Workers’ Compensation Pharmacy Benefit Plan

prescriptions benefits cases

Board Proposes New Workers’ Compensation Pharmacy Benefit Plan. The rapid pace of change in the pharmaceutical industry over the last few years has rendered the Board’s pharmacy benefit structure inadequate to address the overwhelming number of new medications that have been introduced to the medical community.

The Board’s current pharmacy benefit describes reimbursement levels for brand, generic and compounded products, but otherwise provides little structure or guidance to prescribers. There is no drug formulary in place; no requirement for pre-approval/prior authorization; no process to ensure the appropriateness of prescribed medications. The overriding goal of a new Pharmacy Benefit Plan is to ensure that injured workers receive clinically appropriate, cost-effective medications as part of their medical care.

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