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September 29, 2025

Tennessee: Formulary and UR Updates from the Medical Advisory Committee Meeting

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On September 23rd, Healthesystems attended the Tennessee Medical Advisory Committee (MAC) meeting to hear key updates impacting the state’s workers’ comp system.

The Bureau of Workers’ Compensation (BWC) Medical Director announced upcoming changes to their Official Disability Guidelines (ODG) formulary, set to go into effect October 1st. A notable update is the exclusion of ibuprofen 300 mg from the NSAIDs drug class. This unique dosage will now require prior authorization due to cost concerns, as it offers no advantage to prescribing other dosages.

This change was influenced by Healthesystems’ Clinical team, who proactively raised the issue with ODG, advocating for more cost-effective and clinically appropriate formulary management. Their efforts helped prompt this important revision, reinforcing Healthesystems’ commitment to driving smarter, value-based care in workers’ compensation.

Other updates included an internal report on BWC’s Utilization Review (UR) appeals for FY 2024-2025. In Tennessee, injured workers, attorneys, and physicians may appeal UR-denied treatments to the BWC, who issue a final decision to approve, modify, or deny the treatment. 

Healthesystems requested the report, which is not publicly available, and found that 1,276 UR appeals were resolved with an average resolution time of 9.46 days. Among those URs received:

  • 42% were upheld
  • 45% were overturned
  • 12% were administratively closed (e.g., late filings, premature appeals, causation issues).

Additionally, the BWC is finalizing Medical Fee Schedule rule changes with the Attorney General’s office. Once approved, the updates will be published on the Secretary of State’s website. The committee also voted to postpone action on spine-related treatment guidelines until after reviewing the October ODG at their next meeting on November 4, 2025.

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