W. Va. Code R. § 85-26-11

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 85-26-11 - Preferred Drug List

11.1. Purpose. In accordance with the provisions of the Workers' Compensation Act [23-4-3(a)(3)] that require pharmacists, filling a prescription for medication for a workers' compensation claimant, to dispense a generic brand of the prescribed medication if the generic brand exists and in accordance with HCAP's responsibility to establish guidelines for reasonably required health care treatment for occupational injuries and diseases, HCAP shall establish a Preferred Drug List (PDL) for the purposes of:

a. Improving the quality of care of claimants by utilizing a PDL of generics and brand medications in the absence of generics;

b. Affecting cost savings in the provision of health care services by determining what is reasonably required; and

c. Optimizing pharmaceutical care and cost effectiveness.

11.2. Determinations. Considering the purposes the PDL, HCAP shall determine:

a. Therapeutic classifications;

b. Generic medications associated with each therapeutic class; and

c. Certain brand name medications associated with each therapeutic class for which a generic medication is not available.

11.3. Medications prescribed that are not listed on the PDL are subject to the approval of the Commission. In determining whether to approve or not approve the prescription, the Commission shall consider whether any generic or brand name medication for the same therapeutic class is listed on the PDL. If a generic or brand name medication is listed for that therapeutic class, the Commission shall not authorize the prescription.

a. Medications prescribed for off-label use shall not be approved.

b. "Off-label use" means that the medication is prescribed for a condition, which is inconsistent with the manufacturer's label or instructions.

11.4. Procedure. Determinations made by HCAP shall be made in the following manner.

a. HCAP shall make any determination or determinations at a public meeting or meetings held in accordance with the provisions of this rule.

b. The determinations shall be filed with the office of the secretary of state for publication in the state register pursuant to the provisions of W. Va. Code § 29A-2-1 et seq.

11.5. Review. HCAP shall review the listings and classes of the PDL at least every six months as calculated from the effective date of this rule. The PDL may be reviewed and updated more often in the discretion of HCAP in accordance with the purposes and procedures contained within this section.

11.6. The current PDL, as adopted by HCAP, remains in force and effect in all existing and future claims until such time as HCAP adopts or revises the PDL.

W. Va. Code R. § 85-26-11