Joseph Paduda's weblog on managed care for group health, workers compensation & auto insurance, covering health care cost containment, health policy, health research, and medical news for insurers, employers, and healthcare providers.

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PBM win over third party biller

For the dozen or so people in the workers comp business who follow these things, the recent win by ScripNet in its ongoing legal battle with third party biller (TPB) WorkingRx was excellent news - at least for the payers.. The court threw out WorkingRx's lawsuit, noting that it had "no greater right to reimbursement from ScripNet than a pharmacy would have."

WorkingRx and its competitor Third Party Solutions have been working two fronts in their effort to stabilize their businesses; suing payers who refuse to pay their bills in full, while attempting to sign deals with pharmacy benefit managers and payers in return for a "discount" off the TPB's (inflated) charges.

The court win is by no means the final word; TPBs have proven to be remarkably resilient and are proof that businesses that can evolve quickly can survive.

What does this mean for you?

More clarity from the courts re the legal position of TPBs.

Joseph Paduda is the principal of Health Strategy Associates.

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April 2011

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