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Comp insurers challenge physician dispensing policy

Comp insurers challenge physician dispensing policy

A group of Florida workers compensation insurers is challenging the legitimacy of a state policy they claim improperly requires them to authorize physicians and other providers to dispense medications to injured workers.

The insurers said in a challenge filed last week with the Division of Administrative Hearings that the Division of Workers’ Compensation is enforcing a two-year-old unadopted rule.

The DWC said in a March 2020 bulletin that payers are not allowed to deny authorization for prescription drugs solely because they were dispensed by the treating physician.

Injured workers have the right to have prescriptions dispensed by a practitioner, the bulletin reads. And Florida law explicitly authorizes dispensing of drugs to injured workers and provides a methodology for determining reimbursement.

“Thus, failure to authorize and/or reimburse for prescription medication solely because the medication is or will be dispensed by a licensed Florida dispensing practitioner instead of a pharmacist, interferes with the full, free and absolute choice of the sick or injured employee and, therefore, is contrary to law,” the division said.

The insurers are asking the division to invalidate what they’re calling an unadopted agency rule.

“The DWC has not completed rulemaking to adopt this policy as a rule, but nonetheless applies this statement to all workers’ compensation carriers,” the challenge reads. “DWC further mandates compliance with this statement by all carriers and informs carriers via its adjudicatory determinations that carriers who do not comply will face sanctions and penalties of up to $100,000.”

The insurers filing the challenge include Normandy Insurance Co., Zenith Insurance Co., Bridgefield Employers Insurance Co., Bridgefield Casualty Insurance Co., BusinessFirst Insurance Co. and RetailFirst Insurance Co.

WorkCompCentral is a sister publication of Business Insurance. More stories here.