SP0483, LD 1376, item 1, An Act To Ensure the Choice of a Pharmacy for Injured Employees under the Workers' Compensation Act of 1992

An Act To Ensure the Choice of a Pharmacy for Injured Employees under the Workers' Compensation Act of 1992

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 39-A MRSA §206, sub-§11, as amended by PL 2007, c. 695, Pt. B, §24, is further amended to read:

11. Generic drugs. Providers shall prescribe generic drugs whenever medically acceptable for the treatment of an injury or disease for which compensation is claimed. An employee shall purchase generic drugs for the treatment of an injury or disease for which compensation is claimed if the prescribing provider indicates that generic drugs may be used and if generic drugs are available at the time and place of purchase under subsection 11-A. If an employee purchases a nongeneric drug when the prescribing provider has indicated that a generic drug may be used and a generic drug is available at the time and place of purchase, the insurer or self-insurer is required to reimburse the employee for the cost of the generic drug only , pursuant to subsection 11-A, paragraph B. For purposes of this section subsection, "generic drug" has the same meaning found in Title 32, section 13702-A, subsection 14.

Sec. 2. 39-A MRSA §206, sub-§11-A is enacted to read:

11-A. Pharmacy choice. An employee who has been prescribed drugs for the treatment of an injury or disease for which compensation is claimed has the right to select the provider, pharmacy or pharmacist for dispensing and filling the prescription for the drugs. The insurer or self-insurer shall reimburse the prescribing provider, pharmacy or pharmacist pursuant to a formula based on the average wholesale price of the drugs as reported by a nationally recognized pharmaceutical price guide or other publication of pharmaceutical pricing data in effect on the day the prescription is dispensed. The formula for reimbursing a provider, pharmacy or pharmacist for drugs under this section is:

A. For generic drugs, the reimbursement amount is the average wholesale price per unit multiplied by the total number of units multiplied by 1.25, plus a $4.00 dispensing fee; and

B. For brand-name drugs, the reimbursement amount is the average wholesale price per unit multiplied by the total number of units multiplied by 1.09, plus a $4.00 dispensing fee.

For purposes of this subsection, "drug" has the same meaning as in Title 32, section 13702-A, subsection 11 and "generic drug" has the same meaning as in Title 32, section 13702-A, subsection 14.

SUMMARY

This bill gives an injured employee the right under the Maine Workers' Compensation Act of 1992 to choose the provider, pharmacy or pharmacist to dispense any drugs or medication prescribed to treat the injury or disease for which compensation is claimed and sets formulas for reimbursement under the Maine Workers' Compensation Act of 1992 for generic and brand-name drugs or medications.

SP0483 LD 1376	Session - 126th Maine Legislature		LR 2023 Item 1
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