Proposed California workers comp formulary to exempt several drugs

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.

The California Division of Workers’ Compensation is overhauling how drugs are prescribed under the state’s comp system, but the anticipated implementation date was delayed to Jan. 1, 2018, to give stakeholders more time to comment and prepare for the formulary.

Researchers for the Oakland-based California Workers’ Compensation Institute modeled 650,000 prescriptions and other proprietary databases against the terms of the proposed regulations and found that 31% of the prescription drugs dispensed to California injured workers in 2016 are on the proposed exempt drug list and could be dispensed without preauthorization.

The proposed formulary should reduce pharmaceutical disputes and the associated costs and delays as 22.5% of the drug requests that now go through utilization review and 21.4% of those that go through independent medical review involve drugs that are on the proposed exempt drug list, according to the study.

The proposed formulary exempts 15 “special-fill” drugs — allowing a four-day supply following an injury if prescribed or dispensed at the first medical visit within 7 days — and 14 “perioperative” drugs that can be dispensed four days prior to surgery and up to four days after surgery, according to the study. Together, these drugs account for 2.6% of all workers’ compensation prescriptions.

The findings show that the proposed formulary will help assure that drugs provided to injured workers meet evidence-based medicine standards while reducing disputes over prescription drug requests, representing a major step toward achieving the legislative intent of A.B. 1124, which required state regulators to create a formulary for medications prescribed to injured workers, the researchers found. At the same time, the proposed formulary opens the door for additional controls that could be used to address the high cost of workers comp pharmaceuticals, they said.