Ohio
Workers Comp
Medical Providers
Last updated: 4/5/2024
Formulary Medication Request Form {BWC-3935}
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Description
BWC-3935 -- FORMULARY MEDICATION REQUEST FORM. This form is used by medical professionals to request the addition or removal of a drug from the Bureau of Workers' Compensation (BWC) formulary. It requires filling out all sections, including requester contact information and drug details such as name, dosage form, therapeutic use, anticipated monthly usage, and comparison with similar drugs on the BWC formulary. Requests must be submitted with supporting literature and will be reviewed either at the next Pharmacy & Therapeutics Committee meeting or the next bi-annual meeting if received within three months. www.FormsworkFlow.com
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