State legislators to address controversial meds in workers' comp

Opioids and repackaged medications will be the focus of state lawmakers during an upcoming national meeting. Committees in the National Council of Insurance Legislators will look at model laws for states to adopt.

Several panels, including the Workers' Compensation Insurance Committee, will "work to develop a model law to address opioid-related concerns, including costs" during a special joint session March 8. Last year, NCOIL members looked at the Kentucky prescription drug monitoring program and legislation to enhance it.

The Kentucky All Schedule Prescription Electronic Reporting system was expanded with the adoption of H.B. 1. Among other provisions, it required all prescription providers of controlled substances to register with KASPER.

CWCI: Compound drugs are more potent, costly (03/11/13)
NCCI: Physician dispensing on the rise in most states (10/06/11)
Florida Legislature targets repackaged drug costs (01/30/12)
Detailed report offers analysis, suggestions to prevent drug abuse (07/09/12)
Workers' comp physicians not following guidelines for opioid use, study shows (10/25/12)

"When the law passed in April [2012] KASPER had 7,911 registered accounts," according to a statement from the governor's office last fall. "On Oct. 1, KASPER had 21,542 registered users. Users include physicians, dentists, optometrists, advanced practice registered nurses, and podiatrists."

The number of average daily reports jumped from 2,888 to 18,149; most of which are processed in 15 seconds, the statement continued. "Providers are learning that requesting a KASPER report takes less time than measuring a patient's blood pressure, and the practice is becoming routine instead of a special task," said Mary Begley, the Cabinet for Health and Family Services Inspector General. "These reports are providing crucial information that can flag a problem user or may also warn a provider of otherwise unforeseen complications from drug interactions."

Participants in the NCOIL special meeting will also look at prescription and utilization reform. Members of the Workers' Compensation Insurance Committee will additionally consider proposed model legislation addressing repackaged pharmaceutical reimbursement rates.

The draft model is based on a recently revised rule in Tennessee that ties reimbursement rates for repackaged drugs to the original manufacturer's average wholesale prices. It is intended for inclusion in state insurance codes or regulations related to workers' comp medical fee schedules.

Specifically, the draft model says:

All pharmaceutical bills submitted for repackaged products must include the National Drug Code Number of the original manufacturer registered with the Food and Drug Administration or its authorized distributor's stock package used in the repackaging process.
The reimbursement allowed will be based on the current published manufacturer's AWP of the product, calculated on a per unit basis, as of the date of dispensing.
A repackaged NDC Number shall not be used or considered the original manufacturer's NDC Number. If the Number is not provided on the bill the reimbursement will be based on the AWP of the lowest priced therapeutically equivalent drug, calculated on a per unit basis.
The filing fees otherwise provided in [the appropriate workers' comp statute] shall be payable when applicable.

Read more at the WorkersComp Forum homepage.

March 4, 2013

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