Key findings
An overwhelming majority said they had no problems receiving their prescription drugs under the formulary. Among those with problems, a majority thought it was because the insurance company or health care network did not want this care provided.
- Return-to-work rates for network injured employees consistently higher than for non-network injured employees after 2009.
- Return-to-work rate for network injured employees averaged 90 percent before formulary took effect and 94 percent after.
- Return-to-work rate for non-network injured employees averaged 87 percent before formulary took effect and 90 percent after.
High utilization of opioids has been linked to high addiction rates, an increase in accidental overdoses, and suicide. REG studies have shown measurable reductions in opioid utilization in Texas after implementing the closed formulary.
- Mental functioning scores for network injured employees averaged 51.2 before and 51.6 after the formulary went into effect. These scores were higher in 2016 than in any other year since implementing the formulary.
- Mental functioning scores for non-network injured employees averaged 50.0 before and 49.6 after the formulary went into effect. These scores were higher in 2016 than in any other year since implementing the formulary.
- Mental functioning scores for network injured employees were consistently higher than for the non-network injured employees and the U.S. population.
- Mental functioning scores for network injured employees averaged 51.2 before and 51.6 after the formulary went into effect. These scores were higher in 2016 than in any other year since implementing the formulary.
- Mental functioning scores for non-network injured employees averaged 50.0 before and 49.6 after the formulary went into effect. These scores were higher in 2016 than in any other year since implementing the formulary.
- Mental functioning scores for network injured employees were consistently higher than for the non-network injured employees and the U.S. population.
DWC implemented the pharmacy closed formulary for legacy claims in 2013.
DWC created a process to allow a prescribing doctor or pharmacy to obtain a medical interlocutory order (MIO) when an insurance carrier denies preauthorization of previously prescribed drugs. An MIO allows an injured employee to continue using the drug throughout the duration of the dispute process.
As of September 2019, 60 percent of the Medical Interlocutory Orders (MIO) requested were approved.
While the goal of this study is to examine trends in key injured employee outcomes, pre- and post-formulary, it does not seek to measure causal links with the formulary. Since about 50 percent of new injured employees in Texas receive their medical services in health care networks, this study presents findings broken out by both network and non-network claims. Further, to ensure compatible injury years with the cost and utilization timeframes, REG realigned the network outcome data used for its annual Network Report Card study. While some Network Report Card results appear similar to the results in this report, the injury years differ.
