Report Title:

Workers' Compensation; Prescription Drug Benefits

Description:

Requires the director of labor and industrial relations to establish a program that authorizes a private third-party workers' compensation drug card system that allows injured workers to receive prescription drugs promptly at no cost; program administrator to be selected pursuant to chapter 103D.

HOUSE OF REPRESENTATIVES

H.B. NO.

1816

TWENTY-SECOND LEGISLATURE, 2004

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to workers' compensation.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. The legislature finds that third-party prescription drug providers may provide cost savings to Hawaii's workers' compensation system. Under a third-party workers' compensation drug card system, a workers' compensation patient receives a drug card from the patient's health care provider, which is then presented to the patient's pharmacy of choice. Upon presentation of the drug card and a prescription, the pharmacist electronically enters in the appropriate information relating to the particular third-party workers' compensation drug card system, receives payment approval from the third party, and fills the prescription at no charge for the workers' compensation patient.

Under this system, the pharmacist is paid directly by the third-party drug system for an approved workers' compensation drug prescription, which is reimbursed by the insurance carrier. The workers' compensation health care provider receives a small fee from the third-party drug card system for each card and prescription provided to workers' compensation patients for work-related injuries. If operated correctly, this system can be beneficial to all involved. The injured employee is assured of not only having their prescription filled but also having the cost thereof paid by the insurer upfront, rather than after a determination of eligibility is made. The pharmacists benefit because assurance of payment coverage will eliminate the situations in which injured employees do not fill their prescriptions because they lack the funds. Physicians will be able to provide better care for their patients knowing that the drugs they prescribe as part of their course of treatment are actually being used. Finally, insurers will benefit by being able to send a much smaller number of checks to either the third-party administrator or the pharmacies, rather than to hundreds of individual claimants. Additionally, if an employee turns out to not be covered under a workers' compensation policy, the third-party administrator, rather than the insurer, will have the responsibility for recouping the payment.

The third-party workers' compensation drug card system is online for all pharmacies having computer systems with online capabilities, covers the entire workers' compensation managed care forumulary, and is drug company neutral. Such a system also provides certain information concerning each prescription drug that is filled under its online system, making such information conveniently and instantly available for participating workers' compensation patients. The legislature finds that a private third-party workers' compensation drug card system that requires little funding to implement has the potential to produce significant cost savings for Hawaii's workers' compensation system, as well as provide efficient service and satisfaction to both health care provider and injured workers.

The purpose of this Act is to require the department of labor and industrial relations to establish a program to enable the use of private third-party workers' compensation drug card system and to select a program administrator.

SECTION 2. Chapter 386, Hawaii Revised Statutes, is amended by adding a new section to read as follows:

"386-   Third-party workers' compensation drug card system; establishment. The director of labor shall establish a program that enables workers' compensation prescription drug benefits to be provided to injured workers under a private third-party workers' compensation drug card system.

(1) The drug card system shall allow injured workers to fill an approved prescription promptly and at no cost, upon presentation at a participating pharmacy of a prescription and an appropriate identification card that verifies participation in the drug card system;

(2) Participation in the drug card system shall be voluntary and available to all workers' compensation health card providers qualified under this chapter;

(3) Participation in the drug card system shall be voluntary and available to any pharmacy in the State that has appropriate computer system capabilities required by the drug card system;

(4) Prescription drug coverage available under the drug card system shall be any prescription drug currently approved by the department to be prescribed for an injured worker;

(5) The director shall select an administrator of the private third-party workers' compensation prescription drug card system pursuant to the requirements of chapter 103D; and

(6) The department shall adopt rules necessary under chapter 91 to implement the purposes of this section."

SECTION 3 New statutory material is underscored.

SECTION 4. This Act shall take effect upon its approval.

INTRODUCED BY:

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