DULUTH, GA ― PRIUM has released a new white paper, “Legacy Cleanup, Texas Style” on the Texas Closed Formulary (TCF), which requires preauthorization of any drug that has an Official Disability Guidelines (ODG) status of “N,” is investigational/experimental or a compound containing “N” drugs. The white paper shows the number of prescriptions for “N” drugs has decreased since implementation of the TCF’s first phase on Sept. 1, 2011.
However, Mark Pew, author of the white paper and senior vice president for PRIUM, predicts more dramatic results from TCF’s second phase that targets legacy claims, those with date of injury before Sept. 1, 2011. “Every ‘N’ drug will be subject to the TCF on Sept. 1, 2013,” Pew said. “Texas has thousands of legacy claims with these drugs and our experience is the vast majority of ‘N’ drugs are medically inappropriate for the patient.”
“Legacy Cleanup, Texas Style” outlines the state’s goals and timelines into the following process:
- Identify claims with at least one drug that fit the criteria
- Notify in writing the prescribing physician, injured employee and dispensing pharmacy of the need to address the drug regimen
- A peer physician engages the prescriber, comparing drug therapy to ODG for medical appropriateness, and if inconsistent agree in writing to change the regimen
- Weaning/discontinuance begins
- Once all changes have occurred, a statement of medical necessity covering the ongoing use of the modified drug regimen is made available to all parties.
“It will take time to wean claimants off the highly addictive drugs they’ve been taking for years,” Pew noted. “The process needs to start soon.”
The White Paper is available here: PRIUM – Texas Closed Formulary: Legacy Claim Cleanup (PDF).