As workers’ compensation attorneys who only represents injured workers, we have had numerous clients call in a panic because brick and mortar pharmacies would not fill their prescription due to the fact that the insurance adjuster was not available to approve it or the adjuster denied pre approval for whatever whimsical dishonest reason they happen to come up with that day. Even adjuster’s admit the prescription cards issued by the workers’ compensation carriers are not worth the paper or plastic they are printed on. For those that do not use Injured Workers’ Pharmacy, www.iwpharmacy.com, this leads to unnecessary stress, denied treatment or high out of pocket expenses.
Some treating doctors have taken this issue into their own hands by issuing the necessary medications themselves right out of their own office. The carriers resent this practice as they have no ability to block treatment and argue that because the prices of these prescriptions are not regulated, physicians are taking advantage and charging more than a prescription dispensed by a pharmacy. State Rep. Marguerite Quinn introduced a bill to limit physician dispensing last year. This legislation passed in the House and was amended by a Senate committee. This amended legislation was recently voted on and passed in both the House and Senate on October 22, 2014 and is now on its way to Governor Corbett for his signature.
HB 1846 will effectively stop physician dispensing of all prescriptions to their workers’ compensation patients. Ultimately, it requires physicians to dispense only a limited day supply (depending on what type of drugs are being dispensed) of medications and must provide the original NDC code of the manufacturer drug so that the cost may not exceed 110% average wholesale price of the original drug. The dispensing of the medications by physicians is limited to a one-time supply and is limited to the first health care provider. No additional health care providers can seek reimbursement for drugs dispensed under the same workers’ compensation claim. Over the years, the legislature has expanded the “treat only with company doctor requirement” from a few days to 90 days. Now, they want to decide where an injured worker can obtain medications for the life of their injury.
The passage of this bill is troubling because not only was it quickly passed, but it is government interference with an injured workers’ right to obtain needed medical treatment.