Physician Dispensed Prescriptions and RepackagingJanuary 17, 2018
For years, the Workers’ Compensation industry has been fighting an uphill battle against physician dispensed pharmaceuticals and drug compounding. Changing drug strengths and formulations is one way the market has been able to maintain high prices. While the numbers have declined in recent years, the impact this trend has on the Workers’ Compensation industry was discussed at the National Conference of Insurance Legislators’ (NCOIL) Workers’ Compensation Insurance Committee.
According to a 2017 study that analyzed physician dispensing habits across 26 states, prescribing frequency and pricing went down in states with reforms, as well as those without. The study looked at data from 2011 to 2014, when reforms were instituted in several states. Reforms included those that were price-focused which aimed to control high prices and repackaged drugs, capping them at wholesale prices. In addition, limiting reforms would limit certain types of drugs, or only allow them to be used for a specified period. Of the 50 states, 22 currently have reforms in place.
Kathy Fisher, Assistant Director of External Engagement at the Workers’ Compensation Research Institute (WCRI), said that the 2017 study looked at prices, frequency of prescribing and cost share, and how they compared to all prescription drug trends. The following are examples of some of their findings:
- Prescriptions for ibuprofen/Naproxen increased in Florida after the introduction of a new product
- In a non-reform or pre-reform state, prices either went up or remained static
- Physician dispensing went down in all post-reform states, including the following examples:
– There was a 63 percent reduction in South Carolina
– There was a 23 percent reduction in physician dispensing in Tennessee and Indiana
- In many of the reform states, there was a significant decrease in cost share of physician dispensed drugs
New Drug Formulations Offset Decrease in Physician Dispensed Drugs
According to Fisher, California, Florida, and Illinois had the highest number of physician dispensed drugs. They also saw a considerable increase in the number of new drug strengths and formulations of several existing drugs, which offset the decreases found in other states. In these states alone, up to 64 percent of the prescription payments went to physician dispensers. Fisher explained that although the reforms targeted high-priced, repackaged drugs, the costs remained high because manufacturers were able to develop new formulations and strengths.
The principal of Health Strategy Associates, a consulting firm for Workers’ Compensation Managed Care, offered possible solutions that could have a positive impact on Workers’ Compensation, including the following:
- Initiating reimbursement limits per script or per ingredient
- Capping the number of ingredients or the total cost per script
- Giving employers the option of denying coverage for a medication
- Allowing employers to send injured employees to a certain network of pharmacies
Baltimore Workers’ Compensation Lawyers at LeViness, Tolzman & Hamilton Seek Compensation for Injured Workers
If you have been injured at work, contact the Baltimore Workers’ Compensation lawyers at LeViness, Tolzman & Hamilton. We will ensure that you receive the maximum benefits that you are entitled to, while making sure that you are not being overcharged for your medication. We will protect your rights and guide you through the claims or appeals process. To schedule a free consultation, call us today at 844-556-4LAW (4529) or contact us online.