BWC Pharmacy Chief Clarifies What’s Covered/Not Covered in Oxy Chang

Liz Carey

Columbus, OH (WorkersCopmpensation.com) – Ohio’s workers’ compensation agency said it will reimburse injured workers for various pain medications — including several long-acting opioids, despite its latest move to prevent unnecessary prescribing of the drugs.

The Bureau of Workers’ Compensation announced it will not reimburse for prescriptions of time-released Oxycontin or generic sustained-release oxycodone tablets for injuries that occur on or after June 1. But the BWC is not removing all opioids from its drug formulary.

“Although BWC has removed Oxycontin from the formulary, we still provide coverage for several long-acting opioids, including morphine sulfate ER, Embeda, Hysingla ER, Nucynta ER, Butrans, Belbuca, tramadol ER, Xtampza ER, fentanyl, methadone, oxymorphone ER, and Exalgo,” said Interim Pharmacy Director Miranda Williams in an email interview. “There are quantity limits on all of these medications and prior authorization requirements for some.

“We also cover non-opioid medications used for pain management, including anti-inflammatory medications, muscle relaxants, anticonvulsants/antidepressants, acetaminophen and topical products such as lidocaine and diclofenac.”

New medications may be authorized in the future. “BWC does consider coverage for new medications and they are reviewed by our Pharmacy & Therapeutics Committee,” she said. “We also review any medication requested by a provider on a MEDCO-35 form. The committee is made up of 6 pharmacists and 6 physicians and they advise BWC on which medications should be added to or removed from formulary. Recommendations are based on safety and efficacy first, and cost is considered last.”

While the the agency will cover alternative pain therapies, including acupuncture, selected behavior therapy, and chiropractic therapies, it will not reimburse for drugs like marijuana or kratom for pain, a BWC spokesperson said.

Cost Not a Factor

The agency could not say whether or not the move would save the state’s workers’ compensation program any money. “This decision was not made based on a cost-savings perspective. Our agency considers safety and efficacy first when making formulary decisions, and costs last,” Williams said. “With this particular formulary change, our previous pharmacy director estimated the cost will be a wash. His analysis showed that if all current Oxycontin users switched to Xtampza ER, the cost would be nearly the same. This formulary decision was driven by safety.”

The ban was approved by the BWC’s board of directors in February after a study by the BWC’s pharmacy and therapeutics committee looking into the opioid addiction problem in that state. It’s just the latest in the state’s work to reduce the effects of opioids on the state’s workforce. In 2016, the agency instigated the Opioid Rule that restricted what actions a doctor could take in prescribing opioids.

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