California bars unusual list of drugs for pain management treatment

The California Division of Workers’ Compensation’s recent changes to the drug formulary specifically list several newly named drugs as prohibited for pain management — baffling experts who say some of these drugs are unusual for treating pain anyway.

The list now prohibits a host of substances that include vitamins, minerals, body-builder supplements and other pharmaceuticals outside the usual pain-management platform of drugs.

Estrogen is one example experts cited, as the hormone-replacement pharmaceuticals have rarely, if ever, been prescribed for pain stemming from a workplace injury.

A spokesman for the division said the revised formulary is based on the American College of Occupational and Environmental Medicine Practice Guidelines, which uses an evidence-based approach in its recommendations for treating pain. Yet the guidelines already listed these substances in a 2016 version. Such drugs and supplements were not included in the original California formulary, enacted in 2018, but are now specifically prohibited.

“My speculation is that (these drugs are) becoming an issue from a medical necessity perspective and a billing and prescribing pattern perspective; (claims adjusters) needed clarity on whether these (drugs) are appropriate for these kinds of conditions,” said Joe Paduda, the Skaneateles, New York-based president of CompPharma LLC.

“I pity the adjuster who gets a script for estrogen” to treat chronic pain, he said.

“I am sure it has to do with physician trends: that they are seeing these drugs coming through” the comp system, said Silvia Sacalis, a Tampa, Florida-based licensed pharmacist and vice president of clinical services for Healthesystems LLC. “The only way they know what to address is to see the patterns.”