TWCC Issues Advisory Regarding Pharmacy Fee Disputes

The Texas Workers' Compensation Commission has issued ADVISORY 2003-21, concerning Medical Fee Disputes Involving Pharmacies and Usual and Customary Charges: The Commission has received numerous requests for Medical Dispute Resolution of a Medical Fee Dispute concerning a pharmacy's "usual and customary" (U&C) charge for the same or similar services as specified in Commission Rule 134.503(a)(1). Pharmacies are disputing payment made by one or more insurance carriers based upon the insurers' position on how to determine a pharmacy's U&C charge. The Commission's pharmacy prescription pricing ru...