Pharmacy Cost Strategy

States Eyeing Texas-Style Formularies

The success of Texas' closed formulary for workers' comp is piquing the interest of other states seeking savings.
By: | May 12, 2014

“The Texas workers’ compensation system continues to show significant improvements in a variety of areas, including injury rates, employer participation, claims costs, return-to-work outcomes, access to care, and insurance rates and premiums,” said the state’s workers’ comp commissioner.

In testimony before a state legislative committee, Commissioner Rod Bordelon noted a 27 percent decline in injury rates since 2004, 22 percent decrease in workers’ comp claims, and a 50 percent drop in workers’ comp insurance rates from 2003 to 2011.

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The commissioner also noted changes resulting from the state’s implementation of a closed formulary for prescription medications, which requires preauthorization for certain medications such as opioids. Among the resulting changes he noted are reduced prescription drug utilization, costs for new and older claims, and better treatment coordination between prescribing doctors and insurance carriers on individual claims.

“Even more telling is the fact that we have not seen an increase in medical necessity disputes or complaints from injured employees since the implementation of the closed formulary in Texas,” Bordelon said. “The Division of Workers’ Compensation has been contacted by several other states, including Louisiana, Oklahoma, California, looking to see if the adoption of a ‘Texas-like’ pharmacy formulary can help reduce opioid use in their workers’ compensation systems.”

Nancy Grover is the president of NMG Consulting and the Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]

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The R&I Editorial Team can be reached at [email protected]