2022 average medical costs, six months post-injury: $2,897 (non-network); $2,886 (network).
- Since 2017, non-network average medical costs per claim at six months post-injury had been approximately 4% higher on average than network claims. The difference narrowed in 2022 as networks’ average medical costs increased by 14%.
- The medical cost gap widened between network and non-network claims 18 months post-injury: Network medical costs were about 12% lower per claim than non-network claims.
- Nationwide, in 2022, the change in the Consumer Price Index (CPI) for medical care was 4.1%; the change in medical cost per lost-time claim was 5%.
Health Care Costs (Overall)
Average Overall Medical Cost per Claim, Six Months Post-Injury
Health Care Costs (Professional)
Average Professional Cost per Claim, Six Months Post-Injury
Health Care Costs (Hospital)
Average Hospital Cost per Claim, Six Months Post-Injury
Health Care Costs (Pharmacy)
Average Pharmacy Cost per Claim, Six Months Post-Injury
Success of Pharmacy Closed Formulary
A major component of the 2005 legislative reforms was DWC’s adoption of a pharmacy closed formulary for injured employees in the Texas workers’ compensation system. DWC first implemented a pharmacy closed formulary in 2011 to manage drug prescriptions to injured employees. The formulary significantly reduced drug costs and improved injured employee outcomes and return-to-work rates. Between 2009-2022:
- Pharmacy costs decreased 73% (from $163.7M to $44.1M)
- Overall opioid prescription costs decreased- Opioid N status drug costs decreased 97% (from about $18.1 million in service year 2009 to about $603,000 in 2022), opioid non-N status drug costs declined 88% (from about $30.8 million to $3.6 million)
- Total number of prescriptions decreased 73% (from 1.7M to 442,000)
- Total number of opioid prescriptions decreased 86% (from 555,000 to 78,000)
- Total number of generic prescriptions increased 21% (from 74% to 95%)
Return to Work
- Since 2012, network claims consistently report higher return-to-work rates than non-network claims.
- Overall, network claims had higher return-to-work rates than non-network claims.
- Ninety-four percent of injured employees in the network returned to work compared to 89% non-network. The non-network was up slightly from 84% in 2021.
- The average number of weeks employees reported being off work because of a work-related injury is five weeks in network, compared to eight weeks non-network.
- Most networks had a higher percentage of injured employees who reported no problems getting needed medical care after their injury than non-network claims.
- Physical functioning measures a person’s ability to do everyday tasks. Mental functioning measures a person’s ability to think and reason. 2022 network claims reported higher physical and mental functioning scores than non-network claims. This generally means injured employees who received network medical care reported better physical functioning and quality of life outcomes than non-network injured employees.