BWC Proposes Changes to Formulary, Fee Schedules

Tuesday, March 20, 2018 | 0

The Ohio Bureau of Workers’ Compensation has announced proposed changes to fee schedules, claims procedures, adjustment factors and its vaunted drug formulary.

The bureau is accepting public comments on the fee schedules and formulary changes until Thursday, March 22, and on the claims procedures until April 12, according to information released Monday.

If approved later this spring, the formulary changes would:

• Remove the opioid antagonists Suboxone (buprenorphine and naloxone) and Subutex (buprenorphine only) from the list of approved outpatient medications covered by workers’ compensation insurance.
• Add the drugs Belbuca, a long-acting opioid, and Bunavail, for opioid detoxification. Belbuca prescription dosages would be limited to 900 micrograms every 12 hours, the bureau said.
• Limit triptan migraine medications to one product per month.
• Require prior authorization for benzodiazepine sedatives for prescriptions after 30 days of continuous use.

The bureau also proposes to dismiss, not just suspend, applications for permanent partial disability (known as C-92 applications) when the injured worker fails to schedule or attend an independent medical examination.

In keeping with a federal appeals court ruling in Ohio Hospital Association v. Ohio Bureau of Workers’ Compensation, the Bureau also has proposed changes in how it calculates payments to ambulatory surgical centers and to hospital outpatient services.

Details about the changes and the fee schedules are available at the Bureau’s website.