OhioBWC - Provider - Service:  (Prior authorization requirements)

Prior authorization requirements

BWC constantly strives to control costs for employers while also providing the highest quality of care for injured workers. The bureau works with all stakeholders, including medical professionals, toward achieving this goal.

BWC and its Pharmacy and Therapeutic Committee designed an outpatient medication prior authorization (PA) programs to ensure injured workers:

  • Only receive reimbursements for medications used to treat work-related injuries or illnesses;
  • Have access to preferred drugs.

Program details
BWC requires injured workers to get prior authorization for certain drugs not typically used to treat work-related injuries or illnesses (when there is not an allowed condition in the claim that is included among the FDA-approved uses of the prescribed drug). Since physicians don't often prescribe many of these medications for workplace injuries or diseases, BWC seeks to ensure that injured workers who use these drugs do so safely. The program also helps to ensure that injured workers get the right drugs they need for recovery and a healthy return to work.

Injured workers who want to continue receiving these medications must ask their physicians to complete the MEDCO-31 and fax it to OptumRx. The fax number is on the form. An independent physician will review each case. Then, BWC will let the injured worker know if his or her request for prior authorization is approved.

For more information on drug classes not typically associated with treating workplace injuries and illnesses, click here.