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New York Workers Comp Board Issues Pharmacy Rule Extension

The New York State Workers Compensation Board has issued an extension for its emergency ruling which imposes a fee schedule for durable medical supplies and prescription medication. This extension was issued while the Board considers the incoming comments on a permanent schedule based on reforms signed into law by former New York Governor Eliot Spitzer.


The comments are being accepted through October 20 concerning a permanent rule which adopts fee caps which were imposed through emergency board rules each 90 days since July 2008. The proposed permanent rule cap the prescription drug costs at 88% of the average wholesale price plus a $4 fee for dispensing brand-named medications and 80% of the average wholesale price plus a $5 dispensing fee for generic medications.


The fee schedule also provides an increase in payment by 25% for medications given in controverted cases and increases the dispensing fees to $6 for brand-named medications and $7.50 for generic medications. Prices are also capped on durable medical equipment at the state Medicaid levels. Any items not covered by the Medicaid schedule are capped at 150% of the cost of acquisition which will be adjusted for taxes and discounts, or what is usually charged to the general public.