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
Reference: 2021 SelectNet Provider Manual (Section 3)
- 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.
- Rural clinics located more than 15 miles from a participating pharmacy should contact the claims management team for an out-of-network referral.
- For participating pharmacies and the first fill form, please see: pinnacol.com/knowledge-center/pharmacy-program
Prior Authorization
- Prior authorization is required for medications “not recommended” in the Division of Workers’ Compensation (DOWC) Medical Treatment Guidelines for a particular diagnosis. DOWC Rule 18-6(C)(1)(a)
- Prior authorization is required for any non-steroidal anti-inflammatory drug (NSAID), muscle relaxant, or topical agent for which a significantly lower-cost therapeutic equivalent is available, including commercially or over-the-counter (OTC), even in a different strength/ dosage. Significantly lower cost means the therapeutic equivalent costs at least $100 less, for the same number of days’ supply. DOWC Rule 18-6(C)(1)(b)
Prescription writing
- All prescriptions shall be filled with bio-equivalent generic drugs unless the physician indicates “Dispense As Written” (DAW) on the prescription. DOWC Rule 18-6(C)(2)(c)
- The provider shall prescribe no more than a 60-day supply per non-opioid prescription. DOWC Rule 18-6(C)(2)(d)
- Acute opioid prescriptions should be limited to three to seven days and 50 morphine milliequivalents (MME) per day. DOWC Rule 18-9(A)(3)
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. DOWC Rule 18-9(A)(5)(a)
- 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.” DOWC Rule 18-9(A)(4)
- Opioids/scheduled controlled substances that are prescribed for treatment longer than 3 days shall be provided through a pharmacy. DOWC Rule 18-6(C)(2)(e)
- 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 at provider_management@pinnacol.com or 303.361.4945.
