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Good Evening
5:04:07 PM CDT
Wednesday, April 23, 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  

First Fill Program
The First Fill Program allows pharmacies to provide medication immediately to injured workers. Prescribed medications can be dispensed in a timely manner while ensuring payment to the pharmacy. Under this program:

  • Pharmacies will be guaranteed payment for the initial prescriptions of 7 days, not to exceed a total of $100.
  • Charges may be submitted without a claim number, but require the following information:
    • Patient name (first and last)
    • Date of birth
    • Social Security Number
    • Date of injury
    • Employer name
  • Date of injury must be within 30 days from the date of service
  • First Fill Product Exclusions provides a complete list
  • Injured workers qualify for the First Fill program once every six months.
  • Injured workers with claim numbers do not qualify for the First Fill program. Those charges are processed by the on-line adjudication system.

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