Workers’ compensation benefits managers in Ohio, Oklahoma, Texas, and Washington currently utilize state-regulated drug formularies in an effort to decrease prescription drug costs. In addition, Arkansas will reportedly be launching such a program in July. Several other states, including California, Louisiana, Maine, Montana, and Tennessee, are apparently considering establishing a drug formulary as well. In general, a formulary is a list of approved medications that may be prescribed for certain ailments or injuries.
Proponents of state-regulated drug formularies claim such programs not only cut workers’ compensation costs but also help injured workers avoid receiving inappropriate treatment that could keep them out of the workplace for a longer period of time. Although each program is different, state-regulated drug formularies are designed to guide pharmaceutical treatment and ensure that any drugs prescribed to an injured employee are related to his or her workplace harm.
Since such programs are supposed to ensure that injured workers have access to the most effective medications for their particular type of impairment, the implementation of a drug formulary often changes a physician’s prescribing behavior. Formulary proponents claim the state-regulated programs give doctors an incentive to seek out the most appropriate evidence-based drug therapy rather than writing a prescription based on habit.
Since physicians are required to obtain authorization prior to prescribing certain drugs, some believe state-regulated drug formularies may help states reduce the rate of prescription drug dependency and addiction. In Ohio, the state noted that the use of opioids was reduced by more than one-quarter and muscle relaxant prescriptions were reduced by nearly three-fourths after the state’s workers’ compensation drug formulary went into effect.
According to a 2014 Workers Compensation Research Institute study, Massachusetts and 22 other states could potentially reduce workers’ compensation prescription drug costs by approximately 29 percent by establishing a state-regulated drug formulary. Despite the potential cost savings, most experts agree that a successful drug formulary must adequately understand how drugs are assessed, include a list of specific approved medications, and have a reliable enforcement mechanism in place. Additionally, such a program should have a clearly articulated dispute resolution process and an expedited appeal procedure. An effective appeal procedure is particularly important in order to ensure that injured workers are not required to wait to receive necessary pain and other medications.
Experts say another important aspect of a state-regulated drug formulary is stakeholder involvement. Before any such program is established, doctors, injured workers, attorneys, and others must be on board with the program. In order to be effective, a state-regulated drug formulary should take into account such stakeholder input.
If you were harmed in a Massachusetts workplace accident, you may be eligible to recover workers’ compensation benefits. The knowledgeable attorneys at Kantrovitz & Associates, P.C. are available to help you recover the damages you deserve based on the severity of your work-related injuries. To discuss your rights with a skillful Boston workers’ compensation lawyer today, do not hesitate to contact Kantrovitz & Associates, P.C. online or give us a call at 800-367-0871.
More States Considering Workers’ Compensation Drug Formularies, by Denise Johnson, Claims Journal