Jun 20, 2017 a 7:36 pm PDT

The scope of the ODG Formulary is restricted to FDA approved drugs only, and pharmacy compounds are not FDA approved, so they are not listed. The evidence base that supports the Formulary, the ODG treatment guidelines, indicates that all pharmacy compounds are not recommended as a first-line therapy, so pre-auth would be required. For practically every state and every payer using ODG, pharmacy compounds require pre-auth. Texas was unique in establishing carve-out rules for pharmacy compounds that would allow them if they did not contain N drugs, and as a result of their experience with those rules, they are proposing to adopt rules consistent with ODG's recommendations on pharmacy compounds. The issue has nothing to do with a "binary formulary." Every drug formulary is a binary formulary, in the sense that it allows immediate patient access to first-line drugs, but also offers a process for patients to access other drugs, if appropriate depending on diagnosis, severity, and other factors.