State of California Adopts New Drug Formulary

The State of California’s Division of Workers’ Compensation (DWC) has announced its final approval to adopt a new drug formulary for the medical treatment of injured workers. The formulary will go into effect for new injuries January 1, 2018.

The formulary will be part of the Medical Treatment Utilization Schedule (MTUS), which provides medical treatment guidelines for utilization review and outlines specific treatment recommendations based on condition and phase of treatment.

Medications that are classified as exempt will no longer require authorization prior to dispensing, under the state’s drug formulary. Medications that are classified as non-exempt will require authorization through prospective review, prior to prescribing and dispensing. Non-exempt drugs not included in the formulary include brand name drugs and compounded medications.

A transition period for workers injured prior to January 1, 2018 will be allowed up to April 1, 2018. This transition period will allow for a treatment plan to be developed to outline the safe weaning or transition of the injured worker to exempt medications. The transition period will also allow the time to provide the medical justification to continue treatment with non-exempt medications if they are deemed to be medically necessary.

Carlisle Medical has prepared for this formulary change to ensure that only authorized medications are dispensed through our systems. The Carlisle Medical clinical nurse/pharmacy team is overseeing the change and is available for questions or assistance.