In a recent study, the Workers’ Compensation Research Institute found that the costs for prescription drugs used to treat injured workers in Pennsylvania were higher than the median cost. The Cambridge, Massachusetts, based research group found that the average payment per claim for prescriptions was $445, which was eight percent greater than the median established through the 16-state study, entitled Prescription Benchmarks for Pennsylvania.
The study indicated that frequent prescriptions of expensive brand name drugs contributed to the higher price-per-pill payments to pharmacies. Higher priced brand name drugs accounted for 18 percent of all workers’ comp prescriptions compared to 15 percent of such prescriptions in the study states. For pain medications, physicians prescribed expensive brand name drugs 15 percent of the time. The study also noted that when doctors directly prescribed medicines to workers, costs were more expensive compared to pharmacies.
Under Pennsylvania law, payments for prescription drugs are limited to 110 percent of the product’s average wholesale price (AWP). Pharmacists may not bill employees for the difference between the actual charge for the drug and the AWP. As such, if an injured worker is being overcharged for pain medications, or being held liable for the difference in costs, the worker should not be afraid of reporting such charges. Pennsylvania and federal law also protects workers who report unlawful activity. The law also prohibits insurers from denying future claims if a worker reports overcharges.
If you are an injured worker and believe you have been overcharged for prescription pain medication, contact an attorney. An experienced workers’ compensation lawyer can explain how Pennsylvania’s cost containment statute applies, and whether a claim exists. The attorney can also manage the process with the Pennsylvania Department of Labor and Industry.