Prescribing providers must conform to regulations set forth by the respective licensing board and other laws. As a contractual requirement, SelectNet providers are also required to comply with the network participation standards. The SelectNet medication dispensing policy is detailed below.
Medication dispensing policy
- In cases where the clinic offers medication-dispensing services, Pinnacol will only permit the in-house dispensing of prescription or over-the-counter medications in emergent situations. The initial fill is limited to one 14-day supply.
- Following the initial fill, future prescriptions must be filled through Pinnacol’s pharmacy benefits manager (PBM), Optum/Helios.
- Rural clinics located more than 15 miles from a participating pharmacy should contact the claims management team for an out-of-network referral.
Prescription writing
- All prescriptions shall be filled with bio-equivalent generic drugs unless the physician indicates “Dispense As Written” (DAW) on the prescription.
- The provider shall prescribe no more than a 60-day supply per non-opioid prescription.
- Acute opioid prescriptions should be limited to three to seven days and 50 morphine milliequivalents (MME) per day.
Opioid management
- Pinnacol requires prior authorization for reimbursement for new opioid prescriptions in excess of a 14-day supply and has implemented statutory limits on initial opioid prescriptions as enacted by SB 18-022.
- Drug testing shall be done prior to the initial long-term drug prescription being implemented and randomly repeated at least annually.
- Authorized treating physicians prescribing long-term opioid treatment shall comply with the Division’s Chronic Pain Disorder Medical Treatment Guideline and review the Colorado Medical Board Policy #40-26, “Policy for Prescribing and Dispensing Opioids.”
- As of 1/1/20, opioids/scheduled controlled substances that are prescribed for treatment longer than 3 days shall be provided through a pharmacy.
- The Colorado Prescription Drug Monitoring Program (PDMP) securely lists dispensed controlled substances.
If you have any questions or need additional information, please contact Pinnacol Assurance provider_management@pinnacol.com or 303-361-4945.
