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BWC First Fill Rule Approved, Measure Focuses on Injured Worker Health and Safety

Tuesday, November 18, 2014

Change allows for immediate fill of necessary medications for new injuries

A new rule approved Friday by the Ohio Bureau of Workers' Compensation (BWC) Board of Directors allows BWC to provide care to injured workers more quickly following an injury. The first fill rule will ensure that injured workers receive necessary medications while the future of their claims is being determined.

"This new rule is significant for injured workers in Ohio, especially those who do not have health insurance or are otherwise unable to foot the bill while awaiting claim approval," said BWC Administrator/CEO Steve Buehrer. "All injured workers should have the same access to immediate treatment, which in some cases is a matter of life and death. Other states have made similar changes, and I'm pleased injured workers in Ohio will now receive the same protection."

The rule will apply to new injuries and allows for immediate fill of prescriptions for acute injury medications prior to formal claim approval. A 1955 statute previously restricted BWC from allowing this change, but recent legislation proposed by BWC allowed for the newly approved first fill rule to develop.

The rule, available here, details the circumstances under which BWC will pay pharmacies for the first fill of prescription drugs before BWC issues initial claim determination orders. In cases where the first fill rule is used, but the claim is ultimately denied by BWC, the medication payment will be charged to BWC's surplus fund account and not to the employer associated with the disallowed claim.

"We anticipate that this rule will be used for a small percentage of injured workers, but that it will nonetheless have a meaningful impact on their quality of life following their injuries," added Buehrer.

If approved by the Joint Committee on Agency Rule Review, the rule is expected to become effective Feb. 1, 2015.

If you have any questions, call CareWorks toll-free at 1-888-627-7586 and ask to speak with your individually assigned CareWorks Account Executive.

Source: Ohio BWC

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