Physician-Dispensed Medications

Reimbursement at the repackaged medication rate will now be limited to 30 days from the date of a worker’s injury. Thereafter, physicians will be reimbursed at the fee schedule amount applicable to the medication’s original National Drug Code (NDC).

Please note that this update to Rule 18 does not impact the longstanding SelectNet policy on quantities of medications dispensed by a physician. This policy, which can be found in the SelectNet manual, states the following:

“The provider should dispense no more than a one (1) time fourteen (14) day supply of medication. Following this initial fill, and should an injured worker have additional medication needs, Pinnacol requests that any future prescriptions be filled through Pinnacol’s Express Scripts pharmacy benefits program.”

SelectNet providers should practice strict adherence to this policy. If there is no participating network pharmacy within 15 miles of the clinic, or if care might be delayed or prolonged due to this policy, please contact the claims representative to obtain authorization for an out-of-network referral.