H97 - 2015 Appropriations Act, Sec. 15.13B: Industrial Commission/Reimbursement for Prescription Drugs and Professional Pharmaceutical Services (SL 2015-241)

Overview: Sec. 15.13B of S.L. 2015-241 amends the law related to drug reimbursement in workers' compensation as follows:

• By adding prescribed over-the-counter drugs as one of the items for which the reimbursement amount must be established by law. Prior to this change, only the reimbursement amount for prescription drugs and professional pharmaceutical services was established by law.
• By setting the reimbursement amount for prescription drugs, prescribed over-the-counter drugs, and professional pharmaceutical services as the lesser of 95% of the average wholesale price of the product, calculated on a per unit basis, as of the date of dispensing, or the reimbursement amount provided for in an agreement between the dispensing health care provider and the payor employer or workers' compensation insurance carrier.
• By requiring all health care providers seeking reimbursement for prescription drugs, prescribed over-the-counter drugs, and professional pharmaceutical services to comply with the requirements for reimbursement in G.S. 97-26.2(b). Prior to this change, only a physician was required to comply with the requirements for reimbursement.

This section became effective October 1, 2015.