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The Workers Compensation Research Institute (WCRI) released a study examining the impact of Pennsylvania’s House Bill 1846, a bill that changed reimbursement rules by capping prices paid for physician-dispensed drugs, and restricted provider’s ability to dispense opioids and other kinds of drugs to certain time frames. Authors of the study looked at any changes in frequency and costs of physician dispensing.

House Bill 1846 amended the state’s Workers’ Compensation Act to limit reimbursement for prescription drugs to 100 percent of the AWP (average wholesale price) of the product. Physicians cannot seek reimbursement more than 110 percent of the AWP of the drugs dispensed by them. Physicians cannot seek reimbursement for prescriptions of schedule II or III drugs over an initial seven-day supply, or an additional fifteen-day supply if the employee underwent a medical procedure. Physicians cannot seek reimbursement for any other drug prescription over an initial thirty-day supply, or any over-the-counter drugs.

Authors of the study found that two years after the implementation of the bill, frequency and cost of physician-dispensed drugs decreased significantly in the state. Before the reforms (2013-2014), 1 in 3 prescriptions were dispensed by physicians. After the reforms (2015-2016) that number was 1 in 10. The cost share of physician dispensing decreased from 44 percent to 4 percent after the reform. Before the reform, 35 percent of injured workers has at least one prescription, that had dropped to 30 percent in 206 which authors attribute to a drop in injured workers receiving physician dispensed drugs as it did not correspond to an increase in those receiving pharmacy dispensed drugs. As of 2016, starting after January 1 2013, pharmacies dispensed 16 percent of prescriptions and accounted for half of prescription payments.

The study looked at transaction data for both physician and pharmacy dispensed prescriptions filled in 2013 and through 2016 that fell within 24 months after the date of injury. The data came from payors representing 47 percent of medical claims in Pennsylvania.

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