Pharmacy

The pharmaceutical benefits rules in Title 28 of the Texas Administrative Code §134.500 through §134.550 apply to both workers' compensation claims that are part of certified health care networks (network claims) and those that are not (non-network claims).

These rules explain how pharmacy services work, including the first steps in providing care, prescribing generic or brand-name drugs, and offering over-the-counter options. They also cover a list of approved drugs, pharmacy payment guidelines, and other important details. Knowing these rules is important for prescribing the right medicine and getting paid correctly.

Pharmacy rules

Guidelines outlining key definitions, pharmaceutical coverage, criteria for prescribing generics, and other important regulations for optimal patient care.

Pharmacy closed formulary

An overview of the DWC closed formulary, including preauthorization requirements for prescribing medications excluded from the closed formulary.

Appendix A (N status drugs)

A convenient reference for identifying drugs requiring preauthorization (N status drugs) as listed in Appendix A of the ODG Workers’ Compensation Drug Formulary.

Pharmacy fee guideline

Guidance on calculating pharmacy reimbursement rates and the process for submitting bills.

Direction of care prohibitions

Information on how injured employees have the right to choose their preferred pharmacy.

Related resources

Access information on informal/voluntary networks, preauthorization, pharmacy-related studies, and a variety of pharmacy resources, including on-demand training videos for health care providers.

For more information, contact: CompConnection@tdi.texas.gov