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Florida workers’ comp division clarifies stand on physician dispensing

April 8, 2020 · Policy Matters team

The Florida Division of Workers’ Compensation (DWC) has declared that physicians are permitted to dispense medications to injured workers, and that an injured worker shall have full and free choice to utilize their physician for medication dispensing, as well as any other pharmacy or pharmacist.

DWC further stated that it is not appropriate for employers/carriers to deny authorization or reimbursement for prescription medication solely because the medication is dispensed by the treating physician who is a licensed Florida dispensing practitioner instead of a pharmacist.

Dispute led to DWC bulletin
In a recent reimbursement dispute claim, a Florida dispensing practitioner was denied reimbursement for drugs dispensed out of their office. The physician asserted the claims administrator denied reimbursement for the dispensed medications because the physician was not authorized to dispense prescription medications. The Florida Department of Financial Services (DFS) ruled in favor of the physician – DFS Case No.: 20180824-007-WC – and subsequently issued DWC Bulletin DWC-01-2020 on March 31, 2020.

Details of DWC bulletin
Under existing Florida Statutes 440.13(3)(j), a sick or injured employee shall be entitled at all times, to free, full and absolute choice in the selection of the pharmacy or pharmacist dispensing and filling prescriptions for medications required under this chapter. This language specifically addresses the ability of an injured worker to choose their pharmacist or pharmacy when filling their work-related prescriptions. While other sections of the same segment of statute – Florida Statutes 440.13(12)(c) – outline reimbursement rates for dispensed medications and a separate rate for “repackaged or relabeled medications” dispensed by a “dispensing practitioner.”

In issuing the statement, DFS and DWC clearly stated that dispensing practitioners are recognized and granted the ability to dispense medications under Florida Statutes 465.0276 (1) and (2), and that 440.13(12)(c) contains a reimbursement rate not only for pharmacies and pharmacists but for dispensing practitioners.

DFS and DWC also state these statutorily prescribed reimbursement rates are also separately recognized in the Florida Workers’ Compensation Health Care Provider Reimbursement Manual. Therefore, DFS and DWC indicate that physicians are permitted to dispense and receive proper reimbursement and that bills for medications dispensed by physicians, who are compliant dispensing practitioners, should not be rejected or denied based upon the fact that the physician is dispensing practitioner rather than a pharmacist.

A link to the Bulletin can be found here: https://www.myfloridacfo.com/Division/WC/pdf/DWC-01-2020.pdf.


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