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Amendment to Georgia WC Medical Fee Schedule
Released: 03/25/2011
By: Jennifer Fuqua

The following amendment will be made The Georgia Workers Compensation Medical Fee Schedule of April 1, 2011, adopted by the State Board of Workers Compensation and will become effective April 1, 2011.

Page 10, Section IV: General Reimbursement Requirements

Pharmaceuticals:
All prescription drugs must be dispensed using an Orange Book therapeutic equivalent drug(s) (GENERIC) when available unless designated in the doctor’s own handwriting on the face of the prescription, in accordance with O.C.G.A. article 26-4-81, that Brand Medically Necessary or Brand Necessary is required.

Prescription drugs will be reimbursed at the current average wholesale price (AWP) as published by Medispan, plus a dispensing fee of $6.15 for generic medications and $4.11 for single source brand medications. All bills submitted for reimbursement must include the National Drug Code (NDC) of the product provided unless the product provided is a repackaged unit of use product. All pharmaceutical bills submitted for repackaged products must include the NDC of the original manufacturer or distributer stock package used in the repackaging process. The reimbursement allowed shall be based on the current published manufacturers AWP price of the product as of the date of dispensing.

When the authorized treating physician prescribes pharmaceuticals, the prescription will indicate by stamp or other means that it is for a workers compensation claim.



Related Link: www.sbwc.georgia.gov

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