Workers comp prescriptions not requiring review up in California

The number of prescriptions for drugs that do not require a utilization review under California’s year-old workers compensation formulary increased to 38.5% in 2018, up from 35.2% in 2017, and payments for drugs not listed on the formulary increased by more than 10 percentage points, according to a report released Wednesday by the California Workers’ Compensation Research Institute.

The Oakland, California-based research organization examined 658,057 prescriptions in the workers comp system from Jan. 1 to June 30 for 2016, 2017 and 2018 to gauge the impact of the formulary that went into effect on Jan. 1, 2018, according to the report.

While prescriptions for exempt drugs increased, prescriptions for drugs that are listed as nonexempt and require prior authorization decreased to 45.1% in 2018 from 52.9% in 2017. Figures for 2016 and 2017 — prior to the formulary — in both categories remained relatively flat.

The report also found that “not listed” drugs that are not named in the formulary rose to 16.4% of the prescriptions in 2018, up from 11.9% in 2017.

The mix of prescription drug payments also changed. Payments for exempt drugs declined to 18.8% of the payments in 2018 from 21.8% in 2017; nonexempt drugs fell to 42.3% from 50.8%; and “not listed” drugs increased to 38.9% of the total drug spend from 27.4%.