Pharmacy | Dec 19, 2019

Workers’ Compensation Drug Formularies—Changes Afoot, Deadlines Loom

Many state formularies have implementation deadlines approaching in early 2020. Here's what you need to know. 

This past year was a busy time for state workers’ compensation systems in the creation and implementation of drug formularies. As deadlines approach for certain states in 2020, here’s what you need to know.

Kentucky Formulary Deadline: January 1, 2020

The Kentucky workers’ compensation drug formulary will apply to all prescription medications written on or after January 1, 2020, regardless of the date of injury.

Preparation over the last six months included:

  • Working with injured workers with dates of injury prior to July 1, 2019, and receiving drugs that require prior authorization under the drug formulary rule.
  • Transitioning affected workers to a drug that has a “Y” status in the formulary or establishing a treatment plan with prior authorizations in place for any non-formulary or “N” drugs that will be prescribed after January 1, 2020.
  • Communicating any plans or changes to the pharmacy benefit manager to facilitate a smooth transition to the formulary.

More information can be found at the Kentucky Department of Workers’ Claims drug formulary information here

Indiana Formulary Deadline: January 1, 2020

The Indiana legislature passed a law implementing a drug formulary for their workers’ compensation system effective for new claims beginning January 1, 2019. The law also specified that claims with dates of injury prior to January 1, 2019 would be subject to the formulary on January 1, 2020.

All non-formulary or “N” drugs prescribed to injured workers in Indiana will be required to be prior-authorized before being prescribed, with some exceptions for emergency care.

Text of the Indiana statute can be found here.  

Montana Formulary Deadline: April 1, 2020

The Montana workers’ compensation drug formulary took effect for all new claims on April 1, 2019, and will apply to all claims beginning on April 1, 2020.

For injured workers with dates of injury prior to April 1, 2019, and receiving non-formulary medications:

  • They must ensure that these workers are identified.
  • Develop a plan to transition the workers to “Y” drugs or to establish a treatment plan for the non-formulary (“N”) drugs with the necessary prior authorizations in place to avoid any interruptions in pharmacy care.
  • Communicate any plans or changes to the pharmacy benefit manager to avoid any delays in care.

Further details on the drug formulary can be found at the Montana Drug Formulary FAQ site here.

New York Formulary Takes Effect for All Claims June 5, 2020

The New York drug formulary went into effect for new claims on December 5, 2019. Along with the drug formulary, the New York Workers’ Compensation Board (WCB) implemented an electronic medical portal to handle the prior authorization process. There have been some questions along the way about how some of the processes should work and the WCB has posted FAQs to help answer certain questions. 

The Board has an information page on the drug formulary that can be found here

As a reminder, the drug formulary will take effect for all claims on June 5, 2020, so now is the time to begin working on plans to transition claimants to formulary drugs.  

California Formulary Changes: January 15, 2020

The California Division of Workers’ Compensation has just posted an update to its MTUS drug formulary list. The changes are primarily focused on drugs related to treating hip and groin injuries and will take effect on January 15, 2020.  

The version 6 changes can be found here

National Drug Formulary Model Law Adoption: December 13, 2019

The National Council of Insurance Legislators (NCOIL) formally adopted a workers’ compensation drug formulary law at their December 13, 2019 meeting in Austin, TX. The model law is based on the Indiana drug formulary law that passed in 2018. The model was developed to allow flexibility in other states to adapt the language to meet their specific needs.  

The adopted model law can be found here.  

For questions regarding these changes or other regulatory or legislative matters, please contact Brian Allen, Vice President of Government Affairs at Brian.Allen@mitchell.com or at 801.903.5754.   

Regulatory updates are provided for informational purposes only. This update does not constitute legal advice. Readers of this update should contact their attorney if they wish to obtain advice with respect to any particular legal matter.  

The Latest in

Filter By

Related News

{{ArticleCategory(article)}} MPower

{{article.Title}}

@Mitchell_Intl

{{article.ShortDescription | text}}

More News

Will IoT upend the current insurance industry? https://t.co/paLngA6NqA via @ITLupdates Will IoT upend the current insurance industry? https://bit.ly/2tA9vOW via @ITLupdates
Technology-enabled services can provide a variety of benefits to claims organizations including flexibility, scalability and easier integration processes. https://t.co/oDhgVcly5A Technology-enabled services can provide a variety of benefits to claims organizations including flexibility, scalability and easier integration processes. https://bit.ly/2TwYB7o
The new SB1 regulations will allow for new policy limit options in Michigan, as well as mandate a new auto no-fault fee schedule, ultimately having a major impact on the auto casualty insurance market in Michigan. https://t.co/ebVDI2zsH3 The new SB1 regulations will allow for new policy limit options in Michigan, as well as mandate a new auto no-fault fee schedule, ultimately having a major impact on the auto casualty insurance market in Michigan. https://bit.ly/2TuTAwi
Debbie Day, EVP of Auto Physical Damage at Mitchell, shares how we're using augmented reality to transform collision repair and claims at #snapdragonsummit. https://t.co/qbDknJ4HDG Debbie Day, EVP of Auto Physical Damage at Mitchell, shares how we're using augmented reality to transform collision repair and claims at #snapdragonsummit. https://bit.ly/38fcJq4
From passive to active safety systems, airbag technology is moving beyond just reducing injuries. https://t.co/s26RNJgnyv From passive to active safety systems, airbag technology is moving beyond just reducing injuries. https://bit.ly/30DKJtO
Mitchell RepairCenter Now Offers Integration with QuickBooks Online. https://t.co/Vz3soZ9e0v Mitchell RepairCenter Now Offers Integration with QuickBooks Online. https://bit.ly/3ahoMoy
Our latest Industry Trends Reports are available, including the Auto Physical Damage and Casualty editions. Click here to view the reports and subscribe to receive industry trends and insights. https://t.co/MZO6DMAwiO Our latest Industry Trends Reports are available, including the Auto Physical Damage and Casualty editions. Click here to view the reports and subscribe to receive industry trends and insights. https://bit.ly/2slRymM
Celebrate success! The Mitchell mPower Awards recognize companies for their innovative approaches to supporting the Property & Casualty and collision repair industries. Know someone that fits the description? Nominate them here - https://t.co/Eacgczii5B https://t.co/asKCubmB2A Celebrate success! The Mitchell mPower Awards recognize companies for their innovative approaches to supporting the Property & Casualty and collision repair industries. Know someone that fits the description? Nominate them here - https://bit.ly/2PdN2Ql

“As the world requires more and more speed, the claims representative needs to assess that information, and move it towards resolution at an ever-quickening pace.” – Tony Piloseno, Casualty Bodily Injury Resolution Leader at @Westfield1848 https://t.co/NryveWC9ee “As the world requires more and more speed, the claims representative needs to assess that information, and move it towards resolution at an ever-quickening pace.” – Tony Piloseno, Casualty Bodily Injury Resolution Leader at @Westfield1848 https://bit.ly/2VxOAFX
Download this year-end review to get an overview of #medicalmarijuana clinical basics, recent legislative happenings and current research into the drug. https://t.co/Xss8wgRDsU Download this year-end review to get an overview of #medicalmarijuana clinical basics, recent legislative happenings and current research into the drug. https://bit.ly/38sjRQR
"Emotion AI might be used to gain a better understanding of user frustrations and pain points, helping to guide improvements that streamline and simplify the P/C insurance claims process." https://t.co/j5h4HeVvOj via @CarrierMgmt "Emotion AI might be used to gain a better understanding of user frustrations and pain points, helping to guide improvements that streamline and simplify the P/C insurance claims process." https://bit.ly/2sJBZoW via @CarrierMgmt
From EVs to automation, we explore look at the top five automotive trends for 2020 and beyond. https://t.co/Jx8wR781xX From EVs to automation, we explore look at the top five automotive trends for 2020 and beyond. https://bit.ly/36uzllM
Using Advanced Reporting & Analytics in the Claims Process. https://t.co/NKHYTqc1wk Using Advanced Reporting & Analytics in the Claims Process. https://bit.ly/2shEm23
A round-up of our casualty must-reads, written by Mitchell experts. https://t.co/4jTeU1lKvW A round-up of our casualty must-reads, written by Mitchell experts. https://bit.ly/36xqAY9
From medication safety to cyber security to an aging workforce, we explore the three major trends impacting #workerscomp. https://t.co/NG1pHbwRmp From medication safety to cyber security to an aging workforce, we explore the three major trends impacting #workerscomp. https://bit.ly/35ArGSx

Terms of Use | Privacy Practices | Copyright & Usage | [+} Report a Problem
© 2019 Mitchell International, Inc. All Rights Reserved.
By accessing Mitchell.com, each user agrees that they have read and agreed to be bound by the
Terms and Conditions governing Mitchell.com and Privacy Policies governing Mitchell.com.


paykasa bozdurma paykwik bozdurma