Pharmacy Closed Formulary Sample Notification Letters for Fentanyl Transdermal Patches and MS-Contin

The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) notified system participants that the Work Loss Data Institute (WLDI), publisher of the ODG, will make changes affecting two drugs listed in Appendix A, ODG Workers’ Compensation Drug Formulary. Effective February 1, 2016, Fentanyl Transdermal Patches and MS-Contin will change status from “Y” to “N.”

In preparation for the transition of Fentanyl Transdermal Patches and MS-Contin to the “N” drug status list of ODG’s Appendix A, TDI-DWC strongly encourages insurance carriers to initiate communication with the injured employee, prescribing doctor, and pharmacy (if known). Insurance carriers should identify all injured employees that have been prescribed Fentanyl Transdermal Patches and/or MS-Contin and send a written notification to the injured employee, prescribing doctor, and pharmacy (if known) informing them that these drugs will require preauthorization approval starting February 1, 2016. Notifying these parties immediately will ensure that there is adequate time to discuss and coordinate the ongoing course of treatment if Fentanyl Transdermal Patches and/or MS-Contin are currently being prescribed.

The TDI-DWC has created sample notification letters that insurance carriers may use for notifications. The sample notification letters were developed as a courtesy to encourage timely and effective communication for injured employees. Insurance carriers are under no obligation to use these sample templates to initiate their notification process.

Insurance carriers and system participants may also reference the pharmacy page on the TDI website at http://www.tdi.texas.gov//wc/pharmacy/index.html.

If you have any questions regarding the sample notification letters, contact Comp Connection for Health Care Providers at (800) 372-7713, option 3 or by email at medben@tdi.texas.gov.

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