Ohio Workers’ Comp Bureau: Prescription Formulary Saves over $20M

January 24, 2014

The Ohio Bureau of Workers’ Compensation (BWC) announced that changes made to its pharmacy management program in recent years have resulted in a reduction in prescriptions of some of the most commonly overused drugs and total drug cost savings of more than $20 million since 2011.

Opiate doses have dropped by 10.9 million since 2010, before the introduction of BWC’s first-ever outpatient medication formulary in 2011. The changes also resulted in a 27.8-percent drop in opioid prescriptions and a 72.9-percent decrease in skeletal muscle relaxant prescriptions in 2013 compared to 2010.

The formulary is updated regularly and includes guidelines for coverage of various drugs. For example, a 2012 update restricted most skeletal muscle relaxants to coverage for 90 days from the first prescription, plus one additional 30-day prescription per 12-month period.

Some restrictions put into place for opioid and anti-ulcer agents require prior authorization or a related condition approved in the claim.

The announcement comes on the heels of a new rule requiring medical providers caring for chronically injured workers to use the Ohio Automated Rx (prescription) Reporting System (OARRS).

BWC’s newest pharmacy rule, similar to recently adopted statewide Opioid Prescribing Guidelines, became effective Jan 1.

Ohio providers who write controlled substance prescriptions for chronic care must now enroll in OARRS in order for BWC to cover these prescriptions. Chronic care is when providers write three or more prescriptions for controlled substances for the same injured worker during a 12-week period.

Other pharmacy program controls BWC implemented to support prescription drug safety for injured workers include:

  • A lock-in program limits the practice of doctor and pharmacy shopping.
  • Standardized Drug Utilization Reviews objectively evaluate the necessity and appropriateness of prescription drug treatment and identify overuse or danger.
  • Generic medications are required when available.
  • Point of service edits allow for prescriptions that aren’t related to injured worker claims to be screened out to ensure injured workers receive medications relevant to their injuries.

Source: Ohio BWC

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