AN ACT

 

1Amending the act of June 2, 1915 (P.L.736, No.338), entitled, as
2reenacted and amended, "An act defining the liability of an
3employer to pay damages for injuries received by an employe
4in the course of employment; establishing an elective
5schedule of compensation; providing procedure for the
6determination of liability and compensation thereunder; and
7prescribing penalties," further providing for schedule of
8compensation <-and for use of savings.

9The General Assembly of the Commonwealth of Pennsylvania
10hereby enacts as follows:

11Section 1. Section 306(f.1)(3)(vi) of the act of June 2, 
121915 (P.L.736, No.338), known as the Workers' Compensation Act, 
13reenacted and amended June 21, 1939 (P.L.520, No.281) and 
14amended June 24, 1996 (P.L.350, No.57), is amended to read:

15Section 306. The following schedule of compensation is
16hereby established:

17* * *

18(f.1) * * *

19(3) * * *

1(vi) (A) The reimbursement for [prescription] drugs and
2professional pharmaceutical services shall be limited to one
3hundred [ten<-] per centum of the average wholesale price (AWP) of
4the product, calculated on a per unit basis, as of the date of 
5dispensing.

6(B) A physician seeking reimbursement for drugs dispensed by
7a physician shall include the original manufacturer's National
8Drug Code (NDC) number, as assigned by the Food and Drug
9Administration, on the bills and reports required under this
10section.

11(C) In no event may a physician seek reimbursement in excess
12of one hundred <-ten per centum of the AWP of the drugs dispensed
13by a physician as determined by reference to the original
14manufacturer's NDC number.

15(D) A repackaged NDC number may not be used and will not be
16considered the original manufacturer's NDC number. If a
17physician seeking reimbursement for drugs dispensed by a
18physician does not include the original manufacturer's NDC
19number on the bills and reports required by this section,
20reimbursement shall be limited to one hundred <-ten per centum of
21the AWP of the least expensive clinically equivalent drug,
22calculated on a per unit basis.

<-23(E) No outpatient provider, other than a pharmacy licensed
24in this Commonwealth or another state, may seek reimbursement
25for drugs dispensed in excess of an initial fifteen-day supply,
26commencing upon the employe's initial treatment following
27injury. Reimbursement shall be made for such fifteen-day supply
28at the rates set forth in this section.

29(E) <-No outpatient provider, other than a pharmacy licensed
30in this Commonwealth or another state, may do any of the
 

1following:

2(I) Seek reimbursement for a drug listed on Schedule II in
3section 4(2) of the act of April 14, 1972 (P.L.233, No.64),
4known as the "Controlled Substance, Drug, Device and Cosmetic
5Act," dispensed in excess of <-an one initial seven-day supply,
6commencing upon the employe's initial treatment by a health care
7provider <-under the particular for an injury related to a
8specific workers' compensation claim <-number. Should the employe
9require a medical procedure, including surgery, <-an one
10additional fifteen-day supply can be dispensed commencing on the
11date of <-surgery the medical procedure.

12(II) Seek reimbursement for a drug listed on Schedule III in
13section <-4(2) 4(3) of the "Controlled Substance, Drug, Device and
14Cosmetic Act," which contains hydrocodone dispensed in excess of
<-15an one initial seven-day supply, commencing upon the employe's
16initial treatment by a health care provider <-under the particular
<-17for an injury related to a specific workers' compensation claim
<-18number.. Should the employe require a medical procedure,
19including surgery, one additional fifteen-day supply can be
20dispensed commencing on the date of the medical procedure.

21(III) Seek reimbursement for any other drug dispensed in
22excess of <-an initial twenty-day one initial thirty-day supply,
23commencing upon the employe's initial treatment by a health care
24provider under the particular workers' compensation claim
<-25number.

<-26(IV) Seek reimbursement for any drugs dispensed within any 
27period of time in excess of the limitations under subprovision 
28(I), (II) and (III). If one health care provider has dispensed 
29drugs under subprovision (I), (II) or (III), no other health 
30care provider may submit for reimbursement for drugs dispensed
 

1to that employe under the same workers' compensation claim.

<-2(IV) (F) Reimbursement for all drugs dispensed in accordance
3with this subsection shall be made at the rates set forth in
4this section.

<-5(F) (G) No outpatient provider, other than a pharmacy
6licensed in this Commonwealth or another state, may seek
7reimbursement for an over-the-counter drug.

<-8(G) (H) The Workers' Compensation Advisory Council shall
9annually conduct a study of the impact of this subclause,
10including calculation of the savings achieved in the dispensing
11of pharmaceuticals.

12 (G) <-(H) (I) For purposes of this subclause, clinical
13equivalence, in reference to a drug, means the drug has chemical
14equivalents which, when administered in the same amounts, will
15provide essentially the same therapeutic effect as measured by
16the control of a symptom or a disease.

17* * *

<-18Section 1.1. Within 18 months following the effective date
19of this section, the Pennsylvania Compensation Rating Bureau
20shall calculate the savings achieved through the implementation
21of the amendment of section 306(f.1)(3)(vi) of the act. For
22calendar year 2016, the amount of the savings shall be used to
23provide an immediate reduction in rates, equal to the savings,
24applicable to employers' workers compensation policies.

25Section 2. This act shall take effect in 60 days.