Ohio: WC board votes to strengthen requirements for group sponsors
The new requirements, which officials said are part of the continued effort to enhance the agency's rate reform efforts, will give the BWC greater opportunities to ensure sponsor associations and their affiliates are marketing their services accurately and responsibly. Certification requirements will apply to the marketing methodologies of all sponsoring associations and their affiliates. According to the agency, actions that could lead to revocation of certification include:
- Instructing prospective employers to provide false information on forms.
- Claiming the sponsoring association, affiliation or representative is endorsed by the BWC.
- Offering discounts or refunds that are unattainable.
Agency selects new pharmacy benefits manager. In addition to the regulations, the bureau announced that it had selected a new pharmacy benefits manager to fulfill the medication needs of the state's injured workers. SXC Health Solutions Corp. was granted a three-year contract valued at $2.5 million annually, which takes effect Nov. 1. The firm was one of five that responded to the agency's request for proposals.
Marsha Ryan, administrator of the BWC, said SXC was the only firm to offer new, Web-based prior authorization technology that will enable prescribers to obtain instant approvals to fill many pharmaceutical requests. Currently, this is a paper process and can take hours to several days in which to acquire authorization. In addition, officials said the contract with SXC is expected to reduce turnaround time for reimbursing injured workers for out-of-pocket expenses. The current processing requirement for paper reimbursement is 30 days. The new contract will reduce this wait time to seven days.
In addition to partnering with a new PBM vendor, Ryan said the BWC plans to increase the use of generic medications to lower pharmaceutical spending, without impacting the quality of care for injured workers. The agency has also begun to collect drug manufacturing rebates for anticipated revenue of more than $5 million in calendar year 2009.
Read more at the WORKERSCOMP ForumTM homepage.
September 3, 2009
Copyright 2009© LRP Publications