In the midst of a nationwide opioid crisis, Texas implemented a prescription drug formulary in 2011 — not because it would save insurance companies money but because it could save lives.
Prescription opioids are, without a doubt, a factor in the continued rise in opioid overdoses and deaths. In Texas, we were not willing to sit back and hope the situation would resolve itself.
And now, six years later, our formulary is a resounding success, a model for the nation, and the inspiration for many other states’ proposed formularies. We are proud of the work we put into this, the time we spent and the collaboration with carriers, doctors and pharmacists, and with employee groups, to make sure we got it right.
The formulary was specifically designed to ensure injured employees do not get excessive or unnecessary medical services or prescriptions. We also took time to design a specific mechanism, called medical interlocutory orders, that allows injured employees to get medications in specific cases where doctors believe the formulary is too restrictive. We’ve seen fewer than 150 of these orders since 2013 and no increase in complaints or disputes.
We diligently monitor the well-being of injured employees affected by the formulary, and we disclose the results in an annual report card and in a biennial report. We’ve surveyed 3,000 employees a year for the last 10 years to make sure they get the care they need.
I’m proud to say we’ve seen improvements in return to work, medical costs and access to care, and the formulary is a component of that success:
When the formulary was adopted, the number of N-drug prescriptions dropped by 77% in the first year.
The number of prescriptions for N-drug opioids also fell by 81%, which means fewer injured employees are receiving prescriptions for the most dangerous and addictive drugs in the first place.
Almost 83% of employees receiving workers’ compensation income benefits return to work within six months, compared to 74% in 2004.
Employees are returning to work faster (median days off of work reduced from 28-29 days in 2004-2005 to 19-20 days in 2013-2014).
We ensured that injured employees already using restricted drugs did not have to stop taking them abruptly. We implemented a two-year period for doctors and patients to adjust to changes due to the formulary.
We are absolutely certain that the pharmacy closed formulary has enhanced the Texas workers’ compensation system. Other states may decide to take a different approach, but our experience has shown us that this model is of great benefit to injured employees.
Ryan Brannan is commissioner of the Texas workers’ compensation system.
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