California’s new drug formulary isn’t exactly user-friendly. For that reason, we developed a new tool to make authorization for pharmaceuticals much, much easier.
The drug formulary, included in the Medical Treatment Utilization Schedule (MTUS) since January 1 of this year, is simply a massive list of available drugs, each designated either “exempt” from utilization review or “non-exempt.” The list, as provided by the DWC, cannot be filtered or searched in any way.
So we fixed it.
State Assembly Bill 1124, passed in 2015, originally mandated the formulary. Three years and no small amount of controversy later, California providers must obtain prior authorization before treating injured workers with certain drugs.
Providers may dispense only “exempt” drugs without prospective utilization review (UR), while non-exempt drugs (and all drugs not included in the formulary list) require UR authorization.
There are exceptions, such as short-term supplies of non-exempt painkillers at the time of an injury. The regulations also include a phased implementation, as well as rules for physician dispensing, use of generic drugs, off-label use, and compound drugs.
The actual formulary list, however, leaves something to be desired.
The 21-page pdf file includes useful information like the brand name, drug class, exemption status, and the above-mentioned special exceptions. But it’s just that — a list. Providers have to manually “search” the formulary, and can only do so by the alphabetically listed drug ingredient name.
Searchable, Sortable Formulary
Our Drug Formulary Tool is a searchable index of all drugs listed in the formulary, which providers can filter by:
- Drug class
- Official MTUS classification of the drug
- Injury or condition
- MTUS guideline topics that reference the drug
- MTUS recommendations
- MTUS guidelines regarding drug application
- Exemption Status
- “Exempt”: Does not require authorization/UR if dispensed per MTUS, limit one seven-day supply within seven days of injury date
- “Non-Exempt”: Requires authorization prior to prescribing/dispensing (drugs not listed in the formulary are non-exempt)
The Drug Formulary Tool is included with our Work Comp Wizard software. Providers simply enter a search term related to the drug (such as drug name, ingredient, or patient condition), with the option of narrowing the search results by applying the above filters.
Interested providers can sign up for a free trial below.