Oregon: New rule requires justification for seven costliest drugs

Seven drugs comprise about 30 percent of the total pharmaceutical costs in Oregon's workers' comp system, according to the Department of Consumer and Business Services. Regulators have announced a new procedure aimed at curbing some of those costs.

As of April 1, medical providers will need to fill out a special clinical justification form if they prescribe more than a five-day supply of the specific medications. The rule, required by OAR 436-990-0090(4), is intended to "encourage providers to consider other lower-cost options to treat workers' compensation patients when appropriate."

The seven drugs are:

Celebrex.
Cymbalta.
Fentora.
Kadian.
Lidoderm.
Lyrica.
OxyContin.

California: Researchers make pitch for payer access to monitoring program (03/04/13)
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Insurance legislators to focus on physician dispensing repackaged drugs (02/13/12)
Texas: Closed formulary results in fewer opioid scripts in WC (07/26/12)
Ohio formulary cuts $2.1 million in narcotics costs (11/01/12)

The pharmaceutical clinical justification for workers' compensation form lists each drug under the heading, high cost drug, then lists up to five "equally effective and less expensive alternative drugs." For example, next to Celebrex, it lists five alternatives that it says are "up to 98 percent less per pill."

The form also asks "Have you previously prescribed a lower-cost alternative drug for this patient before prescribing the brand name drug checked above?" and "Will your patient need the higher-cost drug for longer than 60 days?"

The form must be completed and sent to the workers' comp insurer. A memo to medical service providers and others notes that drugs not listed do not require justification if prescribed for more than five days.

Read more at the WorkersComp Forum homepage.

March 24, 2011

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