New “N” Drug Classifications in Texas and Oklahoma: Essential Information for Claims Professionals

by Phil Walls, RPh
Chief Clinical Officer

The Texas Department of Insurance Division of Workers’ Compensation has announced that both Duragesic® (fentanyl) transdermal system patches and MS Contin® (morphine sulfate) extended-release tablets will be classified as “N” Drugs, effective February 1, 2016.  These drugs belong to a drug class known as long-acting opioids, which also includes current “N” Drugs like OxyContin® and Opana ER®.

Texas and Oklahoma both require preauthorization for drugs classified as “N” in the current edition of the ODG Workers’ Compensation Drug Formulary/Appendix A.  In Texas, the preauthorization requirement is applicable if the injured employee’s date of injury is on or after January 1, 1991.  In Oklahoma, preauthorization is required for “N” Drugs if the injured employee’s date of injury is on or after February 1, 2014.

“Y” Drug alternative: Ultram

As of February 1, prescribers will still have a “Y” Drug choice for long-acting pain medication:  Ultram ER®.  Ultram ER’s safety profile makes it a better option to other long-acting opioids, but it has not been a drug physicians routinely prescribe as an alternative to Duragesic or MS Contin.

What are the advantages and disadvantages of Ultram ER (tramadol) over one of the soon-to-be reclassified “Y” drugs?

• Advantage: Extended release Ultram (tramadol) is available generically with a corresponding cost savings.

• Ultram ER is a Schedule IV controlled substance—meaning that the potential for abuse and addiction is much lower than with Schedule II opioids like Duragesic and MS Contin.

• Disadvantage: Ultram ER must be converted in the body to an active metabolite.  Therefore, not everyone metabolizes this medication in the same manner, and this could complicate the dose conversion for some patients.

For more information about state formulary changes and other regulatory news, please click here.