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What drugs and medication are covered under my L&I workers’ compensation claim?

L-and-I claim drugs and medication authorized

Have you heard of a drug formulary? How would you know what medication is covered under your L&I claim? Generally, a drug formulary is a list of prescription medications approved under a given health insurance policy. For L&I claims and workers’ compensation claims in Washington State, the Department of Labor and Industries (L&I) has its own drug formularies. Now, effective October 1st 2019, L&I is making changes to its Outpatient Drug Formulary and the Selected Preferred Drug List. Eight new drug classes have been added. Also, L&I uses Therapeutic Class Codes (TCC) to mark drug classes, and the new approved TCCs include A6W, C4X, C4Y, H1D, H8V, J8E, V10, Z0K.

 

New classes of drugs recently authorized by L&I

A6W is a class of cardiovascular diagnostics solutions, including radioactive solutions. C4X and C4Y are classes of antihyperglycemic drugs, which includes insulin. H1D is a new class for Calcitonin Gene-Related Peptide (CGRP) inhibitors. H8V stands for the class of Hypoactive Sexual Desire Disorder (HSDD) treatment agents. J8E is a code for the new class for anti-obesity receptor agonists, and Z0K is a new drug class for gene therapy agents.

 

Inpatient care vs outpatient formulary

It is important to know that these changes apply only to the outpatient formulary. Medications not authorized in the outpatient formulary may be appropriate in other treatment settings like inpatient care. The full outpatient formulary can be found on the L&I website.

 

The newly added drug classes are clearly identified in L&I’s list. In addition to listing the various drug classes and descriptions, the formulary also identifies which medications are authorized, which are denied, and which require pre authorization. On top of the formulary itself, the L&I website also contains L&I’s Selected Preferred Drug List. This document specifically lists the brands and generic names of the preferred medications.

 

When should I be concerned about drug formulary

In my experience, injured workers rarely have to concern themselves with the intricacies of drug formularies. However, on occasion, in cases involving more severe or obscure injuries or conditions, the formularies are a particularly useful resource for prescribing providers.

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