SB 863 created several new requirements for medical service providers when seeking reimbursement. 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. 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.
Proponents of this new law noted 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.
The California legislature has passed, and Governor Brown has signed SB146 which amends labor code section 4602.3. to correct these problems. S.B.146 was enacted as an “urgency statute” and thus it is effective immediately.
This new law (1) provides that a copy of a prescription for pharmaceutical services is not necessary unless the provider of services has entered into a written agreement, as specified, that requires a copy of the prescription for a pharmacy service;(2) allows an employer, pharmacy benefits manager, 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; and, (3) provides 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 until March 31, 2014 to resubmit those bills for payment.