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Good Afternoon
4:32:09 PM CDT
Thursday, April 24, 2014

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Pharmacy Benefit Management

Topics First Fill Program Forms & Publications Service Guide for Pharmacists
Pharmacy Overview Sign Up Process Prior Authorization Form (M3) Quick Reference Sheet
US Script Pharmacy Fee Schedule Formulary/Product Resrictions Brand Medication Prior Authorization Form (P2)
Plan Benefits Generic Dispensing Drug Quantity Limits Relistor Prior Authorization Form (P3)
Plan Design First Fill Product Restrictions DAW1 Policy Statement
    Sample Narcotic Contract  

Generic Dispensing
To maintain a cost effective approach for medications, WSI reimburses for generic medications prescribed for the work injury. If an injured worker is requesting a brand medication when an equivalent generic is available, the injured worker will be required to pay the cost difference for the brand medication. In the absence of a generic equivalent medication, a brand medication would be covered by WSI.

WSI has a prior authorization procedure for prescriptions being written with the “Brand Necessary” or DAW 1 orders. When the prescriber is indicating a medication to be filled as “Brand Necessary,” WSI requires the prescriber provide documentation to substantiate the need for the brand product versus the equivalent generic.

Some additional points concerning dispensing branded medications:

  • If the DAW1 requires prior authorization, the following message will be sent from US Script: “DAW 1 Requires Prior Auth. Call WSI @ 1-800-777-5033.” Another option is to call the WSI pharmacy director directly at 701-328-7222
  • WSI contacts the prescriber and requests written documentation substantiating the need for the brand product versus the generic equivalent
  • WSI contacts US Script with an approval or denial
  • WSI and/or US Script contacts the pharmacy with an approval or denial
  • If the request is denied, the injured worker has the option of paying the cost difference between the generic and brand product
  • Prior authorization will be specific for the drug, dosage form, and strength

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