Bill > SB1215

This bill amends the Workers' Compensation Act to establish new rules for the reimbursement of certain prescription drugs, specifically compound drugs and topical drugs, for injured employees. For compound drugs, which are custom-made preparations not approved by the Food and Drug Administration (FDA) but tailored to an individual's needs, reimbursement will be calculated per ingredient, and if an ingredient lacks a valid National Drug Code (NDC) number, the drug will not be reimbursed. Pharmacies or physicians will receive a $20 compounding fee per prescription, with a maximum reimbursement of $400 per 30-day supply, and compound drugs that are essentially duplicates of commercially available medications will not be covered, as determined by federal law. For topical drugs, which are applied to the skin for localized or systemic effects, reimbursement will be the lesser of 110% of the Average Wholesale Price (AWP), the Federal Upper Limit set by the Centers for Medicare and Medicaid Services (CMS), or $240 for a 30-day supply, plus a $10 dispensing fee per prescription. The bill also defines "compound drug" and "topical drug" for clarity.