A recent Louisiana Supreme Court decision has dealt another blow to physician dispensed medication. In Lafayette Bone & Joint Clinic v. LUBA, LUBA refused to reimburse the clinic for physician repackaged and dispensed medication that was priced 200-800 percent higher than the same medication dispensed at a retail pharmacy. The court justified the actions taken by the insurer in denying the doctors the right to dispense the medication, as long as the insurer got the prescriptions to the patient in a timely manner, reversing the appellate court’s decision. However, the justices upheld penalties and attorney’s fees in the original case.
Jeffrey Napolitano, representing LUBA in this case, explained: “Going forward, on any claims by mail order pharmacies to dispense – or by any physician dispensing the drugs – as soon as the insurer places the dispenser on notice that they are not authorized, the insurer is not obligated to pay the amount billed. The insurer would still have to pay the first $750 of unauthorized charges for the medication. When issuing payment of up to $750 upon receipt of the invoice, the insurer should specify that this was for payment of unauthorized treatment. Once the amount of payment for unauthorized treatment reaches $750, the insurer may terminate any further payments.”
Read the decision in full: Lafayette Bone & Joint Clinic v. LUBA_La Supreme Court