Austin, TX – On July 23, 2026, the Texas Department of Insurance, Division of Workers’ Compensation (DWC) pursued and received constructive input from workers’ compensation system participants on the Topical Analgesic Audit Plan (Audit Plan).
DWC noted its appreciation for the input, and carefully considered and discussed all comments. The plan-based audit was approved with edits based on the comments received.
The Audit Plan sets the priorities for the medical quality review audits during the upcoming year.
Purpose
- Ensure topical analgesics are prescribed in accordance with the ODG and evidence based medical practices.
- Assess provider documentation supporting the medical necessity of any prescribing that deviates from established evidence-based guidelines.
- Support appropriate therapeutic prescribing practices to promote optimal outcomes for injured employees.
Scope and Selection Criteria
The plan-based audit includes health care practitioners who prescribe topical analgesics for injured employees during the audit period. The review will evaluate whether prescribing practices align with the ODG or other evidence-based guidelines.
Specifically, the review will assess whether documentation supports the medical necessity of medications prescribed outside recommended guidelines; whether brandname medications were prescribed when generic equivalents were available or clinically appropriate; and whether the prescribing documentation demonstrates functional or therapeutic improvement, clinical need, and overall compliance with DWC expectations for medical necessity.
Information about the Medical Quality Review Process (Process) and the proposed plan-based audit is on the TDI website at Office of the Medical Advisor.
All medical quality reviews initiated on or after January 1, 2026, will follow the approved
Process in effect.
Source: TDI-DWC