SB 2751

THE SENATE
S.B. NO.
2751
THIRTY-THIRD LEGISLATURE, 2026
S.D. 1
STATE OF HAWAII
A BILL FOR AN ACT
RELATING TO WORKERS' COMPENSATION.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
���� SECTION 1.� The legislature finds that workers'
compensation costs and transparency are critical to maintaining fair and
predictable benefits for injured workers while controlling employer expenses.� The legislature further finds that compounded
prescription drugs can provide essential therapeutic options for injured
workers when commercially available Food and Drug Administration (FDA)-approved
medications are unsuitable due to allergies, dosage requirements, or other
clinical needs.� However, inconsistent
definitions have led to confusion.�
Federal law under section 503A of the Federal Food, Drug, and Cosmetic
Act (21 U.S.C. 353a) establishes clear standards for pharmacy compounding,
including patient specific prescriptions, quality requirements for bulk
substances, and exclusions for simple reconstitution.� Aligning state law with these standards will
promote patient safety by ensuring compounded drugs meet recognized quality benchmarks
and enhance regulatory consistency between state and federal oversight.
���� Accordingly, the purpose of this Act
is to ensure that injured workers in the State receive appropriate,
individualized medical care that is necessary and reasonable for the specific
injury by:
���� (1)� Defining "compounded prescription
drug" in the State's Workers' Compensation Law that references section
503A of the Federal Food, Drug, and Cosmetic Act;
���� (2)� Limiting the dispensing of prescription drugs
by physicians to thirty days following the industrial injury and requiring all prescription
drugs to be obtained through the employer's pharmacy benefit manager
thereafter; and
���� (3)� Requiring prescription drugs not approved by
the Food and Drug Administration, such as compounds, to be identified as
compounds when listed on the treatment plan and when billed, and be supported
by a statement of medical necessity documenting the case of medical need for a
compound drug over an over-the-counter or prescription drug of similar
therapeutic effect that is approved by the Food and Drug Administration.
���� SECTION 2.� Section
386-21.7, Hawaii Revised Statutes, is amended to read as follows:
���� "�386-21.7� Prescription drugs;
pharmaceuticals.� (a)� Notwithstanding any other provision to the
contrary, immediately after a work injury is sustained by an employee and so
long as reasonably needed, the employer shall furnish to the employee all
prescription drugs as the nature of the injury requires; provided that
initial concurrent prescriptions for opioids and benzodiazepines shall
meet the requirements of section 386-29.� The liability for the prescription drugs
shall be subject to the deductible under section 386-100.
���� (b)�
Payment for all forms of prescription drugs including repackaged and
relabeled drugs shall be one hundred forty per cent of the average wholesale
price set by the original manufacturer of the dispensed prescription drug as
identified by its National Drug Code and as published in the Red Book:� Pharmacy's Fundamental Reference as of the
date of dispensing, except where the employer or carrier, or any entity acting
on behalf of the employer or carrier, directly contracts with the provider or
the provider's assignee for a lower amount.
���� (c)� Payment
for compounded prescription drugs shall be the sum of one hundred forty per
cent of the average wholesale price by gram weight of each underlying
prescription drug contained in the compounded prescription drug.� For compounded prescription drugs, the
average wholesale price shall be that set by the original manufacturer of the
underlying prescription drug as identified by its National Drug Code and as
published in the Red Book:� Pharmacy's
Fundamental Reference as of the date of compounding, except where the employer
or carrier, or any entity acting on behalf of the employer or carrier, directly
contracts with the provider or provider's assignee for a lower amount.
���� (d)� All
pharmaceutical claims submitted for repackaged, relabeled, or compounded
prescription drugs shall include the National Drug Code of the original
manufacturer.� If the original
manufacturer of the underlying drug product used in repackaged, relabeled, or
compounded prescription drugs is not provided or is unknown, then reimbursement
shall be one hundred forty per cent of the average wholesale price for the
original manufacturer's National Drug Code number as listed in the Red Book:
Pharmacy's Fundamental Reference of the prescription drug that is most closely
related to the underlying drug product.
���� (e)�
Notwithstanding any other provision in this section to the contrary,
equivalent generic drug products shall be substituted for brand name
pharmaceuticals unless the prescribing physician certifies that no substitution
shall be prescribed because the injured employee's condition does not tolerate
an equivalent generic drug product.
���� (f)� Physician dispensing of prescription drugs shall
be allowed for thirty days following the industrial injury.� Thereafter, all prescription drugs shall be
obtained through the employer's pharmacy benefit manager.
���� (g)� Prescription drugs not approved by the Food
and Drug Administration, such as compounds, shall be identified as compounds
when listed on the treatment plan and when billed, and be supported by a
statement of medical necessity documenting the case of
medical need for a compound drug over an over the counter or prescription drug
of similar therapeutic effect approved by the Food and Drug Administration.� Failure to identify a compound on a treatment
plan or when billed shall make the payment for the drug non‑reimbursable.
���� [[(f)]] (h)� For purposes of this section[[,
"equivalent]]:
���� "Compounded prescription
drug" means a drug product that is compounded in a compounding facility in
compliance with 503A of the Food, Drug, and Cosmetic Act (21 U.S.C. 353a), or
any other type of similar compounding facility approved by the Food and Drug
Administration.
���� "Equivalent generic drug
product" has the same meaning as provided in section 328-91."
���� SECTION 3.�
This Act does not affect rights and duties that matured, penalties that
were incurred, and proceedings that were begun before its effective date.
���� SECTION 4.� Statutory material to be repealed is
bracketed and stricken.� New statutory
material is underscored.
���� SECTION 5.� This Act shall take effect on January 1,
2077.
Report Title:
Workers'
Compensation; Benefits; Prescription Drugs; Compounded Prescription Drugs;
Physician Dispensing Timeframe; Non-FDA-Approved Drugs; Identification;
Statement of Medical Necessity
Description:
Defines
compounded prescription drugs for the purposes of the State's Workers'
Compensation Law.� Limits dispensing of
prescription drugs by physician to 30 days after the industrial injury and
requires all prescription drugs to be obtained through the employer's pharmacy
benefit manager thereafter.� Requires prescription
drugs not approved by the Food and Drug Administration (FDA), such as
compounds, to be identified as compounds when listed on the treatment plan and
when billed, and be supported by a statement of medical necessity documenting
the case of medical need for a compound drug over an FDA-approved over-the-counter
or prescription drug of similar therapeutic effect.� Effective 1/1/2077.� (SD1)
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.