Tuesday, May 3, 2011

AZ's Unique Drug Control Prescription

Friday Arizona Governor Jan Brewer signed into law a unique twist to the various attempts to control prescription drug costs with HB 2616.

Under the new law, which takes effect July 18, an insurance carrier or self-insured employer is not required to pay for office visits when a physician fails to provide justification for narcotic prescriptions or fails to comply with a request to consult with the Controlled Substance Prescription Monitoring Program (a database of prescriptions for controlled substances that was created by lawmakers in 2008 to prevent patients from doctor shopping to obtain multiple prescriptions) before writing a prescription. The bill also allows the insurer or employer to request a change of physician.

This is a unique approach because it incorporates several elements that various other states have implemented or are attempting to implement.

First there is the bureaucratic hassle factor of additional reporting and forms by requiring physicians to provide justification and/or failure to comply with the "program".

Second there is the financial incentive (or disincentive) tied to failure by not getting paid for office visits.

Finally there is the possibility of losing the income stream tied to ongoing patient treatment.

Other states are trying to control physician dispensing prescription medicine abuse with just bureaucracy (Oregon), caps (Texas), outright bans (Florida), and utilization review (California). Some states allege much higher costs to work comp systems as justification for new regulation of physician dispensing of drugs, while other states seem more concerned with social reform.

Regardless, the wave of new ideas on controlling prescription drugs in the work comp market will be interesting to monitor over the long term to see which, if any, solution actually makes a difference. The alphabet soups (NCCI, CWCI, WCRI, etc.) will all be watching.

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