TX: Report Shows ‘Significant Opportunities’ For Docs to Improve Adherence to Best Practices

Nancy Grover

Austin, TX (WorkersCompensation.com) – Texas workers’ compensation physicians largely avoid discussing pain medications they prescribe to injured workers. A new study from the Texas Department of Insurance found less than half the doctors discussed the benefits and risks of medications they prescribed, or ways to deal with pain.

The study looked at patient outcomes since the state adopted a pharmacy closed formulary in 2011. While the findings showed overall modest improvements in outcomes, it highlighted the need for better interactions between treating doctors and injured workers when pain medications are prescribed.

“The 2018 survey results demonstrate that significant opportunities exist for prescribing doctors to help improve injured employee outcomes with more adherence to best practices,” the authors concluded.

The study, Analysis of Injured Employee Outcomes after the Texas Pharmacy Closed Formulary, was produced by the TDI’s Research and Evaluation Group. The researchers conduct an annual survey of about 3,000 injured employees to ascertain measures on injured employee experiences in the workers’ compensation system. It compiles key measures on injured employee outcomes, such as return-to-work rates and health outcomes.

The idea of the study was not to necessarily measure the impact of the drug formulary on outcomes, but to show how the post-formulary outcomes occurred as the system experienced significant decreases in the utilization and cost of many pharmaceuticals, especially so-called “N” drugs and opioids. N drugs, or not recommended, and compound drugs require pre-approval by the insurer before they can be dispensed.

Included in survey questions to injured workers were several relating to best practices used by prescribing physicians.

The injured workers were asked, “When your treating doctor prescribed pain drugs to you, did the doctor:

  • Discuss treatment goals for you, including how much pain you should expect as a result of your injury? — 54 percent said yes.
  • Discuss benefits and risks of you taking the pain drug? — 43 percent said yes
  • Discuss how often and how much of the drug you should take? — 50 percent said yes
  • Ask about other drugs you were taking? — 54 percent said yes
  • Discuss ways you could deal with your pain, especially long-term? — 30 percent said yes
  • Test your urine? — 51 percent said yes.

The injured workers did not indicate they had major problems receiving the prescription drugs they thought they needed for their injuries. “An overwhelming majority said they had no problems in receiving their prescription drugs,” the study says. “Among those with problems, a majority thought it was because the insurance company or health care network did not want this care provided.”

The report showed modest improvements both before and after the closed formulary was implemented. “As the post-formulary utilization and costs of prescriptions decreased, outcomes improved in most measures, especially for network claims,” the study said. “Return-to-work rates and health outcomes increased most years. Medical disputes (which include pharmacy disputes) decreased significantly, a measure of decreasing friction between injured employees and insurance carriers over fees, medical necessity services, and preauthorization.”

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