IWCC-Proposed Regulation Modifications

The Illinois Workers' Compensation Commission (IWCC) has two proposed regulation updates currently in the Illinois Legislature's Joint Committee on Administrative Rules (JCAR) process.

Issue 33 of JCAR's Illinois Register contains both sets of proposed changes:

Page 13005 (PDF document page 72) details changes to the complaint, substitution, and disqualification processes for IL Arbitrators and Commissioners.

Page 13012 (PDF document page 79) details changes to the language regarding the reimbursement for physician-dispensed prescriptions. 

PDF page 94 contains the actual updated language that states reimbursement for physician-dispensed prescriptions is based on the original manufacturer's NDC code, not the repackaged NDC code:

10) Prescriptions

A) This schedule applies to prescriptions filled and dispensed outside of a licensed pharmacy.

B) Prescriptions shall be billed at the Average Wholesale Price, plus a dispensing fee of $4.18. [820 ILCS 305/8.2(a-3)]

C) Average Wholesale Price or its equivalent as registered by the National Drug Code shall be set forth for that drug on that date as published in Medispan. [820 ILCS 305/8.2(a-3)]

D) If a prescription has been repackaged, the Average Wholesale Price used to determine the maximum reimbursement shall be the Average Wholesale Price for the underlying drug product, as identified by its National Drug Code from the original labeler.