By Brian Allen, VP of Government Affairs, Pharmacy Solutions
Following a review of written and oral public comment received at a May 2017 hearing on their initial proposed drug formulary rule, the Arkansas Workers’ Compensation Commission released a revised rule on November 8, 2017. The newly proposed revised rule:
- Incorporates, by reference, the acute and chronic drug formulary lists used in the Public Employee Claims Division. Links to the drug lists can be found here.
- Drugs not on the acute and chronic drug formulary lists may be prescribed following approval via prior authorization.
- Limits an initial prescription for an opioid to a 5-day supply and a maximum dose of 50 MED per day. Exceptions can made by obtaining prior authorization.
- Subsequent prescriptions for opioids are limited to a maximum supply of 90 days and no more than 50 MED per day. Up to 90 MED may be prescribed by obtaining prior authorization. Exceptions can be made by obtaining prior authorization.
- Outlines the conditions that must be met to justify approving a medication using prior authorization.
- Requires payors to have on staff or to contract with a pharmacist and physician or medical director, or to work with a PBM that has on staff or contracts with a pharmacist and physician or medical director. Compliance information must be submitted to the Commission.
- Details the process a pharmacist must follow when filling a workers’ compensation prescription to verify that the medication is on the approved formulary or has been pre-authorized.
- Requires that all compounded medications necessitate prior authorization and certification that the patient cannot tolerate using non-compounded medications.
- Outlines the dispute resolution process when the prescriber and reviewing pharmacist are unable to agree on a prior authorization request or a change to a formulary medication.
- Sets forth the process for review by administrative hearing.
- Affirms the process for on-going rule review and updates.
There is no provision in the rule related to claims with dates of injury prior to July 1, 2018. Medications prescribed for those claims would continue to be handled according to the rules in place prior to July 1, 2018.
The proposed revised rule must still undergo review by a legislative committee. Following completion of that review, the legislative committee could either return the rule to the Commission for further revision or approve the rule. If approved, the Commission would then submit the final rule to the Arkansas Secretary of State and the Arkansas Register for publication.
A complete copy of the proposed revised rule can be found here. Mitchell’s Government Affairs team will be monitoring the progress of this rule as it advances through its final stages of approval. If you have any question regarding this rule, or any other legislative or regulatory activity, please feel free to contact Mitchell’s Vice President of Government Affairs, Brian Allen, at Brian.Allen@mitchell.com or 801-661-2922.