November 14, 2014
First Fill rule will add convenience for post-injury medical care
The Ohio Bureau of Workers’ Compensation (BWC) has announced a new rule that will improve the initial prescription process for injured employees. The First Fill rule, expected to take effect on February 1, 2015, will allow employees to obtain prescribed medications at no cost before their claim is formally allowed by BWC, and even before a claim number is issued.
Injured employees have typically been required to pay out-of-pocket for medications that were prescribed before the claim allowance was addressed and they would have to wait to be reimbursed for the expense. The new rule will ensure that injured employees receive medications for acute injuries as soon as they are prescribed by the physician. BWC will guarantee payment for this initial prescription provided it meets the requirements set forth in the rule (Ohio Administrative Code 4123-6-21.6).
If the claim is eventually disallowed by BWC, the cost of the medications will be covered by BWC’s surplus fund and will not be billed to the employee. If the claim is allowed, the costs will be charged to the claim along with other medical treatment. There are also a few limitations to the accommodations made through this rule:
- Medical necessity of medication must be supported with clinical documentation
- Approval for medication will be for a period of no more than 10 days
- No refills will be approved
- Only one drug per therapeutic class will be permitted
CompManagement Health Systems was the only MCO consulted by the BWC to evaluate the impact this program would have on Ohio injured workers and employers. Dr. David Kessler, CHS’ medical director, provided testimony that explored the benefits this approach would have for injured employees by reducing the delay and inconvenience involved with the standard process and helping them receive appropriate prescription medication for treatment of acute injuries.
Earlier this year, CompManagement Health Systems (CHS) worked with Walgreens pharmacies to make a similar benefit available to our clients’ injured employees. The BWC’s new rule essentially standardizes this benefit statewide. The Walgreens program is still a great option to keep in mind until the First Fill rule becomes effective.
If you have questions about the Walgreens program or the new First Fill rule, please contact your CHS Account Executive directly or call our customer service team at 888-247-7799.