Development Initiated on Florida Workers’ Compensation Prescription Drug Repackaging Rules
Jul 30, 2013
Revisions to Chapter 440, F.S. made by CS/SB 662, a bill representing a 2013 compromise between business groups and doctors over the issue of repackaged drugs and workers’ compensation premiums, will be the topic of a Florida Division of Workers’ Compensation Rule Development Workshop scheduled for August 8, 2013 at 10:30 a.m. (ET)
To view the notice, click here.
If requested by a member of the public, the hearing will address Rule Chapter 69L-7.020, F.A.C., relating to the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, and Chapter 69L-7.602, relating to Florida Workers’ Compensation Medical Services, Billing, Filing and Reporting.
The purpose of the August 8 Workshop is to develop amendments to the two above-referenced rules that would implement the revised language of subsection 440.13(12)(c) and 440.13(12)(e), F.S. enacted as Chapter 2013-131, Laws of Florida.
A copy of the statutory revision can be viewed by clicking here.
Signed by Florida Governor Rick Scott on June 7, 2013 and effective since July 1, CS/SB 662 amends Florida workers’ compensation law relating to reimbursement for prescription medications in the following manner:
- Revises the amount of reimbursement for prescription medications of workers’ compensation claimants by providing that the reimbursement rate for repackaged or relabeled drugs dispensed by a dispensing practitioner would be capped at 112.5 percent of the average wholesale price (“AWP”), plus $8.00 for the dispensing fee.
- Maintains the reimbursement rate for other prescription medications at AWP plus $4.18 dispensing fee.
- Provides that the AWP would be calculated by multiplying the number of units dispensed times the per-unit AWP set by the original manufacturer of the underlying drug dispensed, based upon the published manufacturer AWP published in the Medi-Span Master Drug Database as of the date of dispensing.
- Provides an exception to the reimbursement schedule if the employer or carrier, or a third party acting on behalf of the employer or carrier, directly contracts with a provider seeking reimbursement at a lower rate.
- Prohibits a dispensing practitioner from possessing such medications unless payment has been made to the supplying manufacturer, wholesaler, distributor, or drug repackager within 60 days of the dispensing practitioner taking possession of the medication.
Chapter 440, F.S. generally requires employers and carriers to provide medical and indemnity benefits to workers who are injured due to an accident arising out of, and during the course of employment.
Medical benefits can include, but are not limited to medically necessary care and treatment, and prescription medications. In Florida, the prescription reimbursement rate for dispensing physicians and pharmacies is the AWP, plus a $4.18 dispensing fee, or the contracted rate-whichever is lower.
The National Council on Compensation Insurance estimates that the implementation of CS/SB 662 will reduce workers’ compensation insurance costs by 0.7 percent or approximately $20 million based on preliminary 2012 statewide workers’ compensation insurance premium reported by insurers and self-insurers.
However, Florida’s Division of Risk Management-part of the state’s Department of Financial Services-estimates that implementation of the bill will result in an estimated annual increase in prescription drug costs of $210,377 to the State’s risk management program.
Should you have any questions or comments, please contact Colodny Fass& Webb.
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