NCCI has published a series of studies on the price impact of physician fee schedules. Those studies have shown that “properly designed physician fee schedules can help contain workers’ compensation medical costs. However, fee schedules set too high can undermine their effectiveness.” NCCI has released a new study in the continuation of the series focusing on average wholesale price-based (AWP-based) prescription drug fee schedules. The study looks at differences in prescription drug prices across states to assess the effect of prescription fee schedules on prices paid for medication in state workers’ comp systems. Key findings included a significant difference between high fee schedule states and low fee schedule states, and that average prescription drug prices paid in high-fee-schedule states are greater than in states without fee schedules. NCCI also found that brandname, physician dispensed, and “out of network” prescriptions were paid at close to fee schedule maximums compared to generic, pharmacy dispensed, “in-network” prescriptions.
Access the report in full from NCCI here.