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California aims to add COVID-19 protocols to drug formulary


In a first among 15 states with workers compensation formularies, the California Division of Workers’ Compensation this month launched its process for adopting COVID-19 treatment protocols into its drug formulary for treating injured workers.

Experts say the issue has been complicated by a lack of long-range, evidence-based data on what works best, and that most guidelines are likely subject to change.

“The guidelines give us a good picture of what we know today, but we need to be patient and open-minded as new research emerges, and we should expect revisions to these guidelines as the evidence grows,” said Brian Allen, Salt Lake City-based vice president of government affairs and pharmacy solutions for claims management technology company Mitchell International Inc.

On April 6, the California DWC issued a notice for a virtual public hearing May 14 on the proposed update to the Medical Treatment Utilization Schedule, a step that would put the state’s formulary in line with the American College of Occupational and Environmental Medicine’s Coronavirus (COVID-19) Guideline, which was published March 29. ACOEM, whose guidelines include treatment and safety information, did not return a request for comment. A California DWC spokesman said once the new guideline is adopted into the MTUS, the division “will then consider any medications” to its formulary and will update as ACOEM makes any changes in the future. State officials by law update formulary guidelines regularly. 

The latest ACOEM guideline includes prescription protocols for treating COVID-19, such as when antiviral drugs and other treatments are recommended. 

The California approach likely won’t result in “major changes,” Mr. Allen said.

“It is important to note, and it is stated by the ACOEM researchers, that COVID-19 is a relatively new virus and there is still more we need to learn about how to prevent its spread and how to best treat it when it is contracted,” he said.

“It’s been a real challenge for anyone to develop evidence-based clinical guidelines because there have been so few long-term studies,” said Joe Paduda, Skaneateles, New York-based principal of comp consulting firm Health Strategy Associates LLC.

Most workers comp injuries are musculoskeletal, he said. “COVID-19 is diametrically opposite of that,” and the disease is evolving, Mr. Paduda said. 

States and comp payers typically rely on ACOEM or the Official Disability Guidelines drug list developed by Austin, Texas-based MCG Health LLC to manage and update their formularies. Both entities began addressing COVID-19 at the start of the pandemic last year.

ODG guidelines are scheduled to be updated in June, according to Dr. Laurent S. Tao, editor-in-chief at MCG Health, who oversees research to incorporate emerging data into guidelines — a task he said has been complicated by the nuances of COVID-19.

“It’s definitely been a challenge for us as well as other organizations to offer evidence-based recommendations because there is little data; that makes it difficult for everybody to feel confident in the information we are putting forth,” he said. “We are all eager to look for clinical test results that are ongoing.”

More insurance and workers compensation news on the coronavirus crisis here