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TDI-DWC Issues Reminder on Direction of Care Prohibitions for Pharmacy Services

December 15, 2013 - WorkCompWire

Austin, TX – Texas workers’ compensation system participants are reminded that insurance carriers, including their agents, are prohibited from requiring that injured employees receive pharmacy services from certain pharmacies. Injured employees may fill prescriptions at the pharmacy of their choice as long as the pharmacy accepts workers’ compensation. The Texas Labor Code specifically addresses this as follows:

§408.028. Pharmaceutical Services.

  • (c) Except as otherwise provided by this subtitle, an insurance carrier may not require an employee to use pharmaceutical services designated by the carrier.

§408.0281. Reimbursement for Pharmaceutical Services; Administrative Violation.

  • (b) Notwithstanding any provision of Chapter 1305, Insurance Code, or §504.053 of this code, prescription medication or services, as defined by §401.011(19)(E):
  • (2) may not be delivered through:
    • (A) a workers’ compensation health care network under Chapter 1305, Insurance Code; or
    • (B) a contract described by §504.053(b)(2)
  • Source: TDI-DWC

Filed Under: Industry News, Legislative & Regulatory News, Top Stories, Workers' Compensation

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