California Updates MTUS Drug Formulary

The California Division of Workers' Compensation Administrative Director, George Parisotto, recently posted an order announcing updates to the MTUS Drug Formulary.

The changes are effective on October 1, 2018.

The additions and modifications are fairly extensive and are designed to more closely align the drug formulary with the chronic pain and opioid treatment guidelines.

• Fifty-five medications currently on the formulary had a change in their recommendation status for various conditions.
• Twenty-eight new drugs were added to the MTUS Drug Formulary. Of those, twenty-seven have a non-exempt status.
  • The sole drug added with an exempt status was Naloxone HCL. “Exempt” means that it can be prescribed without prior authorization if done so in accordance with the treatment guidelines.

The changes will have an impact on prescribing patterns for chronic pain, since the treatment guidelines recommend several of the newly added medications with prior authorization. Additionally, most of the changes on recommendations for drugs currently on the formulary were related to chronic pain. Some of the drugs were changed to not recommended and others were moved to a neutral or recommended status.

Aligning the drug formulary with the MTUS treatment guidelines is a positive step. These changes should help reduce confusion and guide prescribers to the most appropriate options when treating injured workers suffering from chronic pain.

A document showing the changes to the MTUS Drug Formulary can be found here.
A copy of the DWC order can be found here.

For questions regarding this alert, or for other regulatory or legislative issues, please contact Brian Allen, vice president of government affairs at Brian.Allen@mitchell.com or at 801.903.5754.