Wednesday, April 24, 2013

FL Moves Forward with Ali Law

Politics, more than anything else in America, is made up of compromise. This is good, and this is bad.

The good is that, for most people most of the time, compromise takes care of the concerns and people can move on.

The bad is that, for some people too much of the time, special interests deeply entrenched in the political negotiation process make out much better than reason would dictate.

And so it is with the latest news out of Florida and the wrestling over physician-dispensed medication.

The Senate Appropriations Committee voted 19-0 Tuesday to adopt Senate Bill 662 with an amendment agreed to last week by the Florida Insurance Council, Associated Industries of Florida, the Florida Chamber of Commerce, AHCS and the Florida Medical Society that will set a price cap of 112.5% of the average wholesale price (AWP) set by the original manufacturer plus an $8 dispensing fee.

Drugs sold by pharmacies would continue to be paid for at AWP plus a $4.18 dispensing fee.

According to Sen. Alan Hays, R-Umatilla, who worked out the compromise, the price cap will trim annual costs in the workers' compensation system by 0.7% and save insurers and employers about $20 million a year.

An earlier House version of the bill, HB 605, filed by Rep. Matt Hudson, R-Naples, would cap the price of repackaged drugs at the AWP set by the original manufacturer plus a $4.18 dispensing fee. That bill is stalled in the House Health and Human Services Committee with 11 days remaining before the Florida Legislature adjourns. 

News reports indicate that Hays' bill will likely get through the legislature and go to the governor's desk for signature - and since it is a compromise after 4 years of fighting, likely it will get signed into law.

Is that the right thing?

If you're tired of the fighting and just want to move on, and be satisfied that the National Council on Compensation Insurance (NCCI) says that the Hays and/or Hudson bills will save around $20 million in costs, or about 1.1% overall, then oki-doki.

If you believe that this is just nonsense to protect some special interest profit center, then it's not okay.

Because also contained in the Hays bill as amended are retractions of provisions in the current law that allows carriers and employers to pay "at the schedule, negotiated or contract price whichever is lower" for drugs when the injured work chooses to obtain them from a provider who is not a party to the discount contract.

This should have employers and their insurers screaming - not to mention the fact that if you're an actual pharmacy you have no ability to price compete against doctors who dispense because of the single point of contact advantage that the treating physician has with the injured worker in the workers' compensation system.

Talk about protectionism...

And what's to keep the treating physician from scheduling return appointments ad nauseum for medication checks in order to maintain that additional profit margin built into SB 662?

Joe Paduda, famous (or infamous, depending on which end of his biting criticism you're on) told WorkCompCentral, "There is no rationale for paying dispensing physicians more than retail pharmacies, especially now that we know that dispensing repackaged drugs increases overall medical costs and extends disability duration."

I can't agree more.

Unless there is a legislature that is tired of the fight and wants to move on.

That's where you get an odd number like 112.5%.

SB 662, as amended, is an Ali Law, after boxing legend Muhammed Ali - where a special interest plays "rope a dope" (pun intended), and is obstinante for so long, that eventually everyone else gets tired and just gives up, so they work up something to make the issue go away.

Until the next time a similar or related issue surfaces. Which will happen.

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