Keystone Rx v. Bureau. of Workers' Compensation (majority)
Annotate this CaseThe Bureau of Workers’ Compensation Fee Review Hearing Office (“Hearing Office”) concluded that, in the fee review setting, a non-treating healthcare provider, like a pharmacy, could not challenge a utilization review (“UR”) determination that medications prescribed by a treating healthcare provider, such as a physician, but dispensed by the non-treating entity, were unreasonable and unnecessary for the treatment of a claimant’s work-related injury. The Commonwealth Court affirmed the Hearing Office’s order. However, after reaching this result, the intermediate court held that for UR procedures occurring in the future, when an employer, insurer or an employee requests UR, non-treating providers, such as pharmacies, had to be afforded notice and an opportunity to establish their right to intervene in the UR proceedings. While the Pennsylvania Supreme Court affirmed the Commonwealth Court’s result, it rejected its prospective holding that non-treating healthcare providers had to be given notice and an opportunity to intervene in UR proceedings.
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