I had three different conversations today, two with customers and one with a reporter, that all went relatively well… until the issue of repackaged drugs came up. Many have pointed out the ills of this rather despicable practice. Excess expense, perverse economic incentives, inappropriate utilization… the list goes on.
The last NCCI prescription drug update from August of 2011 included some sobering statistics:
- Physician-dispensed medications make up 28% of all prescription drug spend in work comp
- In three states (FL, CA, and GA), greater than 40% of the dollar value of work comp medications comes from a physician’s office (with MD, PA, and IL not far behind – all in the 30% range)
- Perhaps most galling, the mix of drugs is shifting. In 2005, the most common physician-dispensed drug in Georgia was ibuprofen (avg. script = $13). In 2009, it was meloxicam (avg. script = $199).
One of the first steps in PRIUM’s process is a physician-led intervention that focuses on a collegial, evidence-based conversation between two peers. How do you think that conversation goes when the prescriber is looking at a material economic loss if he complies with the guidelines-driven, evidence-based treatment plan we present?
So what to do? Three actions we can take:
1) Get aggressive on these claims. Leverage every possible statute, rule, tool, mechanism, and method at your disposal. We brought on in-house legal counsel here at PRIUM to help us advise clients on how to fight the good fight, jurisdiction by jurisdiction. When going to battle with a dispensing doc, you have the moral (and sometimes legal) high ground. Use it.
2) Join with me in following Joe Paduda’s lead; email Florida legislators in support of SB668 which eliminates the economic incentive for doctors to dispense drugs from their offices. The link to Joe’s post with specific instructions is here.
3) For larger payers/employers, read the Florida bill and get active in the state legislatures where you do business. Ridding the world of the practice itself may not be necessary – let’s just take the financial incentive away.
I recognize that when we squeeze the balloon on one end (physician dispensing), we often end up simply shifting the fee-for-service engine that is our modern health care system in another direction… but this particular issue is worth the stand we all need to take.