Employers and Carriers can reject out-of-state/ mail order pharmacies if their prices do not match local prices.
La. R.S. 23:1203 gives the choice of pharmacy to the injured employee, and allows for medical care, services, and treatment to be provided by out-of-state providers or at out-of-state facilities when such care, services, and treatment are not reasonably available within the state or when the care, services, and treatment of the out-of-state provider can be provided for comparable costs.
In Injured Workers’ Pharmacy Employee-Clenon Naron v. LIGA, the injured employee was injured in a slip and fall incident while working for Sonic restaurant in 1999. He received medical treatment following the accident, including prescriptions medications, which were filled at a couple local Louisiana pharmacies.
In 2010, Claimant was referred by his attorney to the Injured Workers’ Pharmacy (“IWP”) for his prescription needs. IWP was licensed in Louisiana and was authorized to fill prescriptions in Louisiana, but it did not have personnel in Louisiana to dispense the prescriptions and instead shipped the prescriptions from Massachusetts. An issue arose over reimbursement of medical prescription costs incurred with IWP.
At trial, the workers’ compensation judge found that Employer and Carrier were liable for the prescription drug costs to IWP. However, on appeal, the Louisiana Second Circuit Court of Appeal reversed the decision of the trial court and determined that because IWP was an out-of-state provider and its services were reasonably available in Louisiana, it was required to provide drugs at a cost comparable to the in-state pharmacy in order to be reimbursed. The Second Circuit Court of Appeal held that Employer and/or Carrier were not responsible for the costs charged for the prescription drugs dispensed by the out-of-state pharmacy that was charging in excess of the local pharmacies.