Greg Abbott, Texas’ Attorney General, has released his opinion re “Whether a workers’ compensation carrier may pay for a prescription drug at a rate lower than the fee rate allowed under the guidelines of the DWC…”
I’m no attorney. And being an attorney would be very helpful in this instance.
The key part of the four-page pronouncement is on page 3 and reads, in part:
“…although a WCHCN (work comp Health Care Network) must not provide prescription medication or services, an insurance carrier may enter into a contract with a WCHCN to obtain a contract with a health care provider to pay for prescriptions at a negotiated rate after January 1, 2011”
I’m not sure what this says. One interpretation I’ve heard is that payers must contract with an HCN, which then contracts with a PBM to provide pharmacy management services. However, a PBM may not qualify as a “provider”.
Another part of Mr Abbott’s opinion holds that there is no statutory minimum requirement for reimbursement under workers comp – and he’s pretty definitive about that. Then again, a later section appears to directly contradict this statement…
More to come – much more.
Dec
10
