What is a Drug Formulary?
In workers' compensation, drug formularies are utilized in seventeen states in some form. Formularies comprise of a list of prescription medications, both brand and generic, that are usually categorized as pre-approved, not approved, or requiring an exception. These formularies utilize evidence-based research in deciding which medications should be a preferred drug for first-line treatment for injured workers. Overall, formularies can help organize medication preferences, improve tracking, control certain costs, and better identify treatment options within workers' compensation.
Why do some States have Drug Formularies?
While it has been a useful organizational tool, formularies were primarily created in response to the opioid epidemic. Several studies from the Workers' Compensation Research Institute (WCRI) show that formularies are useful in lowering opioid utilization among injured workers. Despite such findings, formularies have stalled in popularity amongst states. In 2022, only one state, Illinois, proposed adding a drug formulary into the state's workers' compensation system. The Illinois bill failed to receive approval from legislative committees and lacked significant sponsorship. Similar proposals in Pennsylvania and Louisiana saw some attention in recent years, but also failed to gain traction.
Why are Drug Formularies Declining?
Some experts say that formulary interest may be declining as many states already implemented opioid legislation intended to curb opioid abuse. Meanwhile, others say that consideration for formularies will increase as the Covid pandemic becomes more manageable, enabling legislators to focus on the issue. However, as formulary proposals continue to stall, conflicting data may be to blame.
In December of 2021, the National Council for Compensation Insurance (NCCI) performed an extensive review of formularies with surprising results. NCCI research found little to no difference in opioid prescribing and medication costs between states with formularies and those without. These findings have revived interest in formulary effectiveness and renewed calls for more comprehensive research.
With this newfound research, some states may opt to modify their workers' compensation with specific tweaks rather than implement full-scale formularies. Several states outlined recommended steps for providers in their fee schedules or through added agency rules using CDC's guidelines. For some states, simple alterations or added guidance may be a quicker way to address discrepancies in the workers' compensation system than a formulary.
The emergence of newly revised CDC opioid guidelines may also play a role. More extensive research shows that specific patient populations dealing with chronic or severe acute pain may need more flexibility with opioid dosage to manage extreme pain levels. Along with the CDC, institutions such as the New England Journal of Medicine say that a one-size-fits all policy for opioid restrictions can incur unintended damage. Some industry leaders say more research may be required on prescribing to specific patient populations dealing with high pain levels before moving forward with a complete formulary process.
Formularies are a rigorous endeavor, and while they provide some benefits, some states may be hesitant to propose implementing a formulary due to conflicting research or industry priorities. It could also be that legislatures did not see formularies as a major agenda item, utilizing other methods to curb costs and manage opioid prescribing. In all, time will tell whether formularies gain steam, but for now, more research may be helpful to better address the subject in future sessions.
