CA WCIRB Analyzes Cost Impact of California’s Drug Formulary

San Francisco, CA – The Workers’ Compensation Insurance Rating Bureau of California (WCIRB) has updated the cost impact evaluation of the Medical Treatment Utilization Schedule (MTUS) Drug Formulary, utilizing additional pharmaceutical transaction information in 2019 through the pre-pandemic period in 2020, in its Cost Impact of California’s Drug Formulary – Two-Year Checkup research brief.

California’s drug formulary, which went into effect January 1, 2018, is intended to reduce frictional costs in the workers’ compensation system; restrict inappropriate prescribing, especially that related to opioids; and ensure that injured workers receive medically necessary medications in a timely manner.

Key findings in the research brief include:

While pharmaceutical costs had been declining sharply prior to implementation of the formulary, the decline accelerated in 2018 and continued at a somewhat slower rate through 2019 and the pre-COVID-19 period in 2020.
The share of prescriptions for drugs not subject to prospective utilization review (UR) in accordance with the formulary continued to increase in 2019 and early 2020, while that of drugs subject to UR continued to decline.
The share of pharmaceutical payments for opioids, compounds and brand-name drugs with generic alternatives dropped sharply in 2018 and continued to drop at a similar rate in 2019 and early 2020.

Read the entire WCIRB research brief: Cost Impact of California’s Drug Formulary – Two-Year Checkup (PDF)

WCIRB Research Forum Webinar
Thursday, February 11, 2021, 11:00 – 11:45 AM PT

WCIRB Executive Vice President and Chief Actuary Dave Bellusci and Vice President of Data Analytics Julia Zhang will discuss highlights from the WCIRB’s research brief evaluating the drug formulary impact in this webinar.

For those unable to attend the live webinar, a recording will be posted in the Research section of the WCIRB website following the event.

Source: CA WCIRB