If your workers’ comp accident and injury were approved and allowed by Ohio BWC, then yes, workers’ comp will pay for your prescriptions prescribed by your comp doctor.
I originally paid for the prescription. How can I be reimbursed?
The pharmacist needs to submit the bill information to the BWC’s Pharmacy Benefits Manager (PBM). If the pharmacy does this, you will automatically be reimbursed once your claim is allowed. If you paid as a “cash customer” and the bill information was not submitted to the PBM, ask the pharmacy to complete the Outpatient Medication Invoice (C-17).
Important things to remember
- You have a 1 year deadline from date of service to be reimbursed.
- To be reimbursed, all medications (even over the counter meds) need to be prescribed by a medical professional licensed to prescribe drugs and dispensed by a pharmacy enrolled as a BWC provider.
- Medical supplies, durable medical equipment and other non-drug items have a different reimbursement process. A separate invoice should be sent to the MCO (managed care organization).
Can I be reimbursed for co-pay if my health insurance originally paid for the script?
That’s a no. Any scripts related to a work injury need to be submitted to the BWC’s Pharmacy Benefits Manager (PBM). BWC will not reimburse you for any co-pays.
My medication was denied for requiring a prior authorization. How do I get prior authorization?
The medical professional prescribing your meds should contact BWC's Pharmacy Benefits Manager, ACS State Healthcare at 1-800-644-6292. Or, the prescriber should complete a Medco-31 or Medco-32 (for non-preferred medication). Basically, you need to call your doctor and ask them to make sure your meds are authorized. They should be able to manage this for you.
If you have any questions about your prescriptions or other workers’ comp claim related concerts, don’t hesitate to reach out to experienced and dedicated attorneys at Garson Johnson. We have decades of experience focusing on the Ohio workers’ comp law and BWC system.
***BWC will only reimburse medications that are listed on the BWC medication formulary.