NY Adopts Changes on Network Pharmacies, Notice Requirements
- New York’s Workers’ Compensation Board has adopted amendments to the state’s code to help claimants to obtain medically necessary medication either through use of a network pharmacy or by notice of their ability to use an out-of-network pharmacy.
- Among the changes, a payer may designate a network pharmacy and require claimants to obtain all prescribed medicines from that network pharmacy.
- The amendments will take effect July 11, 2025.
WCRI Looks at Sensitivity of Fee Schedule Adjustments
- A new study from the Workers Compensation Research Institute (WCRI) looks at the “delicate balance” that state WC policymakers need to maintain in setting medical fee schedules.
- “If rates are set too low, treating injured workers may become uneconomical for providers, jeopardizing access to care,” WCRI said as it published the study, Designing Workers’ Compensation Medical Fee Schedules, 2025. “Conversely, rates set too high may reduce potential savings and weaken the fee schedule’s cost-containment goals.”
- The study analyzes the key decisions public officials in 44 states face when establishing or revising physician fee schedules.
- It also compares fee schedule levels across states for professional services, which account for about 41% of workers’ compensation medical costs.
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Ohio BWC Touts Low-Rates Ranking in Oregon Study
- The Ohio Bureau of Workers’ Compensation said its recent fifth-place ranking in the biennial rates study done by the Oregon Department of Consumer and Business Services is “a dramatic improvement from 2008, when it was ranked third highest in premiums across the country.”
- While the latest ranking is unchanged from the 2022 study, Ohio’s premium index rate fell even more, dropping from 83 cents per $100 of payroll in 2022 to 68 cents in 2024.
- Ohio is one of only four states that is the exclusive provider of workers’ compensation coverage for employers in their state.
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