Wednesday, February 22, 2012

Ohio’s Formulary Updates: Excellent Progress

I picked on Ohio’s new “lock in” program last month.  While I liked the overall concept, I was concerned that medically unnecessary drugs would still be prescribed and dispensed (albeit by a single physician and a single pharmacy).  And then I saw some of the formulary changes BWC has made (effective February 1).  Some highlights:
  • Morphine sulfate will be the only sustained release opiate eligible for reimbursement as an initial sustained release opiate (i.e., don’t even try to jump right to Oxycontin or Fentanyl – BWC won’t pay for it).
  • Fentanyl patches won’t be reimbursed if combined with another long acting opiate.
  • Unless there is a documented treatment failure or allergy to MS CR tablets and Oxycontin tablets, Fentanyl patches will only be approved for claims when the injured worker cannot swallow or absorb oral products.
While there’s still work to be done, this is a move in the right direction to clean up Ohio’s work comp prescription drug issue.  To Stephen Buehrer (Administrator/CEO of BWC) and John Hanna (Pharmacy Director of BWC), I say well done.  To work comp professionals in other, non-monopolistic states, I say (as I’ve said before) don’t wait for your state legislature; get to work on a market-driven solution.
On Twitter @PRIUM1

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