Beginning February 28, 2018, in accordance with the discretion granted to DOL and delegated to the Office of Workers' Compensation Programs (OWCP), the Division of Federal Employees' Compensation (DFEC) is instituting a new policy to deny payment of a select group of Pharmaceutical and Non-Pharmaceutical items. The list of items to be denied will be identified by National Drug Code (NDC) and includes, but is not limited to, convenience kits. Any bill identified as containing a charge for any such non-covered NDC will be denied in its entirety. A listing of non-payable NDCs will be available on DFEC's website at https://www.dol.gov/owcp/dfec/.
Beginning February 22, 2019, in accordance with the discretion granted to DOL and delegated to the Office of Workers' Compensation Programs (OWCP), the Division of Federal Employees' Compensation (DFEC) is instituting a new policy to deny payment of a select group of FDA Medical Devices. The list of items to be denied will be identified by National Drug Code (NDC). Any bill identified as containing a charge for any such non-covered NDC will be denied in its entirety. A listing of non-payable NDCs will be available on DFEC's website at https://www.dol.gov/owcp/dfec/.
Beginning in August 2017, the Office of Workers' Compensation Programs (OWCP) Division of Federal Employees' Compensation (DFEC) will require claims with newly prescribed opioid use (i.e. claims where an opioid has not been prescribed within the past 180 days, if ever) to have a completed and approved Letter of Medical Necessity (LMN) form on file for prescription authorizations after an initial 60 day period. Additionally, compounded medications containing opioids will require a completed and approved LMN prior to dispensing, effective June 26, 2017. This form will be made available to registered providers beginning in June 2017 at https://owcprx.dol.gov/portal/main.do.
To submit the form, providers must click on the 'Provider' Link to the right of the DFEC oval located at the top left of the home page, login with their user ID and password, and then click on the 'LMN Documents' link located in the left menu bar. For providers not yet registered, after clicking the 'Provider' link, click the 'Web Registration' link located in the left menu bar to register for web access. For providers not yet enrolled, click on 'Forms & Links' in the horizontal menu at the top of the home page to download the Provider Enrollment form and instructions. Authorizations for opioid medications will be limited to a maximum of 60 days, with initial fills and refills to be issued in no more than 30-day supplies. Beneficiaries already receiving opioid prescriptions will not be subject to the LMN requirement at this time. For additional information, please see the DFEC website at https://www.dol.gov/owcp/dfec/ for further information under the "Latest News" section.
Beginning May 2017, in accordance with the discretion granted to DOL and delegated to the Office of Workers' Compensation Programs (OWCP), the Division of Federal Employees' Compensation (DFEC) is instituting a new policy on filling non-maintenance medications for the treatment of work-related injury or illness. The program's policy will limit the fill of non-maintenance medications to 30 day increments. Additionally, refills cannot be obtained until 75% of the prescription timeline has passed. Maintenance medications (such as those used to treat chronic conditions like high blood pressure and asthma) will not be subject to these limitations. In determining what constitutes a maintenance medication, DFEC will be relying primarily on First Data Bank classifications. Physicians seeking to have the 30 day/75% fill requirement waived for non-maintenance drugs should submit a written request directly to the responsible DFEC district office because there is no method of requesting an exception through the Web Bill Processing Portal. Waiver of the fill requirements for non-maintenance drugs will be authorized on an exception basis only based on approval of the OWCP Chief Medical Officer or his/her designee.
Beginning March, 2017, in accordance with the discretion granted to DOL and delegated to the Office of Workers' Compensation Programs (OWCP), the Division of Federal Employees' Compensation (DFEC) is instituting a new policy for authorizing herbal supplements prescribed by physicians for treatment of work-related injuries or diseases. The Program's policy will be to not authorize payment for herbal supplements, unless a claimant's treating physician acquires prior authorization by submitting rationalized medical evidence that supports the herbal supplement's safety, effectiveness, and necessity. To implement this policy, OWCP will rely primarily on First DataBank (FDB) classification. Physicians wishing prior authorization for an herbal supplement should submit a written request directly to the responsible District Office as there is no form or other provision for authorization to be requested through the Web Bill Processing Portal. Herbal supplements are authorized only on an exception basis on approval of the OWCP Chief Medical Officer or his/her designee. For more information, please visit the DFEC website: https://www.dol.gov/owcp/dfec/PolicyOnHerbalSupplements.htm
Generic Medications: For services billed on or after July 1, 2016, the Office of Workers' Compensation Programs (OWCP) Division of Federal Employees' Compensation (DFEC) will calculate the maximum allowable fee for generic drugs at 60% of the average wholesale price (AWP) plus a $4.00 dispensing fee.
- 50% of AWP of each NDC in the compounded drug, for compounded drugs containing three or fewer ingredients
- 30% of AWP of each NDC in the compounded drugs, for compounded drugs containing four or more ingredients
Effective July 1, 2016, the initial prescriptions for compound medication should be for a period not to exceed 90 days. Initial prescriptions for periods greater than 90-days may be subject to further review for medical necessity.
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