By: Zach Simpson
On March 31, 2020 the Florida Division of Workers’ Compensation (DWC) clarified that physicians are permitted to dispense medications to injured workers, and that an injured worker shall have full and free choice to utilize their physician for medication dispensing, as well as any other pharmacy or pharmacist.
It was declared by the DWC that it is not appropriate for employers/carriers to deny authorization or reimbursement for prescription medication solely because the medication is dispensed by the treating physician who is a licensed Florida dispensing practitioner instead of a pharmacist.
What Led to the DWC Bulletin?
A Florida dispensing practitioner was denied reimbursement for drugs dispensed out of their office to an injured worker in a recent reimbursement dispute claim. The physician asserted the claims administrator denied reimbursement for the dispensed medications because the physician was not authorized to dispense prescription medications. The Florida Department of Financial Services (DFS) ruled in favor of the physician – DFS Case No.: 20180824-007-WC – and subsequently issued DWC Bulletin DWC-01-2020 on March 31, 2020.
Details of the DWC Bulletin
Under existing Florida Statutes 440.13(3)(j), a sick or injured employee shall be entitled at all times, to free, full and absolute choice in the selection of the pharmacy or pharmacist dispensing and filling prescriptions for medications required under this chapter. This language specifically addresses the ability of an injured worker to choose their pharmacist or pharmacy when filling their work-related prescriptions. While other sections of the same segment of statute – Florida Statutes 440.13(12)(c) – outline reimbursement rates for dispensed medications and a separate rate for “repackaged or relabeled medications” dispensed by a “dispensing practitioner.”
DFS and DWC clearly stated in issuing the statement that dispensing practitioners are recognized and granted the ability to dispense medications under Florida Statutes 465.0276 (1) and (2), and that 440.13(12)(c) contains a reimbursement rate not only for pharmacies and pharmacists but for dispensing practitioners.
DFS and DWC also went on to state these statutorily prescribed reimbursement rates are also separately recognized in the Florida Workers’ Compensation Health Care Provider Reimbursement Manual. Therefore, DFS and DWC indicate that physicians are permitted to dispense and receive proper reimbursement and that bills for medications dispensed by physicians, who are compliant dispensing practitioners, should not be rejected or denied based upon the fact that the physician is dispensing practitioner rather than a pharmacist.
The FOLLOWING SECTIONS OF FLORIDA STATUTE ARE RELEVANT TO THE ISSUE:
465.0276 Dispensing practitioner-
- A person may not dispense medicinal drugs unless licensed as a pharmacist or otherwise authorized under this chapter to do so, except that a practitioner authorized by law to prescribe drugs may dispense such drugs to her or his patients in the regular course of her or his practice in compliance with this section.
- (b) A practitioner who dispenses medicinal drugs for human consumption for fee or remuneration of any kind, whether direct or indirect, must: Comply with and be subject to all laws and rules applicable to pharmacists and pharmacies, including, but not limited to, this chapter…
- Medical services and supplies; penalty for violations; limitations. –
- (j) [A] sick or injured employee shall be entitled, at all times, to free, full, and absolute choice in the selection of the pharmacy or pharmacist dispensing and filling prescriptions for medicines required under this chapter. It is expressly forbidden for the department, an employer, or carrier, or any agent or representative of the department, an employer, or a carrier, to select the pharmacy or pharmacist which the sick or injured employee must use; condition coverage or payment on the basis of the pharmacy or pharmacist utilized; or to otherwise interfere in the selection by the sick or injured employee of a pharmacy or pharmacist.
(12)(c) As to reimbursement for a prescription medication, the reimbursement amount for a prescription shall be the average wholesale price plus $4.18 for the dispensing fee. For repackaged or relabeled prescription medications dispensed by a dispensing practitioner as provided in s. 465.0276, the fee schedule for reimbursement shall be 112.5 percent of the average wholesale price, plus $8.00 for the dispensing fee.
A link to the Bulletin can be found here.