Texas prescription drug formulary delivers savings

Texas reported a large decline in the prescribing of “N” drugs for injured workers since the state's pharmacy controlled formulary was put into place, according to a July report.

A report from the Texas Department of Insurance Workers' Compensation Research and Evaluation Group released Thursday said that before the state's closed formulary was put in place, pharmacy services for claims between fiscal year 2011 and 2012 (post-formulary), the number of injured employees receiving N-drugs fell by 67%.

Closed formularies require proof that nonformulary medications — called N drugs — are medically necessary before they can be prescribed to injured workers.

For new claims with services within 24 months after a worker was injured, the report said the number of claims receiving N-drug prescriptions decreased from 24,286 in 2011 to 8,120 in 2012.

When considering the cost of N-drug prescriptions, opioid prescription costs for N-drugs decreased from $1.44 million in 2011 to $323,762 in 2012, a 77% drop.

For pharmacy services by service year including all new and legacy claims, the number of N-drug prescriptions decreased from 335,077 in 2009 to 26,701 in 2015. The cost of N-drugs within that timeframe dropped from over $51 million to $7.2 million, the report also said.

The report used data collected from workers comp claim prescription claims in the fiscal years of 2009 through 2015. The Texas formulary was implemented for new claims starting September 2011, with the formulary starting for legacy claims 24 months after that.