Prescription care in workers’ compensation can be complex depending on one’s state of residence or where an injury occurred. The capability to choose one’s pharmacy provider varies significantly from state to state. This whitepaper explores the rules, limits, and procedures regarding an injured worker’s ability to select their pharmacy.
While most states permit injured workers to receive prescription care from their pharmacy of choice, some states do not. States such as Arkansas, Iowa, Louisiana, Minnesota, Missouri, and New Jersey have generally established that employers/insurance carriers can appoint pharmacy providers for injured workers. One’s choice of provider can be restricted even in states where preference is generally granted. In Arizona, Nevada, and West Virginia, self-insurers can designate an injured worker's medical provider. Employers operating Managed Care Organization’s (MCO’s) in a state such as Connecticut will also be able to select providers on behalf of their workers. An employer’s capacity to dictate the care of an injured worker is known as "direction of care." The states of North Carolina and South Carolina permit injured workers to choose their pharmacy provider with "direction of care" caveats. State regulatory authority allows employers in both states to direct care to providers of their choosing if they do not find the injured worker’s choice of provider suitable.
There is also the matter of evolving rules and laws. Most states that permit pharmacy choice do not guarantee it in their statutes. Only Florida, New Hampshire, Maine & Texas safeguard pharmacy choice in their laws. States that provide for choice but do not reflect it in their statutes permit selection through regulatory rules or state commission protocols. States providing for employer choice of services have done so through a comparable mix of regulatory controls, state statutes, and even judicial precedent, as seen in Louisiana.
An injured worker’s ability to choose one’s pharmacy provider plays numerous roles in terms of accessibility, quality of treatment, and overall injury recovery. Controls and limitations will be specific to each state and its unique prescription care procedures. By downloading this latest whitepaper industry, stakeholders can better ensure they are current on their state’s regulatory and statutory obligations regarding pharmacy choice in workers’ compensation.
