June 19, 2012
Fewer Texas Workers’ Compensation Claims Include Opioids and Not-Recommended Prescriptions
AUSTIN, TX — Fewer opioids, narcotics and other “not recommended” drugs are being prescribed in the Texas workers’ compensation system according to a recent study of medical billing and payment data collected by the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) and the Workers’ Compensation Research and Evaluation Group (REG). The study which will be released later this summer examines the impact of a pharmacy closed formulary adopted by Workers’ Compensation Commissioner Rod Bordelon in 2011.
The study compared injuries that occurred between September and November 2011 with injuries that occurred during the same timeframe in 2010. To ensure comparability, both sets of claims were analyzed at six months post-injury to account for differences in claim maturity. The study found that under the formulary:
- prescription drug costs specifically attributed to not-recommended ( “N”) drugs for 2011 claims were reduced by 75 percent (approximately $841,000) when compared to 2010;
- claims receiving “N” drugs were reduced by 54 percent between 2010 and 2011;
the frequency of “N” drug prescriptions being dispensed to injured employees was reduced by 65 percent;
- total prescription drug costs for 2011 claims were reduced by 26 percent (approximately $1.4 million) when compared to 2010 claims; and
- the frequency of opioid prescriptions dispensed to injured employees decreased by 10 percent and the costs associated with opioid prescriptions decreased by 17 percent
“This is significant,” said Commissioner Bordelon. “With this formulary, along with treatment guidelines, preauthorization requirements and enforcement efforts we’ve recently adopted, Texas is now leading the charge in combating overutilization of unnecessary prescription drugs in the workers’ compensation system, while safeguarding medically necessary care that promotes an injured employee’s return to work quickly and safely.”
The formulary (mandated by House Bill 7, 79th Legislature, 2005), includes all FDA-approved drugs, except for investigational and experimental drugs and excludes drugs listed as “N” drugs (or “not recommended” drugs) in Appendix A of DWC’s adopted treatment guidelines. Under this formulary, which took effect for new workers’ compensation claims with dates of injury on or after September 1, 2011, prescriptions for drugs that are excluded from the formulary require pre-approval from the insurance carrier before they can be dispensed.
The workers’ compensation closed pharmacy formulary will take effect for older claims (i.e., claims with dates of injury prior to September 1, 2011) on September 1, 2013.
To find out more information about the workers’ compensation closed pharmacy formulary, including a copy of the most current list of “N” drugs, see http://www.tdi.texas.gov/wc/pharmacy/index.html.
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Last updated: 07/15/2014