BWC’s Billing and Reimbursement Manual is a great tool for information on outpatient medication covered and non-covered services, billing rules and laws, instructions for completing BWC billing forms and a guide for explanation of benefits.

You can find information on BWC’s outpatient medication program in Chapter 3, Section D and Chapter 4, sections D and E.

Highlights of coverage changes in 2005

• Compound medications - Effective July 10, 2005, BWC no longer reimburses injured workers for compound medications purchased at a pharmacy through the Pharmacy Benefits Manager. However, the injured worker’s managed care organization (MCO) may cover compound medications. Providers may contact the injured worker’s MCO for additional details and to determine if it will reimburse compound medications.
• Ketorolac tablets - Effective July 10, 2005, Ketorolac tablets will have a quantity limit of 20 tablets or five-day supply (whichever is fewer) as a one time prescription for the duration of the claim.
• Preferred drug program - Effective July 10, 2005, BWC will implement a preferred drug list prior authorization program for select drug classes for state-fund claims.
• Generic drugs - Effective Oct. 1, 2005, for all claims regardless of the date of injury, BWC will no longer reimburse for brand name drugs when a generic equivalent is available.