Proposal would limit workers’ compensation payments for certain medicines

Workers’ compensation would reimburse custom-made medicines using ingredient-based pricing, with a $20 compounding fee and a payment ceiling. A custom-made medicine is a non-FDA-approved preparation prescribed for an individual worker and made by a licensed pharmacist or doctor to tailor the medicine to that worker’s needs. Each ingredient must have a valid, recognized drug code, or the medicine would not be reimbursed. A medicine that is essentially a duplicate of a commercially available drug would not be reimbursed. The act would take effect 60 days after enactment.

Workers’ compensation would limit reimbursement for noncompound skin medicines to the lowest of three price measures, plus a $10 dispensing fee. A skin medicine is a drug applied to the skin for a local or body-wide effect, including creams, gels, ointments, and patches. The price measures are 110% of the average wholesale price, a federal upper limit, or $240 for a 30-day supply, whichever is lowest. The $240 amount would be prorated for supplies shorter or longer than 30 days. The act would take effect 60 days after enactment.