On October 16th, Healthesystems attended California’s Pharmacy & Therapeutics (P&T) Committee meeting, where key updates on the pharmacy fee schedule and potential formulary changes were discussed.

The Division of Workers’ Compensation (DWC) Administrative Director George Parisotto announced the revisions to the pharmacy fee schedule, which are now open for a 15-day comment period ending October 23, 2024.

These changes incorporate stakeholder input, including Healthesystems’ recommendation to remove the documented paid cost pricing benchmark for “unfinished drug products” in compounds. Compounds will now be reimbursed using the Medi-Cal formula, with unfinished bulk ingredients included in the Pharmaceutical Fee Schedule Data File.

The committee also discussed developing a "preferred-first" policy for biosimilars, to guide their use as cost-effective alternatives to brand-name biologics. Additionally, concerns were raised about higher prices of naproxen sodium, which is not on the formulary, compared to naproxen, which is in the formulary. Both issues will be examined further at the next meeting.

Other topics included the popular use of GLP-1 drugs and preferred regimens for HIV post-exposure prophylaxis (PEP). Dr. Raymond Meister, DWC Executive Medical Director, emphasized that formulary drugs are tied to MTUS Guidelines, but medically necessary medications outside the guidelines can still be prescribed. The DWC also noted that new guidelines could be proposed to ACOEM if needed.