The bill would cap nonprescription, over the counter, and non-legend drug reimbursements at the drug’s cost plus 40%.
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.
If enacted, this fee schedule would replace the current usual and customary charges, going into effect October 1, 2025.
The three-member panel will recommend to legislators that the DWC be allowed to update fee schedules without legislative approval.
Effective January 1, 2025, these rules are part of the DWC’s adoption of the 2024 Health Care Provider Reimbursement Manual.
These regulations were proposed shortly after Governor Hochul vetoed a bill with similar intent.
Among other key updates, AWP will be replaced by a new pricing benchmark.
The bill would have allowed injured workers to fill prescriptions at any pharmacy of their choice, including outside of network pharmacies.
