State Policies Affecting the Cost and Use of Pharmaceuticals in Workers’ Compensation: A National Inventory

By Richard A. Victor

June 1, 2006 Related Topics: Rx National Inventories

Focusing on the state laws and regulations that affect the cost and use of pharmaceuticals in workers’ compensation, this study provides detailed information on state policies in effect as of November 15, 2005. It is the companion volume to WCRI’s broader analysis of these issues titled The Cost and Use of Pharmaceuticals in Workers’ Compensation: a Guide for Policymakers.  

The study examines the laws and regulations that are unique to workers’ compensation, focusing on those involving:

  • reimbursement rules (e.g., fee schedules);
  • stimulating price competition (e.g., rules about pharmacy networks);
  • utilization management (e.g., authorization for payors to conduct various forms of drug utilization review and specific limitations on the types of drugs that may be dispensed); and
  • control of the choice of pharmacy. 

Pharmaceuticals are also regulated by federal and state governments in a variety of contexts. Among them are premarket approval of new drugs by the Food and Drug Administration, postmarket surveillance, regulations about direct-to-consumer advertising, rules that regulate the prescribing and dispensing of controlled substances (e.g., narcotics), and reimbursement rules for insurance programs where federal or state governments are payors. Analysis of these public policy interventions is outside the scope of this study, as are policies related to over-the-counter drugs and injectables.

State Policies Affecting the Cost and Use of Pharmaceuticals in Workers' Compensation: A National Inventory. Richard A. Victor and Petia Petrova with the assistance of Linda Carrubba. June 2006. WC-06-30.

Copyright: WCRI

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