Healthe attended the April 16th meeting, capturing key updates regarding the pharmacy fee schedule and drug formulary.
Healthe attended the April 16th meeting, capturing key updates regarding the pharmacy fee schedule and drug formulary.
Filed in October 2024, the amendments aimed to adjust AWP discount rates and standardize dispensing fees.
The bill could require biennial updates, utilizing RVUs form the resource-based relative value scale (RBRVS).
The hybrid meeting will cover the pharmacy fee schedule, biosimilars, cannabis coverage, and payments for topical drugs.
These disputes would qualify for independent bill review, and contracts must be presented when justifying payments below fee schedule.
A hearing from the Committee on Economic Matters saw back and forth discussion but yielded no progress.
The medical fee schedule would align reimbursement rates with those of similar neighboring states.
The virtual meeting will take place April 1, 2025 at 10:00 AM to discuss outstanding issues related to the Health Care Provider Manual.
The fee schedule would apply to medical care, dental care, and supplies received by injured employees.
Among other changes, the bill would ban effective rate contracts, making it difficult to forecast drug costs.
Introduced in January, the bill was discussed in a February 25th hearing, with supporters and opponents voicing concerns.
The bill would cap nonprescription, over the counter, and non-legend drug reimbursements at the drug’s cost plus 40%.
If passed, employees would be required to use network pharmacies effective December 31, 2025.
If passed, the bill would limit reimbursements to a one-time, seven-day supply if no commercial equivalent exists.
According to claim data from the CWCI, in 2024 dermatological agents made up 12.6% of prescriptions and 18.9% of drug spend.
