Statistics show PA workers’ comp prescription costs among highest

The workers' compensation system provides a crucial safety net for people hurt on the job, as anyone in Pennsylvania, who has faced a workplace injury knows. Unfortunately, recent reports indicate that Pennsylvania is among the states with the highest workers' compensation program costs resulting from physician dispensing of prescription drugs. Although this may not directly affect people who draw on workers' compensation, it could put a financial strain on the workers' compensation system, making it harder for injured workers to receive the benefits they are entitled to.

Repackaging results in high costs

The Baltimore Sun reported at the end of 2013 that Pennsylvania is one of two states with the highest rate of workers' compensation prescription dispensing by physicians and the highest associated costs. When physicians dispense prescriptions, they buy the prescriptions in bulk and then repackage them into sizes that can be given to patients.

The Baltimore Sun reports that prescription drugs provided by physicians to patients with workers' compensation claims have been found to cost significantly more than the prescriptions given to other patients. The article does not provide figures for Pennsylvania, but in Maryland, the other state with a top rate of physician dispensing and costs, some workers' comp prescriptions cost four times what the same prescription did elsewhere.

The article notes that the cost of medical care, including medication, is one of three major costs that workers' compensation insurance covers. Other significant costs include lost wages and disability for catastrophic injuries. Although costs of medication may not be the biggest expense in each individual case, the prescription costs paid throughout the workers' compensation program may be significant.

Bill would limit prescription costs

In 6 states, it is now illegal for physicians to repackage and dispense prescriptions, and in 14 other states, the profit that physicians can make is limited, according to the Baltimore Sun. Pennsylvania may soon join the latter group; in 2013, a bill to limit these costs was introduced. The bill, as published on the Pennsylvania General Assembly website, would make the following changes:

  • Physicians cannot increase the price of a prescription by more than 110 percent of the wholesale value.
  • Physicians can no longer repackage the prescription with a new National Drug Code number.
  • Physicians are only allowed to prescribe drugs to be used during the initial five days after a patient's visit.
  • Only licensed pharmacies can sell prescriptions to be used beyond the five-day period.

If the bill becomes law, it may not make a significant difference for patients who are already receiving workers' compensation benefits, since there is no co-pay for prescriptions covered under workers' compensation. However, the changes could reduce financial strain on the workers' compensation system and improve the likelihood that injured workers continue to gain access to the care and benefits that they deserve.

If you have been injured on the job in Pennsylvania, you may want to speak with an attorney when preparing to file your claim. An experienced personal injury attorney can improve your odds of having your claim approved and receiving all of the benefits that you are entitled to.