Monday, January 23, 2012

Texas Closed Formulary - Prelude

I was in Austin last week in follow-up to my whitepaper, “Legacy Cleanup, Texas Style”.  I participated in the inaugural Alliance Against Prescription Drug Abuse that is sponsored by the Texas Association of Business and was pleased to see more than 50 in attendance representing a variety of stakeholders in medical care (government, law enforcement, businesses, carriers, medical associations, pharmacy associations, alliances and lobbyists, media).  In addition, I was able to speak with several well-connected individuals in Work Comp, two customers and a well renowned clinician.  As I had anticipated, there was a consensus among all that prescription drug over-utilization is a huge issue that is increasing healthcare costs, reducing the quality of life (and life expectancy and functionality) of patients, and using law enforcement resources best suited for other purposes.  Additionally, it was commonly recognized as a societal issue in America, that it is multi-dimensional in its genesis and impact, and any attempt at stemming the tide of this epidemic must be multi-faceted and coordinated.  My colleague and fellow blogger, Michael Gavin, will be speaking at the National Prescription Drug Abuse Summit in mid-April because we strongly believe this issue is bigger than Work Comp.

Even though I am visiting customers in California this week, my blogs will be focused on how the Texas Department of Workers’ Compensation (DWC) is addressing their part of the pie.  They decided to take a two phased approach.  First was reducing the introduction of Official Disability Guidelines (ODG) “N” drugs for new WC claims effective 9/1/11, and as I will note tomorrow this already has had a positive effect.  The second phase will be fully implemented on 9/1/13 but really should start now - evaluating the ongoing medical appropriateness of ODG “N” drugs for all “legacy claims” (those with a Date of Injury prior to 9/1/11). 

As you can imagine from a state the size of Texas, and the dependence and addiction these “N” drugs often cause, this process will be time consuming and likely not easy.  Which is why, in all of my discussions this week, I tried to push forward a sense of urgency to get started now, as the overall success of this program will be closely linked to how assertive and proactive each of the stakeholders are given the 2 year window the DWC has provided.

From my research of the various plans across the country, I am convinced that Texas has designed a process that can be a game changer and possibly a model for other states.  The issue now is not recognition of the problem, but rather in the execution of solutions.  And, to leverage a famous phrase from the Space Center in Houston in 1970, "failure is not an option".

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