“When You Come to a Fork in the Road…”
“…Take It.” ~ Yogi Berra
The Commonwealth of Kentucky Court of Appeals recently affirmed an opinion and order of the Workers’ Compensation Board relative to pharmacies. I’m going to cut to the chase and give you the takeaway from this decision:
Pharmacies are “medical providers” for purposes of the employee choice rule under KRS 342.020.
Unfortunately, not all pharmacies or Pharmacy Benefit Managers (PBMs) are the same — neither in pricing nor dispensing practices. Just like you may encounter rogue physicians in workers’ comp, there are also rogue pharmacies/PBMs.
In order to specifically limit provider and pharmacy networks, a carrier/group/employer must be part of a certified Managed Care Organization.
We have designed and administered managed care plans since 1994. OMCA knows the right providers and the right PBMs to include in your certified MCO network.
Take the fork in the road that leads you to the best network.
Call us. We can do better.