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Indiana publishes workers’ comp drug formulary guidance

by Mary McNitt | Dec 10, 2018

The Indiana Workers’ Compensation Board (WCB) recently posted “guidance for implementation” of the drug formulary scheduled to take effect January 1, 2019 under their new law (SB 369 - signed earlier this year). This guidance attempts to fill in some details not addressed in the new law, mostly surrounding the authorization, review and appeal processes.

"N" drug stipulations
As a reminder, under the new formulary requirements, reimbursement for drugs designated by the Official Disability Guidelines (ODG) formulary as “N” drugs will not be permitted without prior approval from the employer. However, to address pre-existing drug therapy, if the injured/disabled worker begins use of the “N” drug before July 1, 2018 and continues use after January 1, 2019, reimbursement will be permitted under the law until January 1, 2020.

Note that the new guidance references the expected change in status of compounds by ODG to “N” status effective at the beginning of the year (all compounds, not just those containing "N" ingredients). If/when ODG makes this status change, under the Indiana formulary law all compounds would require preauthorization given they would then be classified as "N" drugs.

Check for future modifications
Though this provides guidance and indicates the WCB’s current positions on certain aspects of how the formulary and related processes should function, it is important to note that it is not actual law (statute or regulation). It has been characterized by the WCB as “a fluid document that will change from time to time” and they encourage checking their website periodically for updates.

We encourage our clients to review this guidance, particularly as it relates to the process the WCB expects payers and their agents to follow when reviewing medications, approving or denying authorization requests, and handling appeals. The guidance can be viewed on the WCB’s website here.

Should you have any questions on this or other public policy development issues, please contact our Government Affairs team at AskGovtAffairs@optum.com.