And that is good news indeed.
WorkCompCentral reported this morning that the state legislature passed the enabling bill late yesterday; the Governor will sign it.
California will join four other states that have formularies in place today, and it is highly likely others will follow suit soon.
As good as that is, please do not make the all-too-common mistake of declaring victory and moving on. The formulary bill is just the first step. Here’s what has to happen to make a formulary actually work for all stakeholders.
- UR – binding utilization review processes and rules that require compliance. Otherwise you have speed limits with no police or laws to enforce them.
- Flexibility – enable payers and PBMs to use rule-based processes and procedures to ensure patients get the drugs they need and aren’t dispensed drugs that may be harmful or counter-productive.
- Specificity – blanket Y/N formularies are blunt instruments – allowing percocet for all claims just isn’t good medical care. Instead, the formulary should be disease/condition/injury specific.
- Timing – Texas’ phased-in rollout of their formulary made a lot of sense. Handling new claims differently from legacy claims is appropriate and sensible.
- Assessment – Monitor, track, and report on changes in prescribing and dispensing patterns, single out potential irregularities, identify problems and publicize same. Fortunately, California has the best state-specific reporting and analysis entity; CWCI will be instrumental in this process.
What does this mean for you?
Wait…are we seeing actual progress in workers’ comp? Hope springs once again!
