28 Texas Administrative Code Chapter 134, Subchapter F, concerning pharmaceutical benefits was updated. Sections 134.506 and 134.510 were removed, and Sections 134.500, 134.501, 134.502, 134.503, 134.504, 134.520, 134.530, 134.540, and 134.550 were revised to remove outdated parts and to make references and wording consistent with other rules.
- §134.500. Definitions. Includes key definitions pertaining to all pharmaceutical benefit rules. Amended April 2018.
- §134.501. Initial Pharmaceutical Coverage. Provides for payment of pharmaceutical services sufficient for the first seven days following the date of injury.
- §134.502. Pharmaceutical Services. Requires doctors to prescribe generics and over-the-counter alternatives when appropriate.
- §134.503. Pharmacy Fee Guideline. Concerns the reimbursement of pharmaceutical services for brand name and generic drugs which are based on the average wholesale price times a multiplier. Details of reimbursement methodologies for compounds and over-the-counter medications are described in this rule.
- §134.504. Pharmaceutical Expenses Incurred by the Injured Employee. Provides a process for the claimant to obtain reimbursement for medications that have been purchased out-of-pocket.
- §134.520. Outpatient Closed Formulary for Dates of Injury On or After September 1, 2011. Applies the closed formulary to dates of injury September 1, 2011, and forward.
- §134.530. Requirements for Use of the Closed Formulary for Claims Not Subject to Certified Networks. Describes the requirements for use of the closed formulary for non-network claims. Amended April 2018.
- §134.540. Requirements for Use of the Closed Formulary for Claims Subject to Certified Networks. Describes the requirements for use of the closed formulary for certified network claims. Amended April 2018.
- §134.550. Medical Interlocutory Order, or MIO. Provides a means for an injured employee to continue use of the previously prescribed and dispensed drug(s) throughout the duration of the appeals/dispute process after a preauthorization denial. A pharmacy or prescribing doctor can submit a request for an MIO using DWC Form-064, Medical Interlocutory Order Request.