Compliance Corner
It’s not news that generic medications typically cost less than their brand name counterparts, but what happens if an injured worker says they have to have the brand and won’t do generic?
Simply Research covers that information. For example, here’s how Ohio addresses the situation.
In Ohio, injured workers who request a brand name drug or whose physician specifies a brand name drug designated by “dispense as written” on the prescription for a medication for which pharmaceutically and therapeutically equivalent medication exist shall be liable for the product cost difference between the AWP of the dispensed brand name drug minus 15% and the established maximum allowable cost price of the drug product.
However, the bureau may approve reimbursement of the dispensed brand name drug if either of the following circumstances is met:
(1) The injured worker has a documented, systemic allergic reaction as a result of taking the generic equivalent.
(2) The injured worker has not achieved the intended therapeutic benefit after a reasonable trial or an unacceptable adverse event has occurred as a result of taking the generic equivalent.
