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Advisory 2002-17

SUBJECT: New Form TWCC-66a, Statement for Pharmacy Services Dated 01/01/03

With the adoption of Rule 134.501, the Commission now issues a final Form TWCC-66a (dated 01/01/03 in the lower left corner), which replaces forms currently in use. This new form is required beginning January 1, 2003, but may be used sooner. The new form is required if the pharmacist wishes to invoke provisions of Rule 134.501, which provides for payment of specified pharmaceutical services sufficient for the first seven days following the date of injury. This is necessary because the new form contains a field for the pharmacist to indicate verification of insurance coverage and receipt of a verbal confirmation of an injury from the employer or from the carrier.

In April 2002 TWCC released an interim form TWCC-66a for review by system participants. The Commission received valuable feedback that was incorporated in revising the form. This Advisory rescinds Advisory 2002-06B (which allowed the use of multiple versions of the TWCC-66a until the form was finalized) and effective January 1, 2003 this new form (dated 01/01/03) will be the Commission's only acceptable form. The Commission allows system participants sufficient time to implement this new form, by not requiring its use until January 1, 2003.

The final form contains several changes that are worth noting.

  • First, there is a place to indicate who to remit payment to if the pharmacy has assigned the benefits to a third party agent.Often pharmacies have arrangements with billing companies that reimburse them directly and then bill the carrier for the medication.Putting this information on the form should facilitate payment to the pharmacy by properly routing payments and should also prevent double compensation (once from the agent and then a second time from the carrier).
  • Second, the form makes it easier to ensure that generic medications are being distributed in all cases other than those when a generic is nonexistent or when the prescribing doctor has indicated that it is medically necessary to "dispense as written." The form now provides space to indicate whether the medication that was dispensed was generic or name brand.As follow-on questions for when name-brand medications are provided, the form requires the provider to indicate if a generic alternative was available, and if generic is available to indicate whether the doctor required the medication to be dispensed as written.The follow-on questions are only required when a brand-name medication is dispensed.
  • The new form uses a number of checkboxes to indicate answers to questions and for the provider to provide the affirmation to invoke the provisions of Rule 134.501 relating to the initial pharmaceutical coverage period. Some providers have indicated they use "dot-matrix" printers which makes use of check boxes difficult. Therefore, providers are free to program the form into their system and simply place an "X" in a blank (rather than a box) if that is easier for them to reproduce.

Signed on this 31st day of October, 2002

Richard F. Reynolds, Executive Director

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