Today’s issue of WorkCompRecap features a new analysis from CWCI that takes a preliminary look at Utilization Review (UR) and Independent Medical Review (IMR) outcomes involving pharmaceutical requests since California implemented its workers’ comp formulary in January.
Key findings included that the proportion of UR decisions involving prescription drug requests fell from 44.5% in the pre-formulary period to 40.7% in the first five months of 2018, a relative decline of 8.5%. The percentage of UR decisions in which a prescription drug request was denied was unchanged at 14.6%, and UR decisions involving opioid requests showed little change, edging down less than a percentage point. UR approval rates for opioids showed a sharper decline however, falling from 72.3% to 68.8%. CWCI noted that this is still a preliminary look from the transition to the formulary, but it has planned a look at full first-year formulary outcomes in a study scheduled for 2019.
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