Work Comp Drug Formularies
Work Comp Drug Formularies have been in place informally for many years. The old system of the pharmacies calling the adjuster to get every prescription approved has now moved to the rearview mirror. This always seemed to be one of the big time-wasters for a claims department.
Many providers such as CorVel, IntraCorp, Medical Services Company (MSC) and other medical network providers offered some type of card system where injured employees were given a benefit card of sorts.
Along came generics such as the Wal-Mart $4/$10 drug lists. The statewide formularies such as Alaska also played an early role in the development of work comp drug formularies by a governmental agency.
Now, with the heightened concern of opiate abuse, formularies are the new buzzword in WC savings and control. Texas, Washington, and California all have decided over the last few years to have a closed work comp drug formulary with a slant towards N-drugs by authorization only.
Once again, the WC world has decided to mimic the same type of drug plans that health plans have had in place for many years. However, authorization was not so strict, but you have to pay up to a $100 deductible for have a certain tier drug, especially with a generic option available. A great example of a drug formulary is United Healthcare.
Texas seemed to have a vast drug formulary. One could spend days to learn about closed formularies. The diagram at the beginning of this article is from Texas’s webpage on formulary rules. namely how to handle the “N ” drugs.
Last year, I had live-blogged a Concierge Medical conference on WC Medicare Set Asides. Formularies were heavily discussed at the conference. Dr. Susan Nemeth is an ODG expert who actually had worked on the National ODG that is now in place.
The slides from Texas’s formulary training program are here. The file contains a large number of slides that cover many aspects of a formulary’s rules and regulations. It may be worth downloading and skimming through the slides.
Work Comp drug formularies are likely here to stay unless the landscape has major changes.
Article provided by James J Moore, AIC, MBA, ChFC, ARM. All articles are original content. Check out the full website at www.cutcompcosts.com