San Francisco,CA.(WorkersCompensation.com) -The Division of Workers' Compensation (DWC) has posted drug formulary draft regulations, including a proposed list of preferred drugs, on its online forum. The goal is to adopt an evidence-based drug formulary, consistent with California's Medical Treatment Utilization Schedule (MTUS), to augment the provision of high-quality medical care, maximize health, and promote return to work in a timely fashion, while reducing administrative burden and cost.
Assembly Bill 1124 (Statutes 2015, Chapter 525) requires the adoption of an evidence-based workers' compensation drug formulary into the Medical Treatment Utilization Schedule (MTUS) by July 1, 2017. DWC intends to concurrently adopt updated MTUS clinical topic guidelines to align with the drug formulary. The proposed updated guidelines are created by the American College of Occupational and Environmental Medicine (ACOEM), published by Reed Group, Ltd. The preferred drug list proposed in the draft regulations was created by DWC, in light of evidence-based drug recommendations in the guidelines
The following documents are posted on the forum:
Draft formulary regulation text (including preferred drug list) RAND Report: Implementing a Drug Formulary for California's Workers Compensation Program ACOEM Treatment Guidelines Ankle and Foot Cervical and Thoracic Spine Elbow Disorders Eye Hand, Wrist, and Forearm Hip and Groin Knee Disorders Low Back Disorders Shoulder Disorders
One of the proposed regulations seems to be a strong tool to limit unfettered dispensing of compound medications. Proposed Section 9792.27.9 provides that "Compounded drugs must be authorized through prospective review prior to being dispensed. If required authorization through prospective review is not obtained prior to dispensing, payment for the drug may be denied. When it is necessary for medical reasons to prescribe or dispense a compounded drug instead of an FDA-approved drug or over-the-counter drug that complies with an OTC Monograph, the physician must document the medical necessity in the patient's medical chart, and in the Doctor's First Report of Injury (Form 5021) or Progress Report (PR-2.) The documentation must include the patient-specific factors that support the physician's determination that a compounded drug is medically necessary."