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Arkansas Formally Adopts Drug Formulary

—December 04, 2017
Arkansas Formally Adopts Drug Formulary

By Brian Allen, VP of Government Affairs, Pharmacy Solutions

On December 1, 2017, the Arkansas Workers’ Compensation Commission (Commission) announced the formal adoption of a drug formulary. The adoption of the drug formulary follows public hearings held earlier in the year and a recent review and approval by a legislative committee. The Arkansas drug formulary is markedly different from drug formularies adopted by other jurisdictions. The following are summaries of the various provisions of the final rule:

 

  • Part I adopts, by reference, “the Public Employees Claim Division (PECD) Workers’ Compensation Drug Formulary, which is maintained and updated by the UAMS College of Pharmacy Evidence Based Prescription Program….”  The drug formulary can be accessed here.

  • Part II requires that payers have on staff or contract with a pharmacist, physician or medical director. Alternatively, they can utilize a PBM that has on staff or has contracted with a physician, pharmacist or medical director. The payer must provide documentation of compliance to the Director of the Medical Cost Containment Division of the Commission.

  • Part III places new restrictions on the prescribing of opioids for newly injured workers.

    • Initial prescriptions of opioids are limited to 5 days in a dose not to exceed 50 MED (morphine equivalent dose) per day.

    • Subsequent prescriptions are limited to 90 days not to exceed 50 MED. Prior authorization with demonstrated medical necessity is required to exceed these limits. 

    • Prior to prescribing an opioid or benzodiazepine, physicians are required to check the Prescription Drug Monitoring Program database.

    • Payers are not required to reimburse for opioids prescribed outside the guidelines unless all prior authorization requirements are met.

  • Part IV details the process for filling a workers’ compensation prescription. 

    • Pharmacists must verify that the medication is on the approved formulary.

    • If not, the pharmacist must contact the payer for approval and must consult with the prescribing physician before switching to an approved medication.

    • The pharmacist must also abide by the opioid limitations unless a variance has been approved via the prior authorization process.

    • All compounded medications require prior authorization.

  • Part V outlines the process for resolving disputes between the payer and the prescribing physician.

  • Part VI describes the hearing process and administrative requirements related to hearings.

  • Part VII affirms the rule review process. Stakeholders can submit comments or suggestions on the drug formulary rule to the Commission for consideration during their annual rule review process.

  • Part VIII establishes the effective date of the drug formulary rule as July 1, 2018, for all claims with a date of injury on or after that date. 

    • Claims with a date of injury prior to July 1, 2018, will be subject to the rules currently in place, including any previous guidelines for prescribing opioids.

A complete text of the new Arkansas drug formulary rule can be found here. Mitchell Pharmacy Solutions is working toward implementation of this new formulary on the July 1, 2018, effective date.  For questions about this alert, please contact Brian Allen, vice president of government affairs at Brian.Allen@mitchell.com or at 801-661-2922.

 

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