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California DWC issues second revision to MTUS Drug Formulary rules

by
Optum Workers' Comp
| Sep 08, 2017

The California Division of Workers’ Compensation (DWC) has issued a second set of proposed modifications to the originally proposed MTUS Drug Formulary rules as well as instituted a second 15-day comment period. These actions follow a review of all stakeholder comments received during the first 15-day comment period and are intended to clarify the rules to help ensure compliance with existing regulations. 

Our Government Affairs and Regulatory Compliance Teams are currently reviewing the second set of proposed regulations, comparing the latest version with those previously released, to identify any significant changes which would impact delivery of pharmacy care. A preliminary review indicates the proposed changes are minor modifications to the following pertinent areas of the rule:

  • Clarifies compounded medications are still subject to pre-authorization even if the medication includes an active ingredient drug that is listed as “Exempt” on the Drug List
  • Removes language regarding the exclusion of repackaged medications from the drug list as the drug list does not make specific distinction for these medications
  • Affirms nothing in the proposed rule shall permit physician dispensing of a compounded medication where otherwise prohibited by a pharmacy benefit contract
  • Modification of the Drug List Headers to match existing proposed regulatory language for Perioperative Fill; no changes to the medications listed

The latest version of the proposed rules can be found on the DWC website via this link:

http://www.dir.ca.gov/dwc/DWCPropRegs/MTUS-Formulary/MTUS-Formulary.htm

All comments are due by September 22, 2017. 

We will continue to monitor this rule-making process and provide our clients with additional information as appropriate. This includes details of an upcoming webinar on this subject. We encourage all concerned stakeholders to provide rule-comments and feedback to the DWC by the September 22 deadline. When doing so, please remember, during this additional comment period all comments should focus on the changes proposed in the most current version of the rule.

Should you have any questions on this development, please contact Kevin Tribout, our Executive Director of Government Affairs, at kevin.tribout@optum.com.





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