DWC Proposes New Rules on Compound Drugs
The Division of Workers’ Compensation has proposed new rules to deal with the problems presented by compound drugs. The agency has announced a public hearing in Austin to take testimony on the proposed rules. In its rule proposal, the Division explains the reason for the suggested changes:
The proposed amendments are necessary to ensure that compounded drugs are prescribed to injured employees only when reasonably required and medically necessary to treat the injured employee’s injury. Preauthorization of compounded drug prescriptions assures that the prescription comports with the commissioner’s adopted treatment guidelines or the network’s treatment guidelines and other treatment standards outlined in the Insurance Code and Texas Administrative Code. Preauthorization may also apply downward pressure on compounded drug system costs because only compounded drugs determined to be medically necessary would be dispensed to injured employees. Of considerable importance, these rule amendments will clarify for stakeholders the division’s requirements regarding compounded drug in the closed formulary.
The Agency will accept public comments on the proposed rules (§§134.500, 134.530, and 134.540). Proposed amendments to §134.500 will exclude from the closed formulary all prescription drugs created through compounding. This means that the rules, if passed, will require preauthorization of all compound medications. The proposed rule changes do not prohibit the use of compounded drugs for injured employees when medically necessary; however, they do require that the medical necessity be determined prior to dispensing these drugs.
The rule proposal will be published in the January 19, 2018 issue of the Texas Register and will be available at www.sos.state.tx.us/texreg/index.shtml once published. A courtesy copy is also available on the TDI website at www.tdi.texas.gov/wc/rules/2018rules.html.
System stakeholders wanting to submit written comments on this proposal, should submit comments by 5 p.m. CST on February 20, 2018. Send written comments by email to rulecomments@tdi.texas.gov or by mail to:
Maria Jimenez
Texas Department of Insurance, Division of Workers’ Compensation, Office of the General Counsel, MS-4D
7551 Metro Center Drive, Suite 100
Austin, Texas 78744-1645
The division will consider written comments and public testimony regarding the proposed rulemaking at a public hearing. The hearing will take place on Thursday, February 15, 2018 at 10 a.m. in the Tippy Foster Room of the Texas Department of Insurance. The hearing will also be audio streamed; to listen to the audio stream, access the DWC Calendar at www.tdi.texas.gov/wc/events/index.html.
Should you have questions regarding this issue, please contact James Sheffield, Steve Tipton, or Bobby Stokes.
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