|[January 18, 2012]
PRIUM's New White Paper Provides Guidance for Phase Two of the Texas Closed Formulary
DULUTH, Ga. --(Business Wire)--
PRIUM released a new white paper, "Legacy
Cleanup, Texas Style" on the Texas Closed Formulary (TCF), which
requires preauthorization of any drug that has an Official Disability
Guidelines (ODG) status of "N," is investigational/experimental or a
compound containing "N" drugs. The white paper shows the number of
prescriptions for "N" drugs has decreased since implementation of the
TCF's first phase on Sept. 1, 2011.
However, Mark Pew (News - Alert), author of the white paper and senior vice president
for PRIUM, predicts more dramatic results from TCF's second phase that
targets legacy claims, those with date of injury before Sept. 1, 2011.
"Every 'N' drug will be subject to the TCF on Sept. 1, 2013," Pew said.
"Texas has thousands of legacy claims with these drugs and our
experience is the vast majority of 'N' drugs are medically inappropriate
for the patient."
"Legacy Cleanup, Texas Style" outlines the state's goals and timelines
into the following process:
Idetify claims with at least one drug that fit the criteria
Notify in writing the prescribing physician, injured employee and
dispensing pharmacy of the need to address the drug regimen
A peer physician engages the prescriber, comparing drug therapy to ODG
for medical appropriateness, and if inconsistent agree in writing to
change the regimen
Once all changes have occurred, a statement of medical necessity
covering the ongoing use of the modified drug regimen is made
available to all parties.
"It will take time to wean claimants off the highly addictive drugs
they've been taking for years," Pew noted. "The process needs to start
to view the white paper.
Based in Duluth, Ga., PRIUM
is a medical cost management company providing prospective, concurrent
and retrospective reviews that facilitate the management of clinical
resources to the workers' compensation industry. Among its services is a
comprehensive narcotics control program rooted in the core principles of
peer-to-peer discussion, enforcement through pharmacy benefit management
and oversight via PRIUM's nurse oversight. To reach PRIUM, call
888-588-4964 or visit www.prium.net.
For insight and commentary on medical management issues in workers'
compensation, please visit PRIUM's blog at http://prium-evidencebased.blogspot.com.
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