On April 30th, the Ohio Bureau of Workers' Compensation (BWC) submitted revised draft rules to the Common Sense Initiative (CSI) for review. These rules address outpatient medication reimbursement for both state-fund and self-insuring employer claims.
The revisions follow the withdrawal of previously proposed rules in 2024, which were withdrawn due to stakeholder concerns, particularly with the self-insuring employer provisions. While the revised rules retain the current reimbursement formula – such as the Average Wholesale Price (AWP) minus 15% plus a $3.50 dispensing fee – the new draft introduces the following updates for self-insured employers:
- Dispense fees are limited to pharmacy providers only.
- Maximum reimbursement for non-sterile compound prescriptions is capped at $100.
- Time-based dispensing fees will replace fixed rates for compounded medications.
The CSI office is accepting feedback on these rules through May 14, 2025. After the comment period closes, CSI will review the input and provide recommendations to BWC. The final rules will then move into the formal rulemaking process, which includes a public hearing approximately 30 days after submission.
