Keystone RX LLC v. Bureau of Workers’ Comp. Fee Review Hearing Office

The Pennsylvania Supreme Court affirmed the Commonwealth Court’s order that held that a pharmacy cannot challenge a utilization review determination that medications prescribed by a treating healthcare provider, but dispensed by the pharmacy, were unreasonable and unnecessary. The Commonwealth Court had affirmed the Hearing Officer’s order, but the Court went further and held that, prospectively, in utilization review (“UR”) hearings when an employer, insurer or an employee requests UR, non-treating providers, such as pharmacies, must be afforded notice and an opportunity to establish their right to intervene in the UR proceedings. The Supreme Court affirmed the Commonwealth Court’s order affirming the Hearing Officer’s order, but wrote specifically to reject its prospective procedural ruling.

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