Should Medicaid be the basis for work comp drug fee schedules?
There’s a good bit of activity on the regulatory front as states with work comp pharmacy fee schedules consider possible changes to address the myriad issues inherent in AWP. A little background will help frame the issue. First, it’s important to understand the fee schedule amount is only paid if the script doesn’t go thru a PBM, and the vast majority of scripts do go thru a PBM, ensuring the carrier/employer/fund pays substantially less than the fee schedule. My firm’s survey of large payers indicates network penetration was 82% in 2008. Therefore, fewer than one in five scripts are paid at fee schedule. Some think setting a fee schedule at Medicaid solves the problem neatly. Were it only that simple. Let’s look at California, which is the only state using Medicaid (known as Medi-Cal in CA). In point of fact, drug costs per claim are up 72% despite a fee schedule reduction that cut price more than 25%. Clearly, the lower fee schedule did NOT control cost. I believe what has suffered i
Related Questions
- What is your process for keeping up-to-date on any changes to fee schedules and/or Statutes relating to bill processing?
- Where can I find a dentist for my children that will accept Medicaid or that offers a sliding fee scale?
- What does it cost to receive resumes / curriculum vitae (CV’s), and fee schedules?
