Industrial commission proposes physician-reimbursement increase
THE AGENCY Idaho Industrial Commission.
THE ISSUE Adjusting payments to physicians and changing the method of reimbursement for prescription drugs for workers compensation cases.
WHATS PROPOSED An overall physician-fee schedule increase of 2.1 percent, an annual adjustment for inflation. Also proposed is a change in how drugs are reimbursed. The state had been using usual and customary charges, which are based on how much patients are charged. The Industrial Commission considers it a vague basis for reimbursement. The commission wants to switch to the average wholesale price, a figure that comes from the drug makers.
The Idaho Attorney Generals Office has settled several cases with drug makers in recent years for allegedly inflating the average wholesale prices of medications, which increased the amount the state paid out in Medicaid reimbursements. Industrial Commission officials say they are aware of the cases but believe the average wholesale price is the best alternative they have. The proposal would be a reimbursement at the average wholesale price plus a $2 dispensing fee for name-brand medications and a $5 dispensing fee for generic drugs. Thats intended to encourage more use of less-costly generics.
WHOS AFFECTED: Businesses that pay workers comp claims.
HOW YOU CAN BE HEARD A public hearing on the proposal is planned for 2 p.m. Monday, Oct. 22, at the Industrial Commission Office, 700 S. Clearwater Lane in Boise. Comments may be addressed to Mindy Montgomery, Director, Industrial Commission, P.O. Box 83720 Boise, ID 83720-0041.
TO LEARN MORE Go to the Idaho Industrial Commission at www.iic.idaho.gov/