White Papers

The purpose of this white paper is to illustrate the differences in processing and dispensing prescription medications in Medicaid versus workers’ compensation. The White Paper has been produced to provide state legislators, regulators and other workers’ compensation stakeholders with information regarding the processes of managing a pharmacy transaction in workers’ compensation. Its goal is to demonstrate why reimbursement levels for workers’ compensation need to be separately recognized and should not be linked to state Medicaid fee schedules.
The focus of this paper is to provide an overview of the Average Wholesale Price (AWP) litigation and settlements and their impact on pharmacy fee schedules in workers’ compensation and to discuss potential financial and operational implications for the Workers’ Compensation Pharmacy Benefit Management (PBM) industry.