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Montana initially approves drug formulary source

by
Optum Workers' Comp
| Oct 09, 2017

Montana’s Labor-Management Advisory Council (LMAC) recently voted to adopt the Official Disability Guidelines (ODG) drug formulary as a formal starting point in their continued efforts to implement a workers’ compensation drug formulary and rules surrounding it.

As previously noted, legislation signed earlier this year granted the Department of Labor and Industry explicit authority to adopt a drug formulary as part of its existing utilization and treatment guidelines. The legislation permitted the Department to annually adopt either an evidence-based commercial or another evidence-based drug formulary. Department staff has held several meetings discussing the topic with a formulary committee over the last several months, where presentations were provided by not only ODG but also ACOEM, the State of Washington and others. This recent choice of ODG was made after carefully considering the pros and cons of each potential formulary option, including state-specific considerations.

While the initial choice of what commercial formulary to use has been made, there is still quite a bit of work to be done on developing the rules surrounding the formulary, including issues addressing prior authorization, existing treatment guidelines and their compatibility with the formulary, an appeal process, an implementation timeframe, and handling of existing/legacy claims. Our Government Affairs team has listened in on the committee meetings where all of these issues have already been topics of discussion, and we have also conducted follow-up discussions with Department staff. We look forward to continued involvement in the process and the eventual formal rule-making.

Should you have questions about this topic, please contact Kevin Tribout at 813-627-2445 or our Government Affairs team at AskGovtAffairs@optum.com. Additional documentation on information presented to the LMAC at their recent meeting, including a summary of the formulary findings and next steps, can be viewed here.




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