April 1 on how a patient is being weaned off medications and what the alternative treatment plan is.
The Sacramento-based California Applicants’ Attorney Association issued a letter criticizing the draft for not containing a “timeframe for a worker to be allowed to transition from a non-formulary drug to a formulary drug.”
“Unfortunately, as we have seen in too many cases, the (Medical Treatment Utilization Schedule) and current applicable utilization review and independent medical review regulations will not protect workers from being cut off ‘cold turkey’ from medications they have been on for years,” the attorney association stated in its letter.
Meanwhile, one organization — Memphis, Tennessee-based Sedgwick Claims Management Services Inc. — called for a shortened timeframe for new reports on weaning: Feb. 1 instead of April. In its letter, the organization argued the dangers of opioids necessitate an earlier deadline.
“Even a one‐day opioid prescription carried a 6% risk of use at one year later and a 2.9% risk of use at three years later,” the Sedgwick letter stated.
Lisa Anne Bickford, director of workers comp government relations for Downers Grove, Illinois-based Coventry Workers’ Comp Services, urged in her letter that the department specify what actions a claims administrator may take if timeframes are not met. The new rules also lack remedies in other instances, she wrote.
“In similar fashion, there are several other references throughout the proposed rules wherein authorization through prospective review is required, but the proposed rules do not specifically state what action is to be taken in the event that the mandatory prospective review is not requested,” she wrote.
In May, when the first public comments session ended, two dozen organizations drafted lengthy proposals to change parts of the new rules for prescribing. A resounding request included a call to delay implementation of the formulary from its original July 1 date, a change that was made in June.
As of July, regulators made further changes to the proposed drug formulary and several workers comp organizations applauded the state’s work to refine the formulary, which grew out of the state’s passage of Assembly Bill 2224 in 2015.
The 2-year-old law called for the creation of an evidence-based closed drug formulary by 2017. Closed formularies limit approved medications for workers comp claims, and prior to the new law, California legislators had carefully examined closed formularies in Texas and Washington state.
Several organizations issued statements simply applauding the Department of Industrial Relations’ newest version, which included changes such as replacing the “Preferred/Non-Preferred” drug designations to “Exempt/Non-Exempt” to better align with how the designations affect the prospective utilization review status of the drug; revised provisions relating to phased implementation of the formulary; deletion of provisions regarding issues that will be addressed in the utilization review regulations rather than in the formulary regulations; clarification of applicable dispute resolution procedures; and an updated drug listing and formatting changes.
More than 30% of the prescription drugs currently dispensed to injured workers in California will be classified as exempt and no longer require authorization prior to dispensing under the state’s proposed drug formulary, according to a study released Tuesday.