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 abegin delete formularyend deletebegin insert medical evidence-based workers’ compensation drug formularyend insert
for medications prescribed in the workers’ compensationbegin delete systemend deletebegin insert system,end insert to be effective commencing July 1, 2017. The bill requires the administrative director to revise the formularybegin delete before its effective date,end deletebegin insert to adopt appropriate changes,end insert as specified, and to publish any revisions on the Internet Web site of the Division of Workers’ Compensation. 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 5307.28 is added to the Labor Code, to
2read:
(a) On or before January 1, 2017, the administrative
4director shall establish abegin insert medical evidence-based workers’
5compensation drugend insert formulary for medications prescribed in the
6workers’ compensationbegin delete systemend deletebegin insert system,end insert to be effective commencing
7July 1, 2017.
8(b) The formulary shall be revised to adopt appropriate changes
9no later than 60 days after the administrative director receives
10recommendations from the Workers’
Compensation Formulary
11Advisory Committee and determines that evidence-based revisions
12are warranted. The administrative director shall determine the
13effective date of the changes, and shall issue an order, exempt from
14Sections 5307.3 andbegin delete 5307.4,end deletebegin insert 5307.4end insert and the rulemaking provisions
15of the Administrative Procedure Act (Chapter 3.5 (commencing
16with Section 11340) of Part 1 of Division 3 of Title 2 of the
17Government Code), informing the public of the changes and their
18effective date. All orders issued pursuant to this subdivision shall
19be published on the Internet Web site of the Division of Workers’
20Compensation.
Section 5307.29 is added to the Labor Code, to read:
(a) The administrative director shall convene a
23Workers’ Compensation Formulary Advisory Committee to assist
24in the development of a formulary pursuant to Section 5307.28.
25The committee shall be composed of members appointed by the
26director and shall include, but not be limited to, health care
27providers, insurers, employers, pharmacists, attorneys who
P3 1represent applicants, an appointee of the Speaker of the Assembly,
2and an appointee of the Senate Rules Committee.
3(b) The committee shall study and make recommendations on
4the development of a workers’ compensation formulary in
5California.
6(c) The committee shall convene on a quarterly basis and provide
7its recommendations to the administrative director on or before
8December 31, 2016.
9(d) Thebegin delete formulary established pursuant to Section 5307.28end delete
10begin insert recommendations developed pursuant to subdivision (c)end insert shall
11ensure all of the following:
12(1) Injured worker access to appropriate opioids,begin insert including those
13with abuse-deterrent properties,end insert other pain management
14prescriptions, and off-label prescription drugs, when medically
15necessary.
16(2) A gradual detoxification plan for a worker receiving
17potentially addictive prescription drug treatment.
18(3) Timely formulary updates that minimize delays involved in
19adding new drugs to the formulary.
20(4) Injured worker access to nonformulary medication when
21the only formulary medication available for a worker’s covered
22condition is one that the worker cannot tolerate or that is not
23clinically effective for the worker, or when a provider determines
24the medication needed
by the worker should include abuse deterrent
25properties. Exceptions to formulary medications as noted in this
26section shall not be required absent a trial period and issuance of
27a medical finding by the injured worker’s provider outlining the
28medical basis for the conclusion that the worker cannot tolerate
29the formulary medication.
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