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California To Develop Drug Formulary

Happy Monday, dear readers!   As the title of this most humble of blog posts suggest, dear readers, Assembly Bill 1124 has been signed into law by Governor Brown.

AB 1124 would require the administrative director, by July 1, 2017, to establish a drug formulary for workers’ comp medication.  The basic idea of a formulary is to have a list of medications that are approved to be used in workers’ compensation treatment.   Some time ago, your humble blogger had submitted his own formulary to be considered by the Legislature, but I have yet to hear back on my proposal, which consisted mostly of dirt and Advil.

Just Rub Dirt On It

4600.1(a) requires a generic drug to be made available by a dispensing physician, but subsection (b) allows a nongeneric to be dispensed “[w]hen the prescribing physician specifically provides in writing that a nongeneric drug must be dispensed.”  Furthermore, subsection (d) states that “[n]othing in this section shall be construed to preclude a prescribing physician, who is also the dispensing physician, from dispensing a generic drug equivalent.”

Now, whenever laws like this get introduced, your humble blogger always cringes when there’s no method of enforcing them.  What nonsense is your humble blogger spouting now?  The fear of what’s to come, dear readers…

Well, look at the new section 5307.29(a): “the administrative director shall make provision for no less than quarterly updates to the drug formulary to allow the provision of all appropriate medications, including those new to the market.”  What happens when the administrative director doesn’t do this?

Can the doctors wait until Q2 and one day and say “pharmacy’s open, boys”?  Can lien claimants argue that because the administrative director failed to update the drug formulary, the treating physicians are no longer bound by 4600.1(a) and dispensaries can provide non-generic drugs?

Furthermore, what are we to do with section 4600.1(b)(2), allowing non-generic drugs to be dispensed “when the prescribing physician specifically provides in writing that a nongeneric drug must be dispensed”?  The whole point in the formulary is to save employers and insurers money, so what happens when doctors start stamping “non-generic” for no reason at all on every single prescription?  Recall, dear readers, the explanation is not required, just a written order for non-generic drugs.

For better or for worse, dear readers, the formulary is supposed to go into effect on July 1, 2017, and pre-7/1/17 injuries are to be phased in as well.  Other states have reported considerable success using formularies, most notably Texas and Washington.  Perhaps California will fare well too.

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