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Indiana Workers’ Compensation Drug Formulary Bill Signed

by User Not Found | Mar 28, 2018

Indiana Senate Bill 369 was recently signed into law. This new law requires implementation of a workers’ compensation drug formulary based on the Official Disability Guidelines (ODG) Workers' Compensation Drug Formulary Appendix A, effective initially January 1, 2019.

Under the formulary requirements, reimbursement for ODG-designated “N” drugs will not be permitted without prior approval from the employer. However, to address pre-existing drug therapy, if the injured/disabled worker begins use of the “N” drug before July 1, 2018 and continues use after January 1, 2019, reimbursement will be permitted under the law until January 1, 2020. There is an additional authorization exemption in cases of a medical emergency.

The authorization process includes submission of a request by the prescriber to the employer which contains their reason for requesting use of the “N” drug. If the employer does not approve the medication(s), they will be required to send the request to a third party certified by the Utilization Review Accreditation Commission (URAC) to make a determination on the request. The employer will be required to notify the prescriber and injured/disabled worker of that determination not more than 5 business days after receiving the request. Failure to provide that notice leads the prescriber's request to be considered approved and reimbursement authorized. If the determination is to deny, the injured/disabled worker will be able to appeal to the Worker's Compensation Board for a final determination.

We look forward to engaging the Indiana Workers’ Compensation Board as they work to implement the new formulary requirements. Further communications for our clients will be forthcoming.  For now, we urge our clients to review the legislation and become familiar with their requirements. Information on the bill, including the final text, can be viewed online here: https://iga.in.gov/legislative/2018/bills/senate/369.    

Should you have any questions on this or other public policy development issues, please contact Kevin C. Tribout, Executive Director of Government Affairs, at kevin.tribout@optum.com.


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