(22) For serious and permanent disfigurement of [the head,
neck or face] exposed areas of the body, of such a character as
to produce an unsightly appearance, and such as is not usually
incident to the employment, sixty-six and two-thirds per centum
of wages not to exceed [two hundred seventy-five weeks.] four
hundred weeks. Disfigurement benefits paid to the injured worker
shall be made separate and apart from total or partial
disability. A claimant is not precluded from collecting both
total or partial disability benefits and a disfigurement benefit
simultaneously.
* * *
(f.1) * * *
(3) * * *
(vi) (A) [The] Except for provision (N), the reimbursement
for drugs and professional pharmaceutical services shall be
limited to one hundred ten per centum of the average wholesale
price (AWP) of the product, calculated on a per unit basis, as
of the date of dispensing.
* * *
(J) No treating health care provider shall prescribe an
opioid to an injured employe unless the provider has ensured
that the opioid is on the preferred drug list and the provider
has:
(I) accessed the Pennsylvania Prescription Drug Monitoring
Program to review the employe's controlled substance
prescription medication history;
(II) consulted with the patient regarding all reasonable and
available non-opioid treatment options; and
(III) informed the patient of the risks associated with the
prescribed opioid.
(K) The department shall ensure that the preferred drug list
is available through the department's publicly accessible
Internet website for reference by physicians and the general
public.
(L) The prescription of drugs that is consistent with or
recommended by the preferred drug list shall be considered
reasonable and necessary for the purposes of paragraph (6).
Except in cases of medical necessity under provision (M), the
prescription of drugs that is not consistent with or recommended
by the preferred drug list shall not be considered reasonable
and necessary for the purposes of paragraph (6).
(M) The prescription of drugs that is not consistent with or
recommended by the preferred drug list may only be considered
reasonable and necessary for the purposes of paragraph (6) if
the treating health care provider has submitted documentation of
medical necessity to the insurer or self-insured employer at the
time of the initial prescription. The documentation of medical
necessity shall be on a form prescribed by the department.
(N) The reimbursement for any compounded medication used
topically to treat pain or for pain management shall be limited
to one hundred ten per centum of the actual cost.
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