Refund for prescription drugs nixed by bureau's denial of coverage
Case name: Patterson v. Rite Aid Corp. Headquarters, No. 1: 10 CV 589 (N.D. Ohio 09/22/10).
Ruling: The U.S. District Court, Northern District of Ohio dismissed a suit in which two workers claimed entitlement to a refund between the difference they paid to a pharmacy for prescription drugs and the Bureau of Workers' Compensation's scheduled price.
What it means:
A pharmacy in Ohio is not required to refund the difference in the price workers paid for prescription drugs and the bureau's scheduled price when the bureau had denied coverage for the drugs at the time of purchase.
Summary: Two workers filed claims with the Ohio Bureau of Workers' Compensation for work-related injuries. Both workers purchased prescription drugs from a pharmacy in connection with their claims. The bureau initially failed to approve the purchase of the drugs, so the workers purchased them as point-of-sale cash customers, paying amounts higher than the bureau-approved charges. The bureau reimbursed the workers for some of the drugs they purchased in the amount allowed under the bureau's fee schedule. The reimbursed amounts were less than what the workers paid the pharmacy for the drugs. In a class action, the workers asked the bureau to refund the difference between the price they paid to the pharmacy and the bureau's scheduled price. The U.S. District Court, Northern District of Ohio dismissed the suit, holding that the workers were not entitled to a refund.
The workers argued that the pharmacy was a health care provider prohibited from collecting an amount in excess of the amount paid by the bureau. The court explained that at the time of purchase, the bureau's coverage for the drugs had been denied. The pharmacy was not required to reopen transactions that were completed for retail customers.
The workers also alleged that they were the intended third-party beneficiaries of the contract between the pharmacy and the bureau for a negotiated rate for covered prescription drugs. The court mentioned that the contract stated that the worker is liable for any difference in the amount paid and the amount reimbursed by the bureau.
Read more at the WorkersComp Forum homepage.
December 9, 2010
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