[{"@context":"https:\/\/schema.org\/","@type":"BlogPosting","@id":"https:\/\/www.brppharma.com\/new-regulations-signed-california-governor#BlogPosting","mainEntityOfPage":"https:\/\/www.brppharma.com\/new-regulations-signed-california-governor","headline":"New Regulations Signed by California Governor","name":"New Regulations Signed by California Governor","description":"Overall, I think this will benefit California physician work comp providers. The highlights of the new law are as follows: 1.\u00a0 It requires the Adm. Director of Workers Comp to “meet and consult with stakeholders”.\u00a0 Everyone will have a voice in the establishment of this “formulary”. The details, however, will probably be left up to […]","datePublished":"2015-10-19","dateModified":"2022-06-29","author":{"@type":"Person","@id":"https:\/\/www.brppharma.com\/author\/brppharma#Person","name":"BRP Pharmaceuticals","url":"https:\/\/www.brppharma.com\/author\/brppharma","identifier":5,"image":{"@type":"ImageObject","@id":"https:\/\/secure.gravatar.com\/avatar\/1823a51a9ebb71b301035ef253ad87e9ea23d88aadbe3f3c420e18ff5966659f?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/1823a51a9ebb71b301035ef253ad87e9ea23d88aadbe3f3c420e18ff5966659f?s=96&d=mm&r=g","height":96,"width":96}},"publisher":{"@type":"Organization","name":"BRP Pharmaceuticals","logo":{"@type":"ImageObject","@id":"https:\/\/www.brppharma.com\/wp-content\/uploads\/2017\/10\/brp-logo.png","url":"https:\/\/www.brppharma.com\/wp-content\/uploads\/2017\/10\/brp-logo.png","width":340,"height":100}},"image":{"@type":"ImageObject","@id":"https:\/\/www.brppharma.com\/wp-content\/uploads\/2018\/08\/brp-Landing-logo.png","url":"https:\/\/www.brppharma.com\/wp-content\/uploads\/2018\/08\/brp-Landing-logo.png","width":133,"height":55},"url":"https:\/\/www.brppharma.com\/new-regulations-signed-california-governor","about":["News"],"wordCount":625,"articleBody":"Overall, I think this will benefit California physician work comp providers. The highlights of the new law are as follows:1.\u00a0 It requires the Adm. Director of Workers Comp to “meet and consult with stakeholders”.\u00a0 Everyone will have a voice in the establishment of this “formulary”. The details, however, will probably be left up to physicians and pharmacists (see #5 below).2.\u00a0 In reviewing formularies that are already in place in other states, I noticed that medications are listed in generic type format without regard to NDC #, strength, or manufacturer.\u00a0 Medications such as naproxen, Naprosyn, hydrocodone, tramadol, etc. are all listed in this general manner. If the prescribed medication falls into the drug category, it should be covered.3. \u00a0Per 4600, section 1. (e)….The use of this formulary is to further “the goal of providing appropriate medications expeditiously while minimizing administrative burden and associated administrative costs”.\u00a0My interpretation of this law is to eliminate the current nightmare in physician offices whereby the insurer is requiring the prescribing physician to submit an “RFA” (request for authorization) to the insurer for many commonly used medications (Norco, naproxen, tramadol, etc.).\u00a0 If the formulary is “evidence based”, \u00a0most medications commonly seen in physician offices \u00a0should have no problem making their way onto this new formulary. This will eliminate the need for the submittal of burdensome RFAs prior to dispensing or prior to prescribing medications which are included in the formulary.4. Per section 4600.2 (a) …“Medicines provided pursuant to the contract shall be subject to the drug formulary adopted by the administrative director pursuant to Section \u00a05307.27, and such contracts may not limit the availability of medications otherwise prescribed pursuant to the formulary based on whether the pharmacy services are provided within or outside a medical provider network”This section above may increase the ability of physicians to dispense medications in their offices.\u00a0 I interpret this section to say when a physician provides “pharmacy services” outside the medical provider network (MPN), \u00a0those services must be paid. I hope this is the case.\u00a0 Currently, many physicians are denied reimbursement by the insurer for their dispensed medications due to “medications must be provided by the patient’s drug program or contracted pharmacy”. Section 4600.2(a) makes it mandatory that if a “pharmacy service” is provided, and the medication is listed on the drug formulary, the insurer will have to allow for those medications \u00a0whether provided “within or outside a medical provider network” (see yellow highlight above). The only question is if “pharmacy services” includes the dispensing of medications from a physician’s office.\u00a0 I feel this has been implied based on other parts of the labor code that describe “pharmacy services” along with physician dispensing [see section 5307.1 (g)] .5. \u00a0Per section 5307.29 (c) 1. Thanks to someone’s common sense, this law requires an “independent pharmacy and therapeutics committee” comprised of six members: \u00a0The Executive Medical Director of Workers Comp, medical doctors, and pharmacists. \u00a0This committee will be responsible in updating the formulary based on efficacy, relative safety, and effectiveness of medications.\u00a0 No one from a PBM, Insurer, or a pharmacy manufacturer will be allowed on this committee .\u00a0 Their decisions will have to be evidence based and clinically appropriate.\u00a0 I have to assume their decisions will be based primarily on what is best for the patient.Again, this is only my interpretation.\u00a0 These laws use very confusing, complex, and complicated language, therefore another person’s interpretation may vary. However,\u00a0I feel this new law has great potential to provide the California work comp system with a reasonable formulary.\u00a0 It may provide patients with the best medications\u00a0and reduce the current unreasonable burden to the physician and their patients.\u00a0\u00a0Overall, I think it supports physician dispensing with less hassle.Feel free to call me if you have any questions, —Thank You,Fred Y. Ganjian"},{"@context":"https:\/\/schema.org\/","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"name":"New Regulations Signed by California Governor","item":"https:\/\/www.brppharma.com\/new-regulations-signed-california-governor#breadcrumbitem"}]}]