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What is a Drug Formulary?

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A drug formulary is a list of prescription drugs that healthcare practitioners use to identify medications that will offer the greatest overall value to patients. Drug formularies include brand name and generic drugs. A committee of local experts, physicians, and pharmacists create and maintain drug formularies, choosing medications based on safety and effectiveness. A new proposed drug formulary in the California Workers’ Compensation Program could reduce costs and make it easier for injured workers to obtain the medications they need.

Drug Formularies and Workers’ Compensation

Drug formularies are beginning to play important roles in states’ workers’ compensation programs. Jurisdictions are discovering the advantages of these lists in improving medical quality and cost of care to injured workers. Potential benefits of a drug formulary in workers’ comp include lower costs of drugs, decreased opioid use and abuse, diminished use of topical medications, and lower utilization review costs. As of today, just five states have adopted state-specific formulary systems, on top of two federally available formularies – the Reed Group formulary and the ODG formulary.

To be effective, a drug formulary must remain properly organized and maintained. There must be well-documented methodology involved in creating drug formularies, using evidence and accepted practice guidelines. When a state decides to create its own formula, it must create a committee to oversee the list’s content. The committee should provide guidance in creating the list, update entries regularly, and enlist the help of local professionals. This is the process that California is currently undergoing to create its new drug formulary laws.

Drug Formulary Laws in California

California is one of the latest states to propose a workers’ comp prescription drug formulary, with the goal of lowering costs and making the system more efficient. Assembly Bill 1124 first introduced drug formularies to CA’s workers’ comp program back in 2015. It passed the state Senate without issue. The new law will take effect January 1, 2018. It proposes modifications to the original bill, such as ensuring that drugs given to injured workers meet proper safety standards. The public has the chance to comment on the new law before it goes to vote.

Stakeholders in the latest bill are pushing for improvements to provisions of the drug formulary regarding weaning injured workers off drugs that would be exempt from prescribing under the new rules. Changes to the law center around preventing and reducing opioid overprescribing – an issue that has plagued the healthcare system and workers’ compensation for years. Under the proposed law, long-term opioid prescriptions will not longer exist without a diligent case review process. Doctors will have more time to place patients on alternative, non-opioid treatment plans, and patients will benefit from clarified weaning rules.

What the Drug Formulary Could Mean for You

If you’re an injured worker currently receiving medications on the California drug formulary, the new laws may affect your prescriptions. This is especially true if you’re taking prescription opioids for pain relief. The new law will potentially update drug listings and enact several other important changes to the way injured workers receive prescription medications. Stay updated on the latest news about the pending law if you or a loved one is an injured worker in California.