April 4, 2018

More States Embrace Closed Drug Formularies

Two formulary bills were recently signed into law, representing the momentum that workers’ compensation drug formularies have gained in the last few years.

Among other workers’ comp reforms, Kentucky House Bill 2 grants the Commissioner of the Department of Workers’ Claims the authority to develop or adopt a pharmaceutical formulary on or before December 31, 2018.

Indiana Senate Bill 369 requires the implementation of an evidence-based drug formulary for workers’ compensation claims. The bill prohibits workers’ compensation and occupational disease compensation reimbursements for drugs specified as “not recommended” in the Official Disability Guidelines (ODG) Workers’ Compensation Drug Formulary.

Pennsylvania Senate Bill 936 recently passed after a long journey to consensus in both chambers of the legislature, but political experts are uncertain if the Governor will actually sign it.

Beyond passing new laws, other states continue to move forward developing formulary rules as they get closer to implementing formularies mandated by legislation.

Earlier this year, California finished implementing their new formulary, and Arkansas is due to implement their formulary by July 1st, while New York, having passed a formulary law last year, is still drafting rules.

In 2017, Montana passed Senate Bill 312, which gave legislators the power to implement a formulary, but did not require it, is currently still in the discovery process, hoping to draft rules and implement a formulary by January 2019. While those rules are still in development, the Division of Workers’ Compensation recommended the use of the ODG formulary, and further updates are expected in the near future.

The push for more statewide formularies is likely to continue spreading, especially as pending legislation continues to make the news.

Massachusetts House Bill 4033 hopes to establish a formulary and is currently facing various amendments in House and Senate deliberations, preparing it for a potential vote.

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