Amended in Senate July 8, 2015

Amended in Assembly June 1, 2015

Amended in Assembly April 14, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 1124

Introduced by Assembly Member Perea

February 27, 2015

An act to add Sections 5307.28 and 5307.29 to the Labor Code, relating to workers’ compensation.

LEGISLATIVE COUNSEL’S DIGEST

AB 1124, as amended, Perea. Workers’ compensation: prescription medication formulary.

Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, to compensate an employee for injuries sustained in the course of employment. The administrative director is authorized to adopt, amend, or repeal, after public hearings, any rules and regulations that are reasonably necessary to enforce the state workers’ compensation provisions, except when that power is specifically reserved to the Workers’ Compensation Appeals Board.

This bill would require the administrative director to, on or before January 1, 2017, establish a formulary for medications prescribed in the workers’ compensation system to be effective commencing July 1, 2017. begin insert The bill requires the administrative director to revise the formulary before its effective date, as specified, and to publish any revisions on the Internet Web site of the Division of Workers’ Compensation. end insert The bill would require the administrative director to convene a Workers’ Compensation Formulary Advisory Committee to assist in the development of the formulary, and would require the committee to study and make recommendations, as specified, on the development of a workers’ compensation formulary in California.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 5307.28 is added to the Labor Code, to
read:

5307.28.  

begin insert (a) end insert begin insert   end insert On or before January 1, 2017, the administrative
director shall establish a formulary for medications prescribed in
the workers’ compensation system to be effective commencing
July 1, 2017.

begin insert

(b) The formulary shall be revised to adopt appropriate changes
no later than 60 days after the administrative director receives
recommendations from the Workers’ Compensation Formulary
Advisory Committee and determines that evidence-based revisions
are warranted. The administrative director shall determine the
effective date of the changes, and shall issue an order, exempt
from Sections 5307.3 and 5307.4, and the rulemaking provisions
of the Administrative Procedure Act (Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code), informing the public of the changes and their
effective date. All orders issued pursuant to this subdivision shall
be published on the Internet Web site of the Division of Workers’
Compensation.

end insert

SEC. 2.  

Section 5307.29 is added to the Labor Code, to read:

5307.29.  

(a) The administrative director shall convene a
Workers’ Compensation Formulary Advisory Committee to assist
in the development of a formulary pursuant to Section 5307.28.
The committee shall be composed of members appointed by the
director and shall include, but not be limited to, health care
providers, insurers, employers, pharmacists, begin delete and injured worker
representatives. end delete begin insert attorneys who represent applicants, an appointee
of the Speaker of the Assembly, and an appointee of the Senate
Rules Committee. end insert

(b) The committee shall study and make recommendations on
the development of a workers’ compensation formulary in
California.

(c) The committee shall convene on a quarterly basis and provide
its recommendations to the administrative director on or before
December 31, 2016.

(d) The begin delete recommendations developed end delete begin insert formulary established end insert
pursuant to begin delete subdivision (c) end delete begin insert Section 5307.28 end insert shall ensure all of the
following:

(1) Injured worker access to appropriate opioids, other pain
management prescriptions, and off-label prescription drugs, when
medically necessary.

(2) A gradual detoxification plan for a worker receiving
potentially addictive prescription drug treatment.

(3) Timely formulary updates that minimize delays involved in
adding new drugs to the formulary.

begin insert

(4) Injured worker access to nonformulary medication when
the only formulary medication available for a worker’s covered
condition is one that the worker cannot tolerate or that is not
clinically effective for the worker, or when a provider determines
the medication needed by the worker should include abuse
deterrent properties. Exceptions to formulary medications as noted
in this section shall not be required absent a trial period and
issuance of a medical finding by the injured worker’s provider
outlining the medical basis for the conclusion that the worker
cannot tolerate the formulary medication.

end insert