The evidence-based Medical Treatment Utilization Schedule (MTUS) Drug Formulary was adopted by the California Division of Workers’ Compensation on January 1, 2018. Its purpose was to reduce frictional costs in the workers’ compensation system, restrict inappropriate prescribing, especially in relation to opioids, and ensure that injured workers receive medically necessary medications in a timely manner.
WCIRB’s key findings include:
Declines in pharmaceutical costs accelerated in 2018, after the initial implementation of the MTUS, and continued declining at a slower pace in 2019 and early 2020.
Drug prescriptions exempt from prospective UR continued to increase in 2019 and early 2020, while prescriptions for non-exempt drugs continued to decline, decreasing UR requests and costs.
Pharmaceutical payments for opioids, compounds, and brand name drugs with generic alternatives decreased sharply in 2018 and continued to drop at a similar rate in 2019 and early 2020.
According to DWC Executive Medical Director, Dr. Raymond Meister, “I believe that having a formulary and drug list that is directly tied into the MTUS-ACOEM treatment guidelines provides a solid evidence-based source for making the best treatment decisions for California’s injured workers.”