Division of Federal Employees' Compensation (DFEC)

The Department of Labor (DOL), on December 1, 2009, will be implementing a new policy for processing Schedule II drugs for claimants who are identified as recipients of the Federal Employees Compensation Act (FECA) Program. The purpose of the process is to ensure that Schedule II drugs are paid appropriately for patients meeting the following criteria:

  • Patients with a cancer diagnosis will continue to be able to receive Schedule II medications in the same manner as today, subject to early refill limitations, including the limitation that a claimant use 75% of the previous fill before being allowed to receive another prescription. However, there will be no limitations on the number of prescriptions of a medication that claimants meeting this criteria can receive.
  • Patients without a cancer diagnosis will be limited to only 3 (three) additional prescription re-fills within a 90-day period after the initial fill, and up to a thirty-day supply limitation for each prescription.

In addition to this change, pharmacy providers will also need to begin using Fields 403-D3 Fill Number and 415-DF "Number of Refills Authorized". Currently these fields are not required, but will be required upon the implementation of Schedule II Processing, in addition to the prior requirements of fields; 405-D5(Days Supply), 442-E7 (Quantity Dispensed), and 408-D8 Dispense as Written).

Please begin to prepare your systems for this implementation.

If your pharmacy submissions are being submitted through a Third Party Billing agency, please advise those parties of this change.