A notice received by some of our Arizona members has raised questions about the obligations of workers’ compensation payers (“payers”) who contract with Express Scripts for pharmacy benefit management (“PBM”) services. The notice says that Walgreens will no longer be a participating pharmacy in the Express Scripts, Inc. network.
The Arizona Workers’ Compensation Act requires payers to provide prescription medications to injured workers. This obligation is separate and distinct from any contractual agreement between a payer (or its PBM) and a pharmacy on reimbursement for prescription medicines required to treat an injured worker. More importantly, the absence of a contract between a payer (or its PBM) and a pharmacy does not alter a payer’s obligation to ensure that prescription medications are promptly provided to injured workers. In short, a payer is obligated to ensure that prescription medications required to treat an injured worker are provided to the injured worker regardless of where the prescription is filled. And, a payer cannot prohibit or dissuade injured workers from filling prescriptions at the pharmacy of their choice.
This change may result in additional costs to payers if injured workers opt to fill their prescriptions at Walgreens. Information from the Industrial Commission of Arizona explaining the situation further can be viewed here.