TX Drug Formulary Outcomes

The Texas Division of Workers’ Compensation released its 2023 Pharmacy Cost and Utilization Report

Texas was early onto the state drug formulary scene when it implemented a required formulary in September 2011.? The rules provided a 2 year time period following that for providers to either transition “N” medications to “Y” status, or remove them completely from the care plan.?

All non-formulary medications would then require preauthorization and be subject to the UR process.

The results measure the 2009-2022 time period. They are significant.

Utilization

• The total number of pharmacy claims decreased 57%
• Total number of prescriptions decreased 73%?
• The average number of prescriptions per claim decreased 38%?

Opioids

• The number of opioid prescriptions decreased 86% and opioid “N” drugs decreased 96%

Costs

• Total pharmacy costs declined 73%
• Average cost per claim declined 39% with the majority coming from lost-time claims
• Opioid “N” status drug costs decreased 97%
• Opioid non-N status drug costs declined 88%

Brand / Generic

• The percentage of generic drugs increased from from 74% to 95%

What it Means

• The national attention from the opioid epidemic certainly contributed to these outcomes - but in 2011, few were talking about it
• According to WCRI, as of 1/1/2023, 17 states have adopted a drug formulary
• State formularies are not a panacea. But they do help guide evidence based care, control pharmacy costs, and prevent human tragedy.