Drug Formulary Update MEDICAL CONFERENCE MARCH 15, 2018 OVERVIEW - - PowerPoint PPT Presentation

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Drug Formulary Update MEDICAL CONFERENCE MARCH 15, 2018 OVERVIEW - - PowerPoint PPT Presentation

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Drug Formulary Update MEDICAL CONFERENCE MARCH 15, 2018 OVERVIEW What ats the Pr Problem Types of Dr Drug g Formularies Goal als an and Ou Outcomes Ear arly y Adopters WC Drug Formu mularies es Legis

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SLIDE 1

Drug Formulary Update

MEDICAL CONFERENCE – MARCH 15, 2018

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SLIDE 2

OVERVIEW

  • What

at’s the Pr Problem

  • Types of Dr

Drug g Formularies

  • Goal

als an and Ou Outcomes

  • Ear

arly y Adopters – WC Drug Formu mularies es

  • Legis

islat ative His History

  • Working Gr

Group Mem embers

  • Core

e Team M m Memb mber ers

  • What We’

e’ve B Bee een Up To

  • What’s Next
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SLIDE 3

Types of Drug Formularies

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SLIDE 4

What’s the Problem?

Source: NCCI

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SLIDE 5

What’s the Problem?...Cont.

Source: NCCI

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SLIDE 6

What’s the Problem?...Cont.

Source: NCCI

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SLIDE 7

What’s the Problem?...Cont.

Source: NCCI

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SLIDE 8

Goals and Outcomes

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SLIDE 9

Early Adopters – WC Formularies

  • Earli

liest D Drug F Formular laries –

  • Washington – May 2004
  • Proprietary PDL
  • North Dakota – mid 2006
  • Proprietary closed formulary
  • Texas – September 2011
  • ODG
  • Ohio – September 2011
  • Proprietary closed formulary
  • Recent D

Drug Formular laries –

  • Delaware – September 2013
  • Proprietary PDL
  • Oklahoma – February 2014
  • ODG
  • Nevada – Winter 2015
  • ACOEM
  • Tennessee – Jan-Feb 2016
  • ODG
  • Arizona – October 2016
  • ODG
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SLIDE 10

Legislative History in Montana

  • SB

SB 292 292 f from 20 2015 s sponsored b by y then Se Senator M Matt R Rosendale

  • Labor

bor M Manag agement A Advisory C Council ( l (LMAC) – 3 m mee eetings

  • SB 292
  • Background on opioids
  • International Association of Industrial Accidents Boards and Commissions (IAIABC) white

paper by Work Loss Data

  • Overview with current statutory structure
  • Prium presentation on developing a formulary best practices and Drug Formulary 101
  • Request for LMAC support
  • SB 312 d

dev evel elopmen ent

  • Sponsor – Senator Jeff Welborn
  • Department may adopt evidence based drug formulary
  • Update provision if a commercial formulary is adopted
  • Appropriate transition of treatment – legacy claims
  • Timely dispute resolution process
  • Passed with broad bi-partisan support
  • Signed by Governor Bullock on 5/22/2017
  • Effective 7/1/2017
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SLIDE 11

Formulary Working Group

Lance Zanto LMAC Doug Buman LMAC Michelle Fairclough Montana State Fund Mike Marsh Midland Claims Char Lewis-Richards

  • St. Pete’s

Leslie Dalpiaz Attorney Becky Curtis Take Courage Coaching Mark Eichler PharmD Tony King PharmD John Petrisko Physician

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SLIDE 12

ERD Formulary Core Team

Adrianne McLane Co-Project Mgr. Karen Wiles Claims Examiner Misty Knight Co-Project Mgr. Jennifer Hepfner WC Mediator Maralyn Lytle

  • Med. Regulations

Mark Cadwallader Staff Attorney Cindy Zimmerman SAW/RTW Coord. Lindi Mandy

  • Admin. Support

Bri Lake Research Analyst Bill Wheeler

  • Dep. Administrator

Kristine Ediger Research Analyst Eric Strauss Administrator John Schumpert Co-Medical Dir. Julia Brennan Epidemiologist

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SLIDE 13

What have we been up to?

  • Eleven Formula

lary y Workin ing G Group m meetings

  • First meeting was October 4, 2016
  • The 12th meeting is tomorrow at ERD and via Go-To Meeting
  • All meetings are posted on our ERD website
  • http://erd.dli.mt.gov/
  • Under Events
  • Open to the public
  • Bac

ackground / Educat ation / Goal als an and Ob Objectives

  • Timel

eline / e / Measurem emen ents / / Types es of formu mularies es a available

  • Decis

isio ions

  • Type of formulary
  • Keep our MT Guidelines or change
  • Other decision points
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SLIDE 14

What have we been up to?...cont.

  • We’ve heard f

from…Working f formularies

  • Work-Loss Data – commercial formulary
  • Reed Group – commercial formulary
  • Washington State – proprietary formulary
  • We’ve heard f

from…Researchers

  • Bri Lake, Research Analyst
  • State comparisons
  • Formulary comparisons
  • Decision point comparisons
  • We’

e’ve hea heard fr from…PBM PBMs

  • MyMatrix
  • Optum
  • HealthESystems
  • Coventry
  • Made

de de decis ision t to g

  • go
  • wit

ith O ODG DG form

  • rmulary lis

ist wit ith MT Gu Guide idelines

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SLIDE 15

What’s Next?

  • Me

Meeting tomorrow ( (the 1 16th) at at ER ERD

  • Bri Lake will share research on –
  • Legacy claim comparison with other states
  • Dispute resolution in other states
  • Working Group will review 1st draft of –
  • First Fill
  • Prior Authorization
  • Core Team will continue to develop concepts into rule drafts and

bring to the Working Group for discussion

  • Education and Outreach
  • Medical Conference (here)
  • Providers / MMA / others
  • LMAC
  • Spring Stakeholder meetings
  • Governor’s Conference
  • More to come….
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SLIDE 16

Questions?

Bill Wheeler, Deputy Administrator Employment Relations Division bwheeler@mt.gov 406.444.6541