December 5, 2017

TDI-DWC Issues Reminder on Pharmacy Informal & Voluntary Network Requirements

Austin, TX – The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) recently issued a notice reminding all workers’ compensation system participants of the requirements in Texas Labor Code §§408.0281 and 408.0282, regarding pharmacy informal and voluntary networks.

Registration Requirements
Pursuant to Texas Labor Code §408.0282, all pharmacy informal or voluntary networks must register with the TDI-DWC not later than thirty days after the network is established and must report any changes in information previously reported to the TDI-DWC within thirty days of the change.

Pharmacy informal and voluntary networks must report the information required by Texas Labor Code §408.0282 to the TDI-DWC through its online reporting system that can be found through the TDI website here: TDI-DWC Pharmacy Informal Network Reporting.

For further information on this registration process, system participants should refer to the TDI-DWC’s Frequently Asked Questions on this topic found on the TDI website.

Failure for a pharmacy informal or voluntary network to comply with these registration requirements is an administrative violation.

Health Care Provider Reporting Requirements
In accordance with Texas Labor Code §408.0281, an insurance carrier, its authorized agent or the pharmacy informal or voluntary network, as appropriate, must notify each health care provider, at least quarterly of any person, other than the injured employee, to which the network’s contractual fee arrangements with the health care providers are sold, leased, transferred or conveyed. The notice must contain certain information listed in Texas Labor Code §408.0281(d) and the delivery of the notice must be documented. The initial notice must be sent to health care providers not later than the 30th day after the effective date of the health care provider’s contract and subsequent notices sent on a quarterly basis thereafter.

Failure to comply with the provisions of Texas Labor Code §408.0281, including health care provider notice requirements, is an administrative violation. Insurance carriers are responsible for any sanction imposed for these violations, regardless of whether the insurance carrier or its authorized agent committed the act or acts of noncompliance.

Delivery of Pharmacy Services
The TDI-DWC also reminds system participants that prescription medications or services may not be delivered by a certified workers’ compensation health care network under Texas Insurance Code Chapter 1305 or by a political subdivision that directly contracts with health care providers pursuant to Texas Labor Code §504.053(b)(2).

Source: TDI-DWC

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