PA Legislation Would Limit Dispensing, Reimbursement of Repackaged Medications

Harrisburg, PA (WorkersCompensation.com) - Representative Marguerite Quinn (R-Buck's County) introduced legislation in the Pennsylvania House Wednesday aimed at curbing the abusive pricing of repackaged medications being dispensed to injured workers. The legislation would require the submission of the original manufacturer's product National Drug Code (NDC) on all bills and reports associated with the claim. Reimbursement would be set at 110% of the average wholesale price of the medication based on the NDC of the original manufacturer's product. The legislation prohibits the use of a repackaged NDC and allows payors to select the NDC of the lowest priced, clinically equivalent drug if the original product NDC is not submitted with the bill. Quinn also included a provision that would limit reimbursement to out-patient providers, other than licensed pharmacies, to an initial five-day supply of medications.

The legislation is supported by the Pennsylvania Chamber, the Insurance Federation and the National Federation of Independent Businesses (NFIB). Quinn is the vice chair of the House Insurance Committee. The legislation will likely not see any action until early December, after the legislature reconvenes following
the Thanksgiving holiday break.

Recent studies published by the Workers' Compensation Research Institute (WCRI) identified the dispensing of repackaged medications as a significant cost driver in the Pennsylvania workers' compensation system. Employers and insurance carriers will benefit from the legislation as the cost of repackaged medications is reduced to levels paid to retail pharmacies for the same medications. Local pharmacies will benefit as repackaged medications are limited to an initial five-day supply and dispensing of more medications is pushed back to the retail pharmacy sector. Injured workers will benefit by being allowed to use their regular pharmacy provider who is familiar with their medication history, can better identify potential negative drug interactions and can more conveniently provide refills. Please let your contacts in the Pennsylvania legislature know of your support for this legislation.

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