Legislative and regulatory action across the country is likely to put a dent in the P&Ls of drug repackaging companies. They'll fight every step of the way and spend lots of money on lobbyists, but the fundamental business model simply isn't sustainable. They're not going away tomorrow, but the writing is on the wall. Some of the more strategically adroit drug repackagers are beginning to explore new revenue sources to replace the waning dollars earned from helping physicians dispense medications. Where are they looking?
One clear area is drug screening. Random urine drug monitoring for chronic opioid users is indicated in several sets of medical treatment guidelines and PRIUM believes strongly in the practice. In fact, this is one of the standard areas we explore on every review we conduct. The importance of random drug screening cannot be overemphasized given its impact on patient safety. But any virtue taken to an extreme can become a vice.
The logic trail here is similar to drug repackaging. Take a therapy or procedure that the doctor feels the patient needs... allow the doctor to administer the therapy or procedure directly in the office... bill the insurance company for services provided... increasing patient convenience and compliance. Sounds rational, right?
The devil, as they say, is in the details.
Drug repackagers routinely develop novel NDC codes, allowing them to create arbitrary average wholesale prices. This practice allows doctors to bill insurance companies significantly more than the insurer would have paid had the drug been filled at a typical retail pharmacy. And there is no evidence to suggest that the practice increases safety or compliance. Additionally, restricting this activity entirely (as several states do) does not appear to impact access to needed medications on the part of injured workers. Not so rational after all.
We see the same trend coming in drug screening. Keep a look out for excessive utilization and/or obnoxiously high bills for urine drug screening performed in the treating physician's office. The drug repackagers are going to start teaching docs how to game this system as well. A couple of examples: http://thephysiciansrx.com/toxicology.html and http://physiciandispensingsolutions.com/services-view/drug-toxicology/
Be vigilant. Understand the services you're buying. Ensure that the screening is truly random and within the treatment guidelines. Get another clinician to look at the test results - is the money you're paying actually telling you anything about the patient's adherence to the drug regimen?