Alaska moves to cap what workers' comp pays for creams and patches

Alaska wants to put a ceiling on what workers' compensation pays for prescription creams and patches — after regulators saw over-the-counter products and minor tweaks to a formula billed at hundreds or even thousands of dollars.

Under a draft fee schedule released this week, reimbursement for a topical cream, whether prescribed or bought over the counter, would be capped at $30 a month. A medicated patch would top out at $70 per month's supply, and a compound cream mixed to order for a single patient at $240. There's no cap today.

The change wouldn't hit injured workers directly. Under state law, a worker doesn't pay for treatment tied to an injury the insurer has accepted as work-related, so the caps govern what insurers reimburse providers — not what patients owe. What drove the proposal was the billing: the committee that developed the caps flagged "instances where over-the-counter products or minor formulation changes resulted in charges of hundreds or thousands of dollars."

The proposal would also end automatic refills — each fill would require a new prescription — and tighten a handful of other drug rules in the same cost-cutting direction.

The caps came out of a state review committee, which includes members who don't work in health care, over a series of summer meetings that compared Alaska against six other states. At those meetings, the two sides of the tradeoff showed up: a pharmacy-benefit manager told the committee that caps have cut costs in other states without creating known access problems, while a representative of the Alaska Chiropractic Society warned that some providers and equipment suppliers might stop offering services if reimbursement falls too low.

The state hasn't put a number on it. Neither the proposal nor the committee's report says how much the caps would save, or how many Alaska claims even involve a topical drug.

Written comment is open through Oct. 9, and an oral hearing is set for Oct. 15 in Anchorage, with call-in options. After that, the board can adopt the changes, alter them, or drop them.