We’re getting a clearer picture of the implications of NY’s adoption of a (very low) fee schedule for WC prescription drugs. As I’ve noted before, the WCB has clearly stated its opinion that the regs do not allow for reimbursement above the fee schedule.
The initial reaction to the news from several large pharmacy chains (at the National Association of Chain Drug Stores conference in Boston) ranged from disappointed acceptance to belligerent rejection.
Regardless of the stores’ wishes or desires, ‘it is what it is’; while it may feel good to threaten to not accept WC scripts or to force customers to pay cash, the implications of irritating customers may well result in a more accomodating strategy.
Meanwhile, sources indicate that the Work Comp Pharmacy Alliance is working hard for an increase in the fee schedule and to eliminate payers’ ability to direct to specific pharmacies. (WCPA’s membership includes the two third-party billers and one WC PBM; while the TPBs’ motivation is obvious, I’m not sure how the PBM’s customers would benefit from either change)
The other big loser looks to be the WC-specific pharmacy. These entities profited handsomely when they could essentially dictate reimbursement (before July 11, 2007 drug pricing was based on usual and customary, defined as the cash price for that drug on that date at that pharmacy)
What does this mean for you?
The legal situation will not be finalized for another six weeks or so (and is always subject to change by the legislature); stay abreast of developments and consider how to appropriately express your concerns/support/perspective. By all accounts the folks at the WCB are reasonable and open-minded; that said they have to operate within the limits of the law.
