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State of the States April 6, 2023

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A federal audit reveals that the Office of Workers’ Compensation Programs (OWCP) existing protocols failed to secure fair drug pricing and lacked comprehensive oversight when it came to prescription monitoring.

NationalA report from the U.S. Department of Labor’s Office of Inspector General audit of its Office of Workers’ Compensation Programs (OWCP) found that protocols in place failed to secure fair drug pricing and execute proper oversight of prescription monitoring for the program. Authors of the report conclude that administrative missteps incurred up to $321.3 million in “excess spending.” Outside auditors from Harper, Rains, Knight & Company analyzing six years of pharmaceutical data from 2015 through 2020 say that the program “lacked a pharmacy benefit manager to help contain costs and (the program) had not determined if alternative prescription drug pricing methodologies would be more competitive.” Findings from the audit also show significant safety concerns, with injured workers receiving thousands of inappropriate prescriptions and high-risk drugs, including 1,330 scripts for fast-acting fentanyl. Recommendations from the audit include bolstering sufficient clinical expertise among staff and the consistent utilization of evidence-based guidelines to create comprehensive prescription drug coverage policies. 


State regulators announce updated pharmaceutical dispensing fees for workers’ compensation.

injured-workers-pharmacy-blog-georgiaThe state’s workers’ compensation fee schedule, updated on April 1st of each year, includes changes to pharmaceutical dispensing fees. Dispensing fees for brand name medications will increase to $4.74 from $4.57 and generics to $7.11 from $6.85. Other updates to the fee schedule include telemedicine eligibility, revised rates for home health services, physician testimony reimbursement increases, restructured codes, and updated guidance from the American Medical Association (AMA). 

Medical cannabis will become legal in the Commonwealth after Governor Andy Beshear signed SB47 into law.

injured-workers-pharmacy-blog-kentuckyFollowing multiple attempts over the years to allow for medical cannabis, state legislators found a middle ground with SB47. The bill signed into law by Governor Andy Beshear over the weekend will enable individuals with cancer, severe pain, epilepsy, multiple sclerosis, muscle spasms or spasticity, chronic nausea or cyclical vomiting, post-traumatic stress disorder, or any other medical condition or disease that the Kentucky Center for Cannabis deems appropriate to be eligible for the state’s medical marijuana program. Provisions within the legislation do not allow for medical cannabis reimbursement for workers’ compensation injuries. State officials hope the program will be up and fully running by January of 2025.

State officials are beginning to create rules and standards for the state’s prescription drug monitoring program (PDMP).

injured-workers-pharmacy-blog-missouriAfter becoming the last state in the nation to establish a prescription drug monitoring program (PDMP), state regulators are now creating rules for the program’s implementation. Of the regulations put forth 1CSR 60-1.010(4) would require each dispenser who submits dispensation information for schedule II, III & IV controlled substances to register with the state PDMP. Comments on this rule are being accepted till April 14th. 

Legislators filed a bill this week aiming to raise attorney fees for prevailing parties to 25 percent.

injured-workers-pharmacy-blog-new-jerseyNJ Assembly Bill 5353, filed Thursday, seeks to raise attorney’s fees for prevailing parties to 25% from the previous 20% cap. Bill language also ensures that judges would be provided with discretion when it comes to the allocation of payment for counsel fees between injured workers and employers. The sponsor of the bill Rep. Anthony Verrelli currently serves as Vice Chair for the Houser Assembly Labor Committee. Verrelli hopes this bill will “incentivize attorneys to zealously represent injured workers and their families in every case compensable under the workers’ compensation law, and to create a disincentive for employers to deny or delay medical, temporary, and permanency benefits without legal defense or cause.” 

Personnel from the state Board of Pharmacy (BOP) propose revising dispensing label requirements.

injured-workers-pharmacy-blog-tennesseePersonnel from the state Board of Pharmacy designated May 8th as a hearing date to review rules/amendments concerning collaborative practice agreements and dispensing label requirements. Regulatory rule 1140-03-.06 clarifies that the “name and address and telephone number of pharmacy practice site; the medical or prescription order serial number, name of prescriber; name of patient; directions for use; date medical or prescription order originally dispensed, and/or refill date; "poison", "shake", "caution", or other appropriate advisory label; name of product (unless otherwise required by the prescriber); and expiration date of the product” be present on the drug dispensing label. The rule also emphasizes accommodation should be made for individuals with visual impairments. 

Lawmakers in the House approved a measure that would assist injured first responders while also clarifying current statute limitations.

injured-workers-pharmacy-blog-texasMembers of the House of Representatives voted unanimously to approve HB471, related to improving workers’ compensation benefits for injured first responders. The bill would require local governments such as cities or towns to provide full-pay salary continuation benefits for injured employees for up to a year. Legislators also clarified that first responders engaging in the use of cigarettes, e-cigarettes, or other tobacco products seven years preceding a potential cancer diagnosis would be ineligible for state presumptive coverage. HB471 now moves to the state senate for further consideration. 


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