A new analysis offers a preliminary look at Utilization Review and Independent Medical Review outcomes involving pharmaceutical requests for California injured workers since the state implemented a workers’ compensation formulary in January.

The analysis from the California Workers’ Compensation Institute issued on Friday shows that the proportion of UR decisions involving prescription drug requests fell from 44.5 percent in the pre-formulary period to 40.7 percent in the first five months of 2018.

At the same time, the percentage of UR decisions in which a prescription drug request was denied was unchanged at 14.6 percent, while 85.4 percent were either approved as submitted or approved with a modification, according to the CWCI study.

UR decisions involving opioid requests showed little change, edging down from 30.6 percent in the pre-formulary period to 30.0 percent after the formulary took effect, though the UR approval rate for opioids showed a sharper decline, falling from 72.3 percent to 68.8 percent.

Read more