Austin, TX – When a Texas House committee asked the Division of Workers’ Compensation to look at compounded drug prescriptions for injured employees, the division turned to its data on pharmacy billing and an ongoing audit of doctors’ practices for answers. It found that the cost of compounded drugs doubled from 2010-2014, and the average cost per prescription had risen to $829 in 2016.
The numbers were concerning because compounded drugs aren’t recommended as first line medications in treatment guidelines for injured employees. After getting DWC’s report, members of the House Committee on Business & Industry asked DWC (PDF) to address the issues through a new rule. On June 16, 2017, DWC announced an informal draft rule to require that compounded drugs be preauthorized.
“We’re looking to DWC to develop a rule that maintains access to these drugs but helps prevent fraud and unnecessary use,” said Chairman Rene Oliveira. “And we’re encouraging DWC to get input from carriers, doctors, patients, pharmacists, and other stakeholders throughout that process.”
Compounded drugs are not FDA-approved and the FDA does not verify their safety, effectiveness, or quality. The FDA has found that the labeling of compounded drugs often omits important information and that poor compounding practices can result in serious drug quality problems, such as contamination or medications that do not possess the strength, quality, and purity they are supposed to have. Additionally, the FDA has reported its concern that some compounders produce drugs for patients even though an FDA-approved drug may have been medically appropriate for them.
Given these safety concerns, Workers’ Compensation Commissioner Ryan Brannan said the preauthorization process strikes a sensible balance.
“We want to make sure the use of these drugs is being reviewed and that physicians are considering efficacy and appropriateness of alternatives while still ensuring that patients who need compounded drugs will still be able to get them,” Brannan said.
Concerns about compounded drugs aren’t unique to the Texas workers’ compensation system. In 2014, the Employee Retirement System of Texas began requiring preauthorization for all compounded drugs costing $300 or more. The change reduced ERS expenditures on those drugs from $35.7 million in Fiscal Year 2014 to $1.2 million in Fiscal Year 2015. In January, ERS tightened the requirements even more, requiring preauthorization for compounded drugs costing more than $50.
Brannan said there will be be multiple opportunities for public and stakeholders to have input on the rule. He also noted that DWC will educate providers on the steps for preauthorization before any change takes effect.
The agency is [Continue Reading]” target=”_blank”>accepting comments on the compound drug rule through February 20.
Looking at the Issue
A May 2017 (PDF) report by DWC’s Research and Evaluation group found that:
- The number of compounded drugs increased from 18,020 prescriptions in 2010 to 26,380 in 2014.
- The total cost of compounded drugs increased from $6 million in 2010 to $12 million in 2014.
- The average cost per compounded drug prescription increased from $356 in 2010 to $829 in 2016.
- Almost a third of compounded drug prescriptions were to treat back injuries.