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Arizona: Hearing set for physicians and pharmaceutical fee schedule
The Industrial Commission proposed an updated fee schedule for medical and pharmacy to incorporate changes from the American Medical Association's 2009 edition of the CPT-4 and review the values of new and selected codes from surgery, radiology and special services.
Currently, the fee schedule does not address the publication to be used for determining the average wholesale price, which the commission said has resulted in disagreements and confusion regarding the reimbursement of prescriptions. The proposed change will require AWP to be determined on the date a drug is dispensed from the most recent issue, including updates, of a nationally recognized pharmaceutical publication that lists AWP, and each entity responsible for prescription drug payment must select one publication to be used for AWP determination no later than Oct. 1. The fee schedule will also change the dispensation of generic products by generalizing the applicable language to state that when a generic drug exists, it shall be dispensed unless the physician has specifically stated that the brand name drug is medically necessary. Proposed changes will also affect an employer's right to direct their claimants to use network providers and contract with health care providers who rent or sell their networks to workers' compensation entities. A fee schedule hearing on the proposed changes will take place June 10 in the Industrial Commission's Phoenix office. For more information, visit www.ica.state.az.us. Read more at the WORKERSCOMP ForumTM homepage.
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