The Ohio Bureau of Workers’ Compensation (BWC) has proposed amendments to its pharmacy fee schedule regulations that govern state fund claims and self-insuring employer claims. While the Ohio BWC administers most workers’ compensation claims, the state does allow employers to self-insure and manage their own workers’ compensation claims.
Aligning compound reimbursement caps
Currently, the maximum product cost component reimbursement for a non-sterile compounded prescription is $100 for state fund claims and $400 for self-insuring employer claims. To align these numbers, the BWC is proposing a $300 decrease to the self-insured compound reimbursement cap, taking it to $100.
Removing fee schedule rates from regulations
The BWC is also proposing to remove specific fee schedule rates, including AWP discounts and dispensing fees, from the state fund and self-insuring employer rules. The proposed language would only state that rates would be “determined by the bureau, subject to annual review.”
Understanding the potential impact of proposed changes
A $300 reduction to the self-insuring employer compound reimbursement cap:
- Should lower overall costs for medications that normally exceed the dollar amount under standard fee schedule rates, particularly those not subject to a different contracted amount.
- Should create parity with the BWC state fund claims.
- May lower the incentive for providers to dispense and bill for compounds.
The removal of specific reimbursement rates from the formal rules would take rates and may take any rate changes out of the formal rulemaking process. Because of this, it may be important for the BWC to document the future fee schedule update process so stakeholders know what to anticipate and how to engage in a potential comment period. Ideally, all rates and rate changes would still be subject to public review and comment prior to adoption, and sufficient time provided for stakeholders to implement new rates by the effective date.
Comments
The BWC has scheduled a public hearing on these proposed changes for December 5, 2024. Those unable to attend that hearing can submit written comments to the BWC at enotification@bwc.state.oh.us, directed toward the following contact person with the BWC:
Eva Dixon
Rules Manager
BWC Legal Division
30 W. Spring Street, Level 26
Columbus, Ohio 43215-2256
(614) 644-8346
The proposed changes to both rules can be viewed via the following links:
Questions on this topic for our Regulatory Affairs team can be sent to MMXRegulatoryAffairs@MyMatrixx.com. For more information on policy developments like this in workers’ compensation impacting pharmacy in states across the country, please visit and bookmark Statehouse Watch at MyMatrixx.com.