Texas Commissioner of Workers’ Compensation Rod Bordelon recently signed an emergency rule adopting amendments to the workers’ comp pharmacy fee guideline. According to industry representatives, the action averted a disruption in the delivery of health care benefits to injured employees.
The adopted amendments are effective Jan. 1, 2011. They permit insurance carriers to continue to reimburse prescription drugs dispensed on or after the effective date at rates either above or below the fees determined by the fee guideline using written contracts between insurance carriers and pharmacies or their processing agents, if applicable.
The rule amendments may remain in effect for a maximum of 180 days if renewed, according to the Texas Department of Insurance-Division of Workers’ Compensation.
“Commissioner Bordelon acted decisively when he adopted amendments to the Pharmacy Fee Guideline rule on an emergency basis,” said Steve Nichols, manager of workers’ compensation services at the Insurance Council of Texas. “The Commissioner’s action will allow insurers to continue to negotiate written contracts with pharmacies or pharmacy processing agents directly or to do so through the use of their authorized agents, such as pharmacy benefit managers.”
The emergency rule amendments are intended to temporarily resolve any uncertainty regarding payment and reimbursement of pharmacy and pharmaceutical services while the Texas Legislature considers possible statutory changes to clarify the reimbursement of pharmaceutical services within the Texas workers’ compensation system, Nichols said.
Topics Texas Workers' Compensation Tech
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