California’s Division of Workers’ Compensation (DWC) ordered an update to the state’s drug formulary, effective May 15.
The update adds 20 drugs to the formulary and removes 12, bringing the total listed drugs from 275 to 283 drugs. The update also includes one change in exemption status, changes to “special fill” rules, and changes to application recommendations for several drugs.
The drug formulary took effect on January 1 of this year. Per State Assembly Bill 1124, before dispensing or prescribing a drug, providers must check the formulary list to determine if the drug requires prior authorization.
Cost containment, as well as concerns regarding opioid abuse, sparked the push to more tightly regulate pharmaceuticals.
The MTUS formulary lists drugs in alphabetical order and designates each either:
- Exempt: does not require prior authorization
- Non-exempt: requires prior authorization
The formulary list notes exceptions to “non-exempt” status, referred to as “special fill.” When a drug is assigned a “special fill” exception, a provider may dispense or prescribe the drug without prior authorization, as long as the following conditions are true:
- The drug must be generic or single-source
- The provider must dispense the drug at the initial visit and only within 7 days of the initial injury date
- The supply of the drug may not exceed the days indicated in the formulary list
- Use of the drug must conform to MTUS guidelines.
The formulary also offers American College of Occupational and Environmental Medicine (ACOEM) recommendations for each drug regarding the use of the drug for various body parts and conditions.
The May 15th update to the formulary is the first update since the introduction of the formulary. A DWC Newsline announced the update which adopts two addendums to the formulary: one highlighting the changes with strikethroughs and red font, the other a clean final version of the list, effective May 15.
What’s New - Updated Formulary
Per the update order, the table below lists:
- Drugs Added - New drugs added to the formulary list. The table indicates the exemption status of each newly added drug; only one new drug (Prednisolone Sodium Ophth) is “non-exempt,” requiring providers to obtain prior authorization before prescribing.
- Drugs Deleted - Drugs deleted from the formulary list. Drugs not listed in the formulary require authorization. Therefore, deleted drugs require authorization effective May 15..
- Exemption Status Changes - Changes to the exemption status of drugs on the formulary list. The update formulary changes the exemption status of one drug currently on the formulary list: Cyclopentolate HCL will be “non-exempt” and require prior authorization.
- “Special fill” Changes - The updated formulary changes the “special fill” status of four drugs.
- ACOEM Guidelines Changes - All drugs for which ACOEM guidelines changed.
MTUS Formulary Changes Effective 5/15/18
Azelastine Ophth (exempt)
Azithromycin Ophth (exempt)
Bepotastine Ophth (exempt)
Besifloxacin Ophth (exempt)
Cromolyn Sodium (exempt)
Emedastine Ophth (exempt)
Epinastine HCL (exempt)
Flurbiprofen Sodium (exempt)
Irrigating Eyewash (exempt)
Ketotifen Fumarate (exempt)
Lidocaine HCl Ophth (exempt)
Lodoxamide Ophth (exempt)
Natamycin Ophth (exempt)
Olopatadine HCL (exempt)
Prednisolone Sodium Ophth (non-exempt)
Tranexamic Acid (exempt)
Bacitracin-Polymyxin B Ophthalmic
Balanced Salt Solution
Gentamicin-Prednisolone Ace Ophthalmic
Neomycin/Bacitracin/Polymyxin B Ophthalmic
Neomycin/Polymyxin B/Gramicidin Ophthalmic
Nepafenac Ophthalmic Suspension
Exemption Status Changes
Cyclopentolate HCL (non-exempt)
Special Fill Changes
Betamethasone (4 days)
Dexamethasone Sodium Phosphate Ophthalmic (4 days)
Fluorometholone (4 days)
Loteprednol Etabonate Ophthalmic (4 days)
ACOEM Guidelines Changes
Choline Magnesium Trisalicylate
Ciprofloxacin HCL Ophthalmic
Homatropine HBr Ophthalmic
Levofloxacin Ophthalmic Solution
Loteprednol Etabonate Ophthalmic
Moxifloxacin HCL Ophthalmic
Ofloxacin Ophthalmic Solution
An Easier Formulary
If poring over 22 pages of 8-point font to check the status of a given drug isn’t your idea of efficiency, DaisyBill offers an alternative to the DWC drug formulary PDF.
Blatant pitch alert: Our Work Comp Wizard now includes the Drug Formulary Tool. Providers can search and filter the formulary list in 3 easy steps.
1. You simply click ‘Drug Formulary
2. Apply the filters of your choice. You can choose to see only “exempt” drugs, for example, or drugs listed by class or patient condition.
3. Enter a search term, such as the name of a drug, class, or condition.
Just like that, you have the information you need — without the time wasted by manually scouring through the DWC Formulary PDF.
For a free trial of the formulary tool, sign up below.