D.F. and U.S. Postal Service, San Francisco Processing & Distribution Center Finance Post Office (Board decision, March 5, 2026)

ECAB final decision. The Board affirmed OWCP's June 21, 2023 refusal to authorize brand-name Butrans patches outside its drug formulary. A party may petition the Board for reconsideration within 30 days of issuance unless this order specifies another period, under 20 C.F.R. § 501.7(a). FECA compensation decisions are generally not subject to court review under 5 U.S.C. § 8128(b).

Plain-English summary

A postal mail processor used Butrans patches for accepted shoulder, carpal tunnel, and elbow conditions. Her physician reported that a generic patch did not adhere effectively, but OWCP's pharmacy manager asked him to change the prescription or request authorization for the brand-name medicine. The record showed no response to those requests. The Board held that OWCP could deny authorization for the nonformulary prescription on that record.

Decision snapshot

• Authority: 5 U.S.C. § 8103(a), concerning medical services and supplies for accepted injuries.
• Outcome: Denial of brand-name Butrans authorization affirmed.
• Key point: The requested formulary exception was not supported by a response through OWCP's authorization process.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
D.F., Appellant
)
)
and ) Docket No. 23-1159
) Issued: March 5, 2026
U.S. POSTAL SERVICE, SAN FRANCISCO
)
PROCESSING & DISTRIBUTION CENTER
)
FINANCE POST OFFICE, San Francisco, CA,
)
Employer
)
__________ )

Appearances: Case Submitted on the Record
Appellant, pro se
Office of Solicitor, for the Director

DECISION AND ORDER

Before:
ALEC J. KOROMILAS, Chief Judge
JANICE B. ASKIN, Judge
VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On September 7, 2023 appellant filed a timely appeal from a June 21, 2023 merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal Employees’ Compensation Act1 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction over the merits of this case.2

ISSUE

The issue is whether OWCP properly denied authorization for a nonformulary prescription medication.

1
5 U.S.C. § 8101 et seq.
2
The Board notes that, following the June 21, 2023 decision, OWCP received additional evidence. However, the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case record that was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the Board for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this additional evidence for the first time on appeal. Id.
FACTUAL HISTORY

On May 22, 2003 appellant, then a 38-year-old mail processor, filed a traumatic injury claim (Form CA-1) alleging that on that date she injured her right hand and shoulder when sweeping and sorting mail while in the performance of duty. OWCP accepted the claim for right shoulder sprain. It subsequently expanded the acceptance of the claim to include rotator cuff tear or rupture of the right shoulder, carpal tunnel syndrome of the right upper limb, medial epicondylitis of the right elbow, and lateral epicondylitis of the right elbow. OWCP paid appellant wage-loss compensation on the supplemental rolls, effective April 2, 2004, and on the periodic rolls, effective November 22, 2009.

In a series of reports dated June 25, 2019 through December 22, 2022, Dr. Adrian Bartoli, a Board-certified anesthesiologist, renewed appellant’s prescription for Butrans patches, noting that she required the name-brand Butrans because the generic patch did not stick to her skin effectively.

In letters dated July 7 and October 14, 2022, Optum, OWCP’s pharmacy benefit manager (PBM), advised appellant that pharmacy benefits for injured employees under FECA were managed under a drug formulary that went into effect December 9, 2021. It related that the prescription for Butrans was outside the formulary allowances, but would be allowed until December 8, 2022. The PBM requested that appellant’s prescriber take appropriate action. It referred to the drug formulary and information regarding the prior authorization process including the prior authorization request form (PARF) via the FECA PBM prescriber portal.

In letters dated July 7 and October 14, 2022, the PBM informed Dr. Bartoli that the formulary contained a list of medications, including quantity and generic allowances, that injured employees were eligible to receive under FECA. The PBM advised that appellant’s prescription for Butrans was outside the formulary allowances, but would be allowed until December 8, 2022. It advised him to take one of the following actions: (1) transition appellant’s prescription to comply with the formulary allowances; (2) transition appellant to a different formulary medication, complying with the formulary allowances; or (3) request a prior authorization via the prescriber portal to obtain approval or an exception to the formulary allowance. No response was received.

In a letter dated May 10, 2023, OWCP noted that appellant was currently receiving Butrans, a medication falling outside formulary allowances, which was last filled on March 13, 2023. It advised her that, while the medication currently prescribed would be covered until June 30, 2023, this letter was a final notice to allow time for her prescriber to safely transition to an alternative on formulary medication or submit a PARF via the PBM prescriber portal for consideration. No response was received.

By decision dated June 21, 2023, OWCP denied authorization for Butrans, finding that the evidence of record was insufficient to establish that the medication was medically necessary to address the effects of her accepted condition under FECA.

2
LEGAL PRECEDENT

Section 8103(a) of FECA3 provides that the United States shall furnish to an employee who is injured while in the performance of duty, the services, appliances, and supplies prescribed or recommended by a qualified physician, which OWCP considers likely to cure, give relief, reduce the degree, or the period of disability, or aid in lessening the amount of monthly compensation.4 While OWCP is obligated to pay for treatment of employment-related conditions, the employee has the burden of proof to establish that the expenditure is incurred for treatment of the effects of an employment-related injury or condition.5

In interpreting section 8103 of FECA, the Board has recognized that OWCP has broad discretion in approving services provided, with the only limitation on OWCP’s authority being that of reasonableness.6 OWCP has the general objective of ensuring that an employee recovers from his or her injury to the fullest extent possible, in the shortest amount of time. It, therefore, has broad administrative discretion in choosing means to achieve this goal.7

Abuse of discretion is generally shown through proof of manifest error, clearly unreasonable exercise of judgment, or actions taken which are contrary to both logic and probable deductions from established facts. It is not enough to merely show that the evidence could be construed so as to produce a contrary factual conclusion.8

ANALYSIS

The Board finds that OWCP properly denied authorization for a nonformulary prescription medication.

In letters dated July 7 and October 14, 2022, the PBM advised appellant that pharmacy benefits for injured employees under FECA were managed under a drug formulary that went into effect December 9, 2021. It related that the prescription for Butrans was outside the formulary allowances, but would be allowed until December 8, 2022. The PBM requested that appellant’s prescriber take appropriate action. It referred to the drug formulary and information regarding the prior authorization process including the PARF via the FECA PBM prescriber portal.

In letters dated July 7 and October 14, 2022, the PBM informed Dr. Bartoli that the formulary contained a list of medications, including quantity and generic allowances, that injured

3
Supra note 1.
4
Id. § 8103(a); see O.M., Docket No. 21-1383 (issued March 1, 2023); R.B., Docket No. 21-0598 (issued May 19, 2022); N.G., Docket No. 18-1340 (issued March 6, 2019); Thomas W. Stevens, 50 ECAB 288 (1999). 5 R.B., id.; J.M., Docket No. 20-0396 (issued April 9, 20201); M.P., Docket No. 19-1557 (issued February 24, 2020); M.B., 58 ECAB 588 (2007).
6
O.M., supra note 4; J.M., Docket No. 20-0457 (issued July 16, 2020); Daniel J. Perea, 42 ECAB 214 (1990) (holding that abuse of discretion by OWCP is generally shown through proof of manifest error, clearly unreasonable exercise of judgment, or administrative actions which are contrary to both logic, and probable deductions from established facts). 7 R.B., supra note 4; P.L., Docket No. 18-0260 (issued April 14, 2020).
8
Supra note 6; C.S., Docket No. 19-0516 (issued August 15, 2019).

3 employees were eligible to receive under FECA. The PBM advised that the prescription for Butrans was outside the formulary allowances, but would be allowed until December 8, 2022. It advised him to take one of the following actions: (1) transition appellant’s prescription to comply with the formulary allowances; (2) transition appellant to a different formulary medication, complying with the formulary allowances; or (3) request a prior authorization via the prescriber portal to obtain approval or an exception to the formulary allowance. No response was received.

However, the Board notes that the record contains no evidence in response to OWCP’s request. Thus, the Board finds that OWCP properly denied authorization for the prescription for Butrans.9

Appellant may submit new evidence or argument with a written request for reconsideration to OWCP within one year of this merit decision, pursuant to 5 U.S.C. § 8128(a) and 20 C.F.R.
§§ 10.605 through 10.607.

CONCLUSION

The Board finds that OWCP properly denied authorization for a nonformulary prescription medication.

ORDER

IT IS HEREBY ORDERED THAT the June 21, 2023 decision of the Office of Workers’ Compensation Programs is affirmed.

Issued: March 5, 2026
Washington, DC

Alec J. Koromilas, Chief Judge
Employees’ Compensation Appeals Board

Janice B. Askin, Judge
Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge Employees’ Compensation Appeals Board

9
See FECA Bulletin No. 21-07 (issued March 9, 2021); FECA Bulletin No. 22-02 (issued November 23, 2021).

4