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Arkansas drug formulary receives legislative approval

by Heidi Snow | Dec 08, 2017

The Arkansas Workers’ Compensation Commission’s (ARWCC) most recent version of their Drug Formulary rule received approval by a legislative oversight committee. This approval permits the ARWCC to move forward with finalization and implementation of the drug formulary.

The approved version creates Rule 099.41 containing restrictions on the prescribing and utilization of opioids along with imposition of a drug formulary and associated dispensing rules. The rule is split into various sections providing regulatory language on opioid utilization and application of the drug formulary. The rule establishes an effective date for all opioid and formulary requirements on all prescriptions for claims with a date of injury on or after July 1, 2018, (prior dates of injury are not addressed at this point).

Opioid Utilization
Establishes all initial prescriptions for opioid analgesics shall be limited to a five-day supply and shall not exceed 50 MED per day without prior authorization. All subsequent opioid prescriptions shall be limited to a 90-day maximum supply and shall not exceed a 50 MED per day dosage without prior authorization. With prior authorization subsequent prescriptions for opioid analgesics may be prescribed in excess of 50 MED per day but shall not exceed 90 MED per day. The ARWCC is required to adopt criteria for prior authorization for prescriptions in excess of 50 MED and criteria for recertification every 90 days.

Drug Formulary 
The rule adopts by reference the Public Employee Claims Division (PECD) Workers’ Compensation Drug Formulary maintained by the University of Arkansas for Medical Sciences College of Pharmacy. The PECD formulary is the source used to determine if a medication requires prior authorization. Under the drug formulary rule, a pharmacist filling a workers’ compensation prescription must verify the prescribed drug is listed on the approved drug formulary. If the prescribed drug is not on the approved drug formulary, the pharmacist must contact the payor for approval and must consult with the prescribing physician before switching the medication to a formulary-approved drug.

The formulary rule also contains language detailing requirements for resolving disputes over non-approval of medications and time frames for requesting a review of non-approved medications after a denial has occurred.

We urge our clients to review the approved rule and become familiar with the requirements for opioid utilization and utilization of drugs not approved by the formulary by reviewing a copy of the rule here: http://www.awcc.state.ar.us/rules/rule099_41.pdf.

Should you have any questions on this or other public policy development issues, please contact Kevin C. Tribout, Executive Director of Government Affairs, at kevin.tribout@optum.com.

 

 

 


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