Friday, January 25, 2013

The Trend Against DR Dispensing Is About Cheating

Idaho has decided on a pre-emptive strike and enact rules and regulations concerning repackaged drugs before there is any evidence that the state's workers' compensation system has become infected with profit driven prescription practices.

The Idaho House Commerce and Human Resources Committee on Wednesday approved a regulatory proposal that would tie the payments for repackaged drugs to the original manufacturer’s average wholesale price and provide no separate reimbursement for the doctors who dispense the medications.

The trend to control repackaged drugs and physician dispensing has gained considerable momentum.

According to CompPharma, seven states prohibit physician dispensing. Ten states have regulations that attempt to control physician dispensing and repackaged drugs with pricing controls.

Other states have imposed variables such as time and quantity limits. For example, Arkansas limits physicians to dispensing a 72-hour supply and New Jersey limits doctor dispensing to a seven-day supply. Minnesota requires physicians to disclose their profits from dispensing to patients.

A bill pending in Maryland would authorize provider reimbursement only in situations where drugs are dispensed within 72 hours of an accident or the discovery of an industrial disease and would limit doctors to dispensing a 30-day supply.

Hawaii is contemplating a bill introduced this year that would set reimbursement for physician-dispensed repackaged drugs at the average wholesale price of the original manufacturer, plus an additional 40% for brand-name medications and 60% for generic drugs. This is similar to what was proposed, and defeated, in last years legislative session.

Florida, home of repackaging and physician dispensing, may never get that issue under control.

The Florida Medical Association said it will oppose any effort to limit the ability of physicians to dispense medications directly to their patients, general counsel Jeff Scott said in an email to WorkCompCentral.

“Rather than imposing arbitrary caps on dispensing repackaged medications, it would be more productive for business groups to focus on the real cost drivers in the workers compensation system – a system, unlike medical malpractice, in which statewide premiums are not the highest in the nation,” Scott wrote. “Furthermore, the FMA strongly believes that dispensing by physicians leads to innumerable benefits, including increased patient compliance, reduced drug diversion and better access to care – important factors in complying with the federal (Affordable Care Act).”

I don't see how a physician, as opposed to a pharmacist, has any better control over patient compliance. In my mind that makes no sense.

Likewise it escapes my rather stifled imagination how physician dispensing reduces drug diversion - if recent headlines are any indication, it seems the exact opposite: inscrutable physicians seem to be quite willing to turn their heads and cough, while their patients load up on prized pills.

In a 16-state study released in April, 2010, the Workers Compensation Research Institute (WCRI) found Florida’s drug claims were 38 percent above average. It also found that workers were getting more drugs than those in other states, especially painkillers and muscle-relaxers that can be abused.

The main reason for the higher prescription costs in Florida, WCRI says, was that some physicians wrote prescriptions and dispensed the prescribed medications directly to their patients. When physicians dispensed prescription drugs, they often were paid much more than pharmacies for the same prescription.

The truth in Florida is that Automated Healthcare Solutions (AHS), a Miramar, Fla.-based company that provides claims management software to assist physicians in the dispensing of repackaged drugs, had given state lawmakers $3.2 million since 2002 according to the Florida Independent in a story published January 2012.

So better access to care is really just another red herring.

There's a lot of money at stake. In Florida the issue is accused of increasing system costs by $27 million per year. The average payment per claim for prescription drugs in Florida’s workers’ compensation system was $565—38 percent higher than the median of the study states, according to WCRI. The price per pill paid to Florida physician dispensers for Carisoprodol was 4 times higher than if the same prescription was filled at pharmacies in the state.

I bag on California quite a bit because often I feel that my home state doesn't live up to its potential. But at least with regards to this issue, California leads the nation. WCRI shows the percentage of prescription payments for physician-dispensed drugs increased in 16 of 17 states studied between 2008 and 2011, with California being the only state in which the percentage decreased.

The California Division of Workers' Compensation adopted a regulation in 2007 that capped the price of repackaged drugs.

Much is made about this issue being a cost driver. But in my estimation, costs aren't what really rankles people's emotions on this topic.

What gets people upset, as in many areas of life, is someone taking unfair advantage of a system - using loopholes in the law to generate revenue at the expense of the social good.

In other words, people just don't like cheats.

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