Pennsylvania Senate Bill 1215 was introduced, which would cap reimbursement for compound drugs and non-compound topical medications.
The bill would create a $400, 30-day supply cap for compound drugs, or a prorated amount if the supply is greater or less than 30 days. Compounds which are duplicates of commercially available products would not be reimbursable, and if a compound contains any individual ingredient that does not have a valid and recognized NDC number, the compound drug shall not be reimbursed.
Additionally, the bill establishes a new “lesser-of” reimbursement methodology for non-compound topicals at $240 for a 30-day supply, or 110% of AWP.
Establishing new reimbursement limits for compounded and topical drugs would have a direct financial impact on workers’ comp claims. Healthesystems has been directly involved in the Pennsylvania Workers’ Compensation Advisory Council discussions addressing high-cost topical drugs and is actively monitoring the bill, while also engaging with AAPAN, our trade association, for broader industry alignment.
Healthesystems attended the April 14th meeting of the Pennsylvania Workers’ Compensation Advisory Council, where members received an update on Senate Bill 1215. The bill has not received a formal hearing and is unlikely to advance after a scheduled committee vote to move the bill was canceled due to stakeholder concerns that the proposed $240 reimbursement cap for topical drugs was too low.
The Council voted to send a general communication to the General Assembly and the Governor’s Office, acknowledging that the issue warrants legislative attention, without endorsing specific provisions or taking a position on reimbursement levels.
For ongoing coverage of the latest legislation and policy updates impacting workers' comp, visit the Healthesystems Advocacy & Compliance page for our weekly Regulatory Recap.
