BILL ANALYSIS �
Senate Committee on Labor and Industrial Relations
Ted W. Lieu, Chair
Date of Hearing: March 13, 2013 2013-2014 Regular
Session
Consultant: Gideon L. Baum Fiscal:Yes
Urgency: No
Bill No: SB 146
Author: Lara
As Introduced/Amended: March 6, 2013
SUBJECT
Workers' compensation: medical treatment: billing.
KEY ISSUE
Should the Legislature remove the requirement of the inclusion
of a copy of a prescription for pharmaceutical services in a
request for payment in the workers' compensation system?
ANALYSIS
Existing law establishes a workers' compensation system that
provides benefits to an employee who suffers from an injury or
illness that arises out of and in the course of employment,
irrespective of fault. This system requires all employers to
secure payment of benefits by either securing the consent of the
Department of Industrial Relations to self-insure or by securing
insurance against liability from an insurance company duly
authorized by the state.
Existing law provides that medical, surgical, chiropractic,
acupuncture, and hospital treatment, including nursing,
medicines, medical and surgical supplies, crutches, and
apparatuses, including orthotic and prosthetic devices and
services, that is reasonably required to cure or relieve the
injured worker from the effects of his or her injury shall be
provided by the employer.
(Labor Code �4600)
Existing law requires that any provider of medical services,
including pharmacies, must submit its request for payment with
an itemization of services provided and the charge for each
service,
a copy of all reports showing the services performed, the
prescription or referral from the primary treating physician if
the services were performed by a person other than the primary
treating physician, and any evidence of authorization for the
services that may have been received. (Labor Code
�4603.2(b)(1))
This bill would provide that a copy of a prescription for
pharmaceutical services is not necessary unless required under a
written agreement between an employer, insurer, or third-party
claims administrator and a pharmacy.
This bill would also allow an employer insurer, or third-party
claims administrator to request a copy of the prescription
during a review of any records of prescription drugs dispensed
by a pharmacy.
This bill would also provide that any entity submitting a
pharmacy bill for payment, on or after January 1, 2013, and
denied payment for not including a copy of the prescription from
the treating physician, shall have 90 days after January 1,
2014, to resubmit those bills for payment.
COMMENTS
1. Need for this bill?
Senate Bill 863 (DeLeon), Statutes of 2012, Chapter 363,
created several new requirements for medical service providers
when seeking reimbursement, including the submission of
documents that appropriate detail the services provided and
the cost of those services. This included the provision of a
copy of a prescription for pharmaceutical services. After the
passage of SB 863, several stakeholders reached out to the
Legislature regarding the challenges of this requirement.
Hearing Date: March 13, 2013 SB 146
Consultant: Gideon L. Baum Page 2
Senate Committee on Labor and Industrial Relations
Specifically, proponents note that there is no electronic
method to transmit a paper prescription, and that the use of
paper prescriptions is becoming increasingly rare.
Additionally, some stakeholders have noted that other states
have used electronic prescriptions, rather than paper
prescriptions, as a method for combating opioid abuse.
SB 146 addressed these concerns by:
1) Prohibiting the requirement of a prescription for
pharmaceutical services by an employer, insurer, or
third-party claims administrator, unless required by a
written agreement between a specific pharmacy and an
employer, insurer, or third-party claims administrator;
2) Allowing an employer, insurer, or third-party claims
administrator to request a copy of the prescription during
a review of records; and
3) Ensuring that any pharmacy that was denied payment due
to the non-provision of a prescription can resubmit that
bills within 90 days of January 1, 2013.
2. Proponent Arguments :
Proponents argue that the requirement of a copy of a
prescription with a request for payment is both unnecessary
and an undue burden. Proponents note that the Division of
Workers Compensation's electronic billing standard for
pharmacy bills does not currently support the inclusion of
attachments, making pharmacy billers unable to comply.
Proponents also argue that a list of billed components
provides the same information as prescription for
pharmaceutical drugs, and that the requirement of a
prescription may impact a pharmacy's ability to fill workers'
compensation prescriptions, limiting access to medically
necessary medication. Proponents believe that SB 146 will
address this issue and ensure access to pharmaceutical
products for injured workers.
3. Staff Notes :
On page 3, line 13, SB 146 states that the providing a copy of
Hearing Date: March 13, 2013 SB 146
Consultant: Gideon L. Baum Page 3
Senate Committee on Labor and Industrial Relations
a prescription for pharmaceutical services shall not be
required "unless the provider of services otherwise agrees to
follow the requirements of this paragraph", or Labor Code
�4603.2(b)(1). While the legislative intent is quite clear
(no copy of the prescription required unless a written
agreement is in place between a pharmacy and an employer,
insurer, or third-party claims administrator), the literal
reading is rather confusing.
The author may wish to consider clarifying the language at a
later date to something along the lines of "unless the
provider of services has entered a written agreement, as
provided in this paragraph, which requires the provision of a
copy of a prescription for a pharmacy service."
4. Prior Legislation :
SB 863 (DeLeon), Statutes of 2012, Chapter 363, was discussed
above.
SUPPORT
CompPharma (Sponsor)
California Pharmacists Association
California Retailers Association
Express Scripts Holding Company
Helathesystems
Modern Medical, Inc.
National Association of Chain Drug Stores
PMSI
Progressive MedicalCalifornia Pharmacists Association
OPPOSITION
None on file.
Hearing Date: March 13, 2013 SB 146
Consultant: Gideon L. Baum Page 4
Senate Committee on Labor and Industrial Relations