On June 12th, the Industrial Commission of Arizona (ICA) held a stakeholder meeting to address growing concerns over the cost and utilization of prescription topical medications, and Healthesystems’ Advocacy & Compliance and Clinical teams participated in the discussion.

Stakeholders highlighted an increase in the use and cost of topical medications, particularly diclofenac and lidocaine. These drugs are often prescribed by a small group of prescribers, dispensed by out-of-network pharmacies, and they often bypass more affordable prescription formulations or over-the-counter alternatives.

While opioid avoidance was cited as reasons for prescribing these medications, many stakeholders noted that the clinical appropriateness and cost-effectiveness of these medications remain questionable.

Healthesystems emphasized the importance of giving payers the tools to direct care for pharmacy services, while acknowledging that such changes would require legislative support. For changes within the ICA’s authority, Healthesystems advocated for fee schedule clarity and defined reimbursement caps to reduce ambiguity and prevent payment disputes. Other stakeholders expressed support for these changes or adopting a restricted NCD list, like the Division of Federal Employee’s Compensation, to prohibit reimbursement for certain high-cost topicals. 

At the close of the meeting, the ICA committed to reviewing stakeholder feedback and exploring potential next steps. They noted they would reach out to stakeholders if they decide to move forward with any changes. Advocacy & Compliance will continue to engage with the ICA as efforts to revise these policies progress.