Outpatient medications paid for prior to a claim being allowed by the BWC takes effect February 1, 2015

by Kara Dolan-West | Jan 30, 2015 | Medical Care Benefits

The BWC’s Board of Directors adopted O.A.C. 4123-6-21.6, which provides for first fill of outpatient medications.  This rule, expected to take effect on February 1, 2015, permits the BWC to approve payment for prescription medication for certain drugs (listed in an appendix to the rule) before the administrator makes the initial determination whether to allow the claim.  The rule also permits the BWC to provide first fill reimbursement for prescription medication not included in the appendix “in cases of medical necessity supported by clinical documentation and evidence of need.” Under this plan, the BWC will pay for no more than ten days worth of prescription medication, with no refills permitted.

Tags: medications; pills; medicine; medications paid for