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Provider eNews - December edition

Pharmacy program coverage changes cont.

Formulary changes for hypnotic agents, Metaxalone, Butalbital and benzodiazepine products go into effect Jan. 1, 2014. There are also new rules for non-sterile compound products and Ohio Automated Rx Reporting System (OARRS) registration.

  • Formulary revisions (Effective Jan. 1, 2014)
    • New prescriptions for hypnotic agents are limited to zolpidem IR, zolpidem ER, temazepam, ezopiclone and zaleplon effective Jan. 1, 2014
    • Current prescriptions for non-formulary hypnotics stop paying June 1, 2014. New prescriptions for metaxalone are subject to step therapy effective Jan. 1, 2014. You must try one other skeletal muscle relaxant (SMR) for 10 days and demonstrate failure. Current prescriptions for metaxalone stop paying April 1, 2014.
    • New prescriptions for any butalbital-containing product restricted to 24 doses per month effective Jan. 1, 2014.
    • Current injured workers receiving butalbital-containing prescriptions restricted to 24 doses per month effective June 1, 2014.
    • All prescriptions for benzodiazepine products are limited to the equivalent of 40 mg diazepam per day effective Jan. 1, 2014.
    • Current injured workers receiving benzodiazepine doses greater than the equivalent of 40 mg diazepam per day are limited to their current dose beginning Jan. 1, 2014.
    • You can find the complete BWC formulary in the appendix of rule 4123-6-21.3.
  • Non-sterile compound products (Effective Jan. 1, 2014)
    • To be eligible for reimbursement, the final product can contain no more than three active ingredients from three separate drug classes (no duplication of drug classes) with a reimbursement cap of $600 or the standard fee schedule. This is for whichever is less.
    • All new compounded prescriptions will require a Request for Prior Authorization of Medication (MEDCO-31).
    • The prescriber must submit a copy of the prescription with the cost of the product along with the MEDCO-31 request.
    • All initial prior authorizations will be for 90 days with any ongoing approvals contingent on documentation of efficacy.
    • You may view the full language of the revised rule in Section E.
  • OARRS registration required (Effective Jan. 1, 2014)
    • All prescribers of controlled substances used for chronic care must register in the OARRS for BWC to cover their controlled substance prescriptions.
    • Pharmacies will receive a reject edit stating "Prescriber must be registered in OARRS for coverage." You can find the full language of the revised rule in Section B3.