Use of Compound Drugs, Medical Foods, and Co-Packs in California's Workers' Compensation Program

An Overview of the Issues

by Barbara O. Wynn

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Abstract

There is considerable controversy over the growing use of compound drugs, medical foods, and co-packs for workers' compensation (WC) patients. The issues surrounding the use of these products rest on uncertainties regarding whether the products are medically appropriate and whether payments are reasonable. Clarifying the coverage and payment rules and removing inappropriate financial incentives for physician-dispensing would help address these issues.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Compound Drugs, Medical Foods and Co-Packs

  • Chapter Three

    Determining payment under the Official Medical Fee Schedule OMFS

  • Chapter Four

    Tools to Ensure Drugs Are Medically Appropriate and Payments Are Reasonable

  • Chapter Five

    Discussion

  • Appendix A

    California Pharmacy Regulations

  • Appendix B

    OMFS Regulations

  • Appendix C

    Sample Bills for Compound Drugs

  • Appendix D

    Warning Letter to Physician Therapeutics, LLC

This research was conducted under the umbrella of RAND's Center for Health and Safety in the Workplace.

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