Pharmacy Benefit
Management Program
Texas Mutual Insurance Company partners with ScripNet to help ensure that injured workers get the prescriptions they need for their compensable on-the-job injuries.
If you prescribe medication for the treatment of injured workers, you should be familiar with DWC Rule 134.502.
State adopts pharmacy closed formulary
The Texas Department of Insurance, Division of Workers' Compensation (DWC) has adopted a pharmacy closed formulary for claims occurring on or after September 1, 2011. The formulary is intended to facilitate drug-prescribing consistency between network and non-network claims. DWC has posted the entire list of “N” drugs as published by Official Disability Guidelines (ODG) in Appendix A on its website, free of charge.
Do electronic billing requirements apply to you?
Under Texas law, most pharmacies that dispense to workers' compensation patients in Texas must bill insurance carriers electronically.
For more information, contact ScripNet at providerrelations@scripnet.com or (888) 880-1087.
Your pharmacy may qualify for an exemption if it meets one of these conditions:
- You are a small practice with 10 or fewer employees and workers' compensation accounts for less than 10% of your practice.
- You can show that implementing electronic billing presents an unreasonable financial burden.
Even if you qualify for a waiver, you should consider billing electonically. It saves time, and it reduces paperwork and coding errors.