Workers’ Compensation Pharmaceutical Formulary

Posted January 23, 2019

The Commissioner of the Kentucky Department of Workers’ Claims (DWC) has promulgated an administrative regulation (803 KAR 25:270) adopting the ODG by MCG Health pharmaceutical formulary for use in the treatment of work-related injuries and occupational disease. The adoption and implementation of a formulary was mandated by House Bill 2 during the 2018 session of the General Assembly. Drugs listed in the formulary are assigned “Y” or “N” status. Drugs assigned “Y” status may be dispensed without preauthorization and do not require utilization review. Drugs assigned “N” status require preauthorization.

The formulary is available online at www.odgbymcg.com/state-formulary.

The formulary will take effect as follows:

(a) For claims in which the date of injury or last exposure is on or after January 1, 2019, the formulary shall be effective July 1, 2019.

(b) For claims in which the date of injury or last exposure is prior to January 1, 2019, the formulary shall be effective:

(1) July 1, 2019 for a prescription that is not a refill prescription;

(2) January 1, 2020 for a refill prescription of a drug initially prescribed prior to July 1, 2019.

In the coming weeks the DWC will announce and offer a formulary training webinar in conjunction with ODG.

Questions about the formulary regulation may be directed to John Mann at 502-782-4532 or JohnW.Mann@ky.gov.

Support and training is also available through the ODG Helpdesk at 800-488-5548 or online at odghelp@mcg.com.