Tuesday, October 2, 2012

Fighting Fire with Fire: Kudos to Florida Payers

Back in March, I wrote a post about a little known corner of the Florida work comp regs that allows carriers and employers to reduce the price they pay for repackaged drugs. 

Here's how this works: An injured worker gets hurt and sees a doctor. The doctor prescribes and dispenses a drug, then makes up an NDC code, marks it up 300%, and bills the insurer. However, if a retail pharmacy, under contract with the insurer, is "reasonably accessible" for the injured worker, the insurer can re-price the drug to the contracted rate it has with the retail pharmacy. I've talked to the Florida DWC about the definition of "reasonably accessible" - candidly, they're not really sure.  Perhaps they've clarified this for payers in the state, but I couldn't get a straight answer. 

I'm not the only one that pointed this out.  The folks at workcompcentral and several other bloggers pointed to Florida statute 440.13 (12) as a potential tool for payers in the fight against repackaged drug pricing. 

Today brings news from NCCI that this tactic appears to be working.  NCCI has cut its estimate of savings from a proposed repackaged drug bill by half (from about $62 million to about $27 million) due to employers and carriers re-pricing obnoxious bills on their own. 

Predictably, AHCS (a software firm specializing in drug repackaging) says this is further evidence that NCCI's numbers are a moving target.  On the contrary, NCCI's numbers reflect the market reality of payers taking control of the situation in Florida and using any and all available statutes and regulations to stem the tide of inappropriately priced drugs. 

Way to go Florida payers. 

On Twitter @PRIUM1

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