How workers comp drug policies affect health care costs
As the number of states establishing workers’ compensation drug formularies continues to increase, the American College of Occupational and Environmental Medicine (ACOEM) has issued a position paper that focuses on how the use of properly designed formularies can improve medical quality and contain costs for injured workers.
Recent studies have demonstrated that formularies—recommendations for the most appropriate medication therapy for patients—can dramatically decrease the direct cost of medications, the costs of utilization review (UR), and the inappropriate use of certain medications including opioids, non-generics, and compounded topical medications. “The use of formularies must be seen as an opportunity to improve medical quality and not just a cost-reduction tool. Furthermore, as UR rules become more complex, states who adopt formularies must keep firmly in mind that the patient—the injured worker—is at the center of all these considerations,” said Paul Papanek, MD, a member of the Task Force that developed the paper.
ACOEM recognizes that if the details of a formulary system are not well managed, formulary use may actually delay care for some patients and increase administrative costs. The Task Force noted that formulary inclusion and exclusion decisions should follow principles of evidence‐based medicine (EBM) where such evidence exists. UR decisions about prescription authorization should be subject to a robust appeals process, particularly where medical evidence may be lacking or where clinical practice is emerging. “A well-organized formulary system, founded on the principles of evidence-based medicine, can be expected to drive improvements in medical quality.”
In the report, ACOEM specifically recommends the establishment of a Pharmacy and Therapeutics (P&T) Committee to oversee the content of workers’ compensation formularies prior to formulary implementation. The P&T Committee should consist of experts of which one or more should be occupational medicine physicians or other practitioners proficient in disability management and other areas of occupational medicine practice.
The document also reviews the key features of different national and state formularies and discusses how the use of formularies in general might interact with existing utilization review (UR) processes. The paper provides specific recommendations for state legislators and other policy makers in state labor agencies, in deciding on the details of a workers’ compensation drug formulary in their jurisdictions.
The report, Drug Formularies in Workers’ Compensation Systems, is available online at http://tinyurl.com/h2t6kr6.
About ACOEM — The American College of Occupational and Environmental Medicine (ACOEM) is an international society of 4,500 occupational physicians and other health care professionals, provides leadership to promote optimal health and safety of workers, workplaces, and environments. For further information, contact ACOEM at email@example.com.