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Workers' compensation issues: pharmacy pricing dispute leaves fee cases on hold; bureau readies direct-deposit form
Summary
Department officials said a Commonwealth Court ruling on pharmacy pricing has left about 6,200 workers' compensation pharmacy fee disputes on hold because the court barred use of a cited pricing guide. Separately, the bureau has prepared a claimant form to collect routing and account information before insurers deposit settlement or benefit funds
Department witnesses told the appropriations committee that a Commonwealth Court decision on pharmacy pricing in workers' compensation has placed roughly 6,200 pharmacy-fee disputes on hold and is complicating payment determinations.
Secretary Walker said the Commonwealth Court held that the department could not use a particular pricing guide (the Red Book) to set pharmacy fee schedules. The department told lawmakers it has about 6,200 pharmacy fee disputes paused while the legal question is resolved; the case is on appeal. The department urged the legislature to consider a statutory solution to avoid repeated litigation over pricing methodology.
On benefit payments, Bureau of Workers' Compensation staff said they had developed a standardized form that claimants (and their counsel, if represented) must complete prior to any direct deposit of funds. The bureau expects the rule to be implemented in October 2025 and said the claimant will provide routing and account information on the form; bureau staff offered to provide training and guidance to insurers and stakeholders on the process.
Lawmakers also pressed department officials about the Uninsured Employers Guaranty Fund (UEGF) and liabilities tied to uninsured or misclassified employers. Secretary Walker and deputies acknowledged the fund is underfunded relative to liabilities and said they support enforcement and statutory fixes recommended by prior task forces to limit exploitation of uninsured-worker schemes.
Why it matters: The pharmacy pricing ruling affects thousands of fee disputes and could require legislative action to set a clear payment standard. The direct-deposit form will change how insurers transmit funds and the bureau will require claimants to provide account routing information in advance of deposits.
Ending: The department recommended a legislative fix for pharmacy pricing guidance and offered technical assistance on training insurers and claimants for the direct-deposit procedure.
