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Claims with nonpreferred meds decreased 67% with formulary

Stop opioids

The total number of injured workers receiving not-recommended drugs decreased by 67% in Texas’ workers compensation system, according to a report on the effect of the state’s 8-year-old drug formulary that aimed to rein in drugs such as opioids.

The Texas Division of Workers’ Compensation, whose formulary took effect in phases starting in 2011, on Monday released the outcome of its tracking of pharmacy trends since 2010.

While the total number of claims receiving pharmaceuticals decreased by 2% and the total number of prescriptions decreased by 11%, the total number of claims receiving high levels of nonpreferred opioids decreased to 489 in 2015 from 14,959 in 2009, according to the report.

Other report highlights include:

  • In addition to the 67% drop in claims with not-recommended drugs, the state saw the total number of not-recommended drug prescriptions decrease by 77%.
  • The number of workers compensation medical disputes decreased 38% from 2011 to 2017.
  • Preauthorization disputes, which could include disputes over not-recommended drug prescriptions, decreased to 17% of all medical disputes in 2017 from 41% in 2010.
  • The decrease in disputes is related to several factors, such as fewer claims filed, the creation of health care networks in 2006, the adoption of medical treatment guidelines in 2007, and the adoption of professional, inpatient and outpatient hospital, and ambulatory surgical center fee guidelines in 2008.
  • Seventy-eight percent of injured employees surveyed in 2018 said they had no problem receiving their prescriptions, while an additional 10% said it was a “small problem.”




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