The California Legislature passed A.B. 1124, which would establish an evidence-based closed drug formulary for Workers’ Compensation by July 1, 2017 if signed by the Governor. Notwithstanding this legislation, the DWC has already commenced public hearings on a drug formulary believing that it has authority to adopt one without further legislation.

An article in Business Insurance reports that California insurance experts are optimistic that a new workers compensation prescription drug formulary will help injured workers and reduce comp costs in the state, but the legislation could face hurdles from claimants who need to be weaned from banned drugs or want to continue using them off-label.

The formulary “takes a significant step forward in improving the state workers compensation system as it will assist in injured workers’ medical outcomes, decrease system bureaucracy and provide for savings,” Steve Suchil, Western region assistant vice president of state affairs at the American Insurance Association, said Wednesday in a statement.

Mark Sektnan, president of the Sacramento-based Association of California Insurance Cos., said the proposal could help curb opioid addiction and ensure injured workers receive appropriate medications. “We need to be very careful about ensuring that we provide the correct drug at the right time to that injured worker so they can do what they need to do, which is get back to work,” Mr. Sektnan said.

While California’s formulary has received positive reactions, experts say there also could be some pushback. Mr. Sektnan said California insurance regulators have discussed limiting the off-label use of medications for conditions that aren’t Food and Drug Administration-approved for such drugs. For instance, injured workers would have difficulty getting prescriptions for some powerful opioids that are indicated for treating end-stage cancer pain, Mr. Sektnan said.

The formulary could include a process for claimants who want to continue taking medications for off-label uses. Speakers also cautioned that patients already on medications need a robust and carefully managed transition process – a provision in the bill requires a yet-to-be-determined transition period. However, Mr. Eichler advised against adopting transition rules from the plan Texas implemented in 2011, which used a two-year phase-in for legacy claims. “It doesn’t take two years to wean a patient,” Mr. Eichler said. “My personal recommendation is to go with one year for legacy claims. You need to protect injured workers with the best protocols possible.”

A major concern voiced by several participants during the public meeting was the need to ensure that the formulary is consistent with the state’s medical treatment utilization schedule, which provides guidelines for utilization review, a framework to evaluate and treat injured workers; and information for providers on understanding which evidence-based treatments have been effective.