IN THE COMMONWEALTH COURT OF PENNSYLVANIA Armour Pharmacy, : Petitioner : : v. : No. 1726 C.D. 2017 : Argued: December 12, 2018 Bureau of Workers’ Compensation : Fee Review Hearing Office : (Wegman’s Food Markets, Inc.), : Respondent : BEFORE: HONORABLE MARY HANNAH LEAVITT, President Judge HONORABLE RENÉE COHN JUBELIRER, Judge HONORABLE ROBERT SIMPSON, Judge HONORABLE PATRICIA A. McCULLOUGH, Judge HONORABLE ANNE E. COVEY, Judge HONORABLE MICHAEL H. WOJCIK, Judge HONORABLE ELLEN CEISLER, Judge OPINION NOT REPORTED MEMORANDUM OPINION BY PRESIDENT JUDGE LEAVITT FILED: April 12, 2019 Armour Pharmacy (Pharmacy) petitions for review of an adjudication of the Bureau of Workers’ Compensation, Fee Review Hearing Office (Hearing Office) vacating two determinations of the Bureau’s Medical Fee Review Section that directed Wegmans Food Markets, Inc. (Employer) to reimburse Pharmacy for medications it had dispensed to Kathleen Hackman (Claimant). Employer challenged these fee determinations for the stated reason that Pharmacy was not a “provider” under the Pennsylvania Workers’ Compensation Act (Act)1 and, thus, not entitled to reimbursement. Concluding that the Bureau’s Medical Fee Review Section lacked jurisdiction to determine whether Pharmacy was a “provider,” the 1 Act of June 2, 1915, P.L. 736, as amended, 77 P.S. §§1-1041.4, 2501-2710. Hearing Office vacated the two determinations and dismissed Employer’s appeal thereof. Pharmacy argues that the Hearing Office’s adjudication has left it without a forum in which to challenge Employer’s refusal to reimburse it for medications it dispensed to treat Claimant for her work injury, and this violates due process. Concluding that this matter is controlled by our recent decision in Armour Pharmacy v. Bureau of Workers’ Compensation Fee Review Hearing Office (Wegman’s Food Markets, Inc.) __ A.3d __, (Pa. Cmwlth., No. 1725 C.D. 2017, filed March 29, 2019) (en banc) (Armour I),2 we reverse and remand. On November 18, 2016, Jeffrey M. Friedman, M.D., prescribed Claimant a medical cream compound consisting of “Ketamine 10%, Flurbiprofen 10%, Gabapentin 10%, Cyclobenzaprine 3%, Bupivacaine 2%, [and] Transdermal Base (qs)” to treat her pain. Reproduced Record at 5a (R.R. __). Pharmacy dispensed the medication to Claimant on two occasions and thereafter invoiced Employer $2,426.11 for each prescription. Employer denied payment on the first invoice of November 22, 2016, for the following reasons: Charge for pharmaceuticals exceed the fees established by the fee schedule/UCR [usual and customary] rates [and Employer] does not cover pain cream compounds[.] [A] letter of medical necessity from your doctor is required if no alternatives are available[.] R.R. 4a. Employer denied payment on the second invoice of December 21, 2016, stating, “Denied: Medical records. Please resubmit with related medical records to: [Employer’s address].” R.R. 23a. 2 This matter was argued seriately with Armour I. The two cases were consolidated at the hearing before the hearing officer. Nevertheless, the hearing officer issued two separate decisions that were not consolidated before this Court. 2 Pharmacy filed two applications with the Bureau’s Medical Fee Review Section, requesting a review of Employer’s refusal to pay the two invoices. The Medical Fee Review Section determined that the amount ...
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