| Summer 2009
Prescription Drug Formulary Coming Soon
By Nicholas Tsourmas, M.D.
Texas Mutual Medical Director
The Texas Department of Insurance, Division of Workers’ Compensation (DWC) has proposed a formulary for medications used to treat injuries covered by workers’ compensation. The formulary could be effective anytime between September 1, 2009 and the end of the calendar year.
Until then, continue to follow the Official Disability Guidelines – Treatment in Workers’ Comp (ODG). Seek preauthorization for treatment, including prescriptions, when services fall outside or in excess of the ODG treatment guidelines.
I strongly recommend you visit the DWC website. and review the proposed formulary. You will find a concise compendium of approved drugs. When correlated under the treatment scenarios, the formulary defines what you should consider when treating injured workers. It also offers generic substitutions when available, and it provides a relative value of current pharmacy pricing.
Most importantly, the new formulary is consistent with the workers’ comp system’s goal to deliver quality, cost-effective medical care to injured workers. The DWC is still determining how the formulary will apply to legacy claims.
A committee of medical specialists began working on the formulary in response to House Bill 7, passed during the 2005 legislative session. The bill, which provided a new dawn for the Texas workers’ compensation system, mandated that the DWC adopt a formulary and methodology for the appropriate use of medications for workers’ compensation injuries.
The committee reviewed the medical literature and considered adopting other states’ guidelines and formularies. In Spring 2008, the committee turned over its recommendations to the DWC, which has since held a series of stakeholder meetings to review the proposed formulary.
For updated information, stay tuned to the DWC website.
About the author
Nicholas F. Tsourmas, M.D. is a board certified orthopedic surgeon with more than 30 years of clinical experience. He is a founding partner of Southwest Orthopaedic Group and an adjunct professor at the University of Texas Medical Branch in Galveston,
where he teaches family practice, aeronautics, orthopedics and occupational medicine residents. Dr. Tsourmas graduated from Georgetown University Medical School in Washington, D.C. He presently serves as the Texas Mutual medical director. You can reach him at ntsourmas@texasmutual.com.
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