Texas Closed Formulary Resource Center

With the second phase of Texas Closed Formulary regulations upon us, payers are faced with the daunting task of eliminating "N" drugs on legacy claims with an injury date on or before September 1, 2011.

This resource center is tailored specifically to help payers navigate legacy claim cleanup for the September 1, 2013 deadline. Here you will find resources dedicated to helping you understand the regulation, learn about the cleanup process and take necessary actions to ensure compliance.


What You Need to Do

It's essential that payers act now to ensure they meet the upcoming deadline and avoid fines of up to $25,000 per day per claim. Engaging prescribing physicians to modify treatment plans and weaning injured workers from "N" drugs will take time.

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PRIUM's QMI process eliminates the administrative burdens placed on your claims professionals. Our innovative approach leverages physician-to-physician engagement to ensure that injured worker treatment plans are modified using evidence-based guidelines. See how our approach works for yourself:

Learn more about our Texas legacy QMI process

Prium Resources

Texas Closed Formulary Webinar - On Demand

Watch PRIUM's webinar on legacy claim compliance, hosted by PRIUM's TCF expert, Mark Pew. This continuing education webinar was designed to help the audience understand:

  • What Texas Closed Formulary legacy claim cleanup means to your organization
  • The process for compliance
  • Benefits of compliance including reduced claim costs, improved outcomes

Texas Legacy Qualified Medical Intervention Program
An overview of PRIUM's award winning QMI program and how it uniquely and effectively addresses cleanup of legacy claims.

Legacy Cleanup, Texas Style
With the successful implementation of the Texas Closed Formulary on prescription drugs for workers' compensation claims, the focus now must shift to the cleanup of legacy claims.

Claim Cleanup: Review of Texas' Closed Formulary and National Implications
Mark Pew's co-presentation with Jim Andrews of Healthcare Solutions from the 2012 National Workers' Compensation and Disability Conference & Expo.

Evidence-Based Blog

November 1, 2012

Texas Closed Formulary: Still an Education Gap

May 8, 2012

Texas: The Clock is Ticking on Legacy Claims

January 27, 2012

Texas Closed Formulary: Just Do It

January 25, 2012

Texas Closed Formulary – 9/1/2013, Legacy Claim Cleanup

January 3, 2012

Texas Closed Formulary: So Far, So Good…But What About the Legacy Claims?


Other Resources

Texas Department of Insurance Division of Workers’ Compensation Pharmaceutical Benefits
Resource page provided by the Texas Department of Insurance, Division of Workers’ Compensation – includes a variety of official documents and links that outline rules and regulations for the pharmacy benefits in the state of Texas.

Listing Status of “N” Drugs
Official listing from the Texas Department of Insurance, Division of Workers’ Compensation of drugs that are not recommended (“N” drugs) for treatment of injured workers. These drugs are the signifiers of legacy claims that may need clean up under the new Texas regulations.

Prescription Benchmarks, 2nd Edition: Trends and Interstate Comparisons
Study conducted in 2011 by the Workers Compensation Research Institute, summarizing the results of the first phase of Texas Closed Formulary for workers' compensation claims.