NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.
Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.
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The State Office of Administrative Hearings recently decided to deny payment for compounded
medications which are usually various topical creams which are touted as relieving pain or healing
scars. Texas insurance carriers have been seeing bills of more than $12,000 for a one month
prescription. It was thought by some that so long as the compound didn’t contain an “N” drug from
the DWC’s closed formulary, preauthorization under DWC Rule 134.600 was not required. But the
insurance carrier in this case decided to deny payment based on the defense that Rule 134.600
requires that investigational or experimental drugs be preauthorized. SOAH determined, based on
expert testimony from Dr. Suzanne Novak and her expertise in the application of the ODG treatment
guidelines, that compounded drugs are by their very nature investigational and experimental. That
being the case, the creams would require preauthorization. Many in the pharmacy and treatment
industries disagree, but for now, at least we know which way the wind is blowing.