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

Drug Formulary Update MEDICAL CONFERENCE – MARCH 15, 2018

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 •

Types of Drug Formularies

What’s the Problem? Source: NCCI

What’s the Problem?...Cont. Source: NCCI

What’s the Problem?...Cont. Source: NCCI

What’s the Problem?...Cont. Source: NCCI

Goals and Outcomes

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 •

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 •

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

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

What have we been up to? Eleven Formula lary y Workin ing G Group m meetings • First meeting was October 4, 2016 • The 12 th 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 •

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 o go o wit ith O ODG DG form ormulary lis ist wit ith MT Gu Guide idelines •

What’s Next? Me Meeting tomorrow ( (the 1 16 th ) 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 1 st 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…. •

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