A study from the California Workers’ Compensation Institute (CWCI) shows that since the state implemented their workers’ compensation formulary last year more drugs being prescribed to injured workers are either “exempt” from prospective utilization review or unlisted in the formulary, while non-exempt drugs that require utilization review are declining.
California’s prescription drug formulary took effect on January 1st of 2018. It was intended to improve care for workers by ensuring that the drugs they received met evidence-based standards in terms of frequency, duration, strength and appropriateness. It was also intended to reduce the amount spent on prescription drugs, reduce delays and other costs associated with drug disputes.
The formulary includes exempt and non-exempt drug lists based on the need for prospective utilization review. Drugs that are not listed are permitted if the treating physician can show the use of these drugs for a specific injury follows the medical treatment utilization schedule or other permissible guideline.
Authors of the study compared pre-formulary data from prescriptions filled in the first half of 2016 to the first half of 2017, to post-formulary data from prescriptions filled in the first half of 2018 to try and figure out the impact of the formulary on the mix of drugs prescribed to workers. There were a total of 658,057 prescriptions that were grouped by exempt, non-exempt or not listed.
They found exempt drugs rose to 38.5 percent of prescriptions, increasing from 33.2 and 35.2 percent. Non-exempt drugs (Which require UR), decreased to 45.1 percent of all prescriptions down from 54.3 and 52.9 percent. Not listed drugs increased to 16.4 percent of prescriptions, up from 12.4 and 11.9 percent.
Exempt drugs declined from about 22 percent of the payments to 19 percent. Non-exempt drugs fell from over half the payments to 42 percent of payments and not listed drugs increased from almost a quarter of total drug spend to almost 39 percent.
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