The California Pharmacy & Therapeutics Committee held a meeting on April 15th to review targeted MTUS formulary issues, and Healthesystems was in attendance to monitor anticipated drug formulary changes that may affect pharmacy authorization and reimbursement.

The meeting covered perioperative pain management, pricing outliers, and formulary specificity. During the meeting, the Committee voted to recommend targeted changes affecting three drug categories for potential inclusion in future MTUS formulary updates:

The Committee examined whether the non-exempt status and 4-day perioperative allowance for immediate release pregabalin and gabapentin products is appropriately aligned with ACOEM guidance and post-surgical use. The Committee retained the non-exempt status while recommending an extension of the perioperative allowance from 4 days to 14 days.

The Committee approved removing ibuprofen 300 mg tablet from the expanded (RxCUI-based) MTUS formulary due to limited clinical use and pricing concerns. The committee discussed adding a clarifying note to the current MTUS drug list which does not yet reflect RxCUI expansion, which would indicate that the 300 mg strength is excluded.

The Committee determined that Special Fill eligibility for cyclobenzaprine and tizanidine was overly broad, approving targeted refinements to limit access to commonly used acute formulations. This resulted in restricting cyclobenzaprine Special Fill to immediate release tablets (5 mg–10 mg) and tizanidine Special Fill to 2 mg and 4 mg tablets and the oral solution, while excluding extended release, sublingual, and capsule products.

Looking ahead, the Committee indicated that the next meeting would focus on broader, data driven reviews, including biosimilar utilization trends, GLP-1 agents, extended proton pump inhibitor (PPI) use, and review of migraine therapies to support ongoing assessment of prescribing patterns and potential future formulary considerations.

The next quarterly meeting is scheduled for July.