On April 21, 2023, the ODG Drug Formulary (Appendix A) status will change for several medications within the topical analgesic and nonsteroidal anti-inflammatory (NSAID) classes. The topical analgesic lidocaine 5% patch (Lidoderm^®) will change from an N drug to a Y drug. In addition, lidocaine 4% over-the-counter (OTC) patches along with other lidocaine formulations including creams, gels, lotions, and ointments will be designated as unlisted drugs. The lidocaine 1.8% patch (ZTLido^®) will remain a Y drug. The primary status changes within the NSAID class include meloxicam 5 mg and 10 mg capsules (Vivlodex^®) changing from Unlisted drugs to Y drugs and diclofenac potassium 18 mg and 35 mg capsules (Zorvolex^®) changing from Y drugs to Unlisted drugs. In states following the ODG Drug Formulary for medications associated with their workers’ compensation claims, a shift in the utilization of these medications is expected.

Understanding the ODG Drug Formulary

The ODG Drug Formulary includes medications approved by the U.S. Food and Drug Administration (FDA) that are often prescribed for the treatment of workers’ compensation injuries and provides information such as: therapeutic class, generic name, brand-name, generic or OTC availability, status and cost. Hyperlinks within the formulary can be used to redirect the user to the appropriate treatment guidelines to find more information on recommendations and selection criteria.

A medication designated as a Y drug is typically preferred as a first-line treatment in ODG. Conversely, a medication designated as an N drug is non-formulary and may not be recommended as first-line treatment for an illness or injury. Additionally, prior authorization may be required for non-Y drugs to determine medical necessity for the approved injury. Some states or payers may require a utilization review (UR) for N drugs per jurisdictional guidelines.

Impact on workers’ compensation and auto no-fault

Optum offers several formularies, including an ODG-based formulary. To maintain integrity of our ODG-based formulary, we review the published list from ODG on a scheduled and ad-hoc basis and perform impact analyses of the affected medications ― most recently, the topical analgesic and NSAID medications. Based on our analysis, necessary formulary changes are made and communicated to clients.

More information on ODG

A widely used resource in the workers’ compensation industry, ODG by MCG provides independent, evidence-based medical treatment, disability, and return-to-work guidelines for medications commonly used to treat injuries. They publish the ODG Drug Formulary as well, also known as Appendix A.

Resources

How to use the ODG Drug Formulary
ODG state adoptions

Source:
ODG by MCG [database online]. An MCG Health Company. Available at: https://www.mcg.com/odg/workers-comp-guidelines/. Accessed March 14, 2023.