Case is Part of an Ongoing Review Into Prescription Pricing Procedures in the Workers’ Compensation System
Following on the heels of its recent agreement with Express Scripts, Attorney General Maura Healey’s Office has announced another settlement over workers’ compensation pricing procedure failures. Retail pharmacy provider Walmart, Inc. has agreed to pay $500,000 after allegedly failing to follow prescription pricing procedures that are in place to keep costs down and prevent overcharges in the workers’ compensation insurance system.
“Having a workers’ compensation system that is transparent, functional, and affordable is essential for employers and workers across Massachusetts,” said AG Healey. “My office will continue to ensure that companies are following our state’s rules and regulations that guarantee drug pricing in our workers’ compensation system is handled fairly.”
The pricing procedures, required by Massachusetts regulations, ensure that prescription costs will be reviewed against certain regulatory benchmarks. According to the assurance of discontinuance, filed this week in Suffolk Superior Court, Walmart allegedly failed to follow those regulations when applying prices for various injured worker prescriptions from 2016 to the present, at Walmart pharmacy locations in Massachusetts.
Under Massachusetts’ Workers’ Compensation system, when employees are hurt on the job, they are entitled to lost wages, compensation for injuries, and payments for certain injury-related expenses. The system sets limits for the cost of prescriptions for injured workers and requires companies to validate prices against certain regulatory benchmarks before processing their charges, such as the Federal Upper Limit for Medicare and the Massachusetts Maximum Allowable Cost.
This case is part of an ongoing review by the Attorney General’s Office into prescription pricing procedures in the workers’ compensation system. AG Healey has now reached settlements with Walmart, Express Scripts, Optum Rx, Walgreens, Stop & Shop, and United Pharmacy for workers’ compensation drug pricing violations totaling over $16 million.