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Feb
22

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.


Joe Paduda is the principal of Health Strategy Associates

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A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.

 

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