Flipping the Script: How Closed Formularies Can Impact WC Drug Experiences
When it comes to the makeup of a workers compensation claim, the mix of expenditures is ever-changing. Beyond the initial medical treatment and facility costs when a worker becomes injured on the job, prescription drug payments comprise a substantial portion of medical-related expenses.
As states grapple with high prescription drug costs and an ongoing opioid crisis, regulation of prescription drug prices and utilization has become a focus of legislative activity in workers compensation.
In this paper, NCCI researchers take a deeper look at critical factors that are influencing pharmacy experience in workers compensation, including:
- The initial impact of the Official Disability Guidelines Workers’ Compensation Drug Formulary (the ODG Formulary) on pharmacy costs
- Utilization rates of drugs (N-drugs) that require prior authorization by the employer or workers compensation insurer, and those that do not (Y-drugs)
- A review of two states, Arizona and Tennessee, which both recently adopted the ODG Formulary, to analyze cost and utilization trends
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