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North Carolina weighs benefits of closed drug formulary


North Carolina's workers compensation system could benefit greatly from adopting a closed drug formulary if physicians in the state mimic the prescribing patterns of those in Texas, according to a new study by the Workers Compensation Research Institute.

Since North Carolina is among states weighing a closed formulary for medications prescribed in workers comp, Cambridge, Massachusetts-based WCRI's “Texas-Like Formulary for North Carolina State Employees,” released Wednesday, examines how a Texas-like formulary might affect the prevalence and costs of drugs prescribed to state employees in North Carolina.

If physicians in North Carolina adjust to a closed formulary like physicians in Texas did — by reducing prescriptions for nonformulary drugs and infrequently substituting formulary drugs for nonformulary drugs — “we estimate large effects,” researchers said, including a “30% reduction in total prescription costs or close to $8.7 million over the three-year period.”

Nonformulary drugs accounted for 23% of all prescriptions and 39% of total prescription costs filled in North Carolina during calendar year 2014, according to the study. And 10 drugs — Voltaren, Lidoderm, Oxycontin, Nucynta, Topamax, Desyrel, Xanax, Duragesic, Kadian, Valium — accounted for more than half of the nonformulary drug prescriptions filled by state employees.

According to a June 2014 report by WCRI, nonformulary drugs accounted for 10% to 17% of all prescriptions and 18% to 37% of total prescription costs in 23 states studied, including North Carolina.

The study found that, if physicians in the 23 states changed their prescribing patterns in the same way physicians in Texas did, adopting a closed drug formulary could result in a 14% to 29% decrease in total prescription costs.

A similar study published by the California Workers' Compensation Institute in October 2014 found that adopting a mandatory formulary like Texas or Washington state could reduce California's workers comp pharmacy costs by $124 million to $420 million a year.

California Gov. Jerry Brown in October signed a bill requiring the administrative director of California's Division of Workers' Compensation to create a formulary on or before July 1, 2017.

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