Earlier this year, I predicted Florida would pass a bill limiting reimbursement for physician dispensed drugs. This morning, we made some significant progress.
Spent a good chunk of the morning watching the Florida Senate hearing on Sen Hays’ bill that would peg reimbursement for physician dispensed drugs at what a retail pharmacy would charge for the same drug.
Automated Healthcare Services’ lobbyist Tom Panza was up to speak in opposition. A passionate advocate for his client, Panza’s speech was notable for its energy if not for its accuracy.
He conflated drug costs, saying that repackaged/physician dispensed drugs average price of $137 is the same as the average pharmacy price of $120. What Panza didn’t say, and none of the Senators asked about, is drug mix. Physician dispensers almost exclusively dispense generics, which are much cheaper – on a per script basis – than brand drugs. And retail chains sell brands and generics – brands cost over $200 per script. Thus, Panza’s claim that physician dispensed drugs only cost $17 more on average than retail was misleading and false on its face; in fact WCRI’s recent report on pharmacy in Florida notes: “physicians were paid 35-60 percent more than pharmacies for the same prescription.”
Panza also trotted out the hoary old chestnut that physician dispensing increases compliance, citing the statistic that 30% of scripts aren’t filled – ignoring that this figure is a) dated; b) addresses group health and not work comp; and c) the main reason people don’t fill their group health scripts is cost. And as we all know, comp claimants don’t pay anything for drugs.
Panza also stated that physician dispensed drugs reduced litigation and increased patient satisfaction, without citing any data or research to support that assertion. Gotta respect his passion, even if his logic and supporting data (of which there was almost none) was suspect at best.
Lori Lovgren came up after Panza, and debunked his claim that prices were the same for physician and pharmacy prices. Sen Bennett was somehow confused about her response, or perhaps more accurately Bennett didn’t like what he heard. Bennett’s been vocal about his support for the egregious over-billing for drugs by physician dispensers. Sen Negron, another physician dispensing supporter, asked some unsubtle questions asking if insurers had any ownership of pharmacies or PBMs, which Lovgren did not answer – the answer, of course, is no.
While Lovgren was, or course, accurate, she wasn’t a particularly effective speaker, and failed twice to make key points refuting Panza’s claims. It’s one thing to have the right information, but it’s a whole different thing to present that information cogently and effectively.
Several other Senators seemed to focus on narcotics, and wanted to know if the pill mill bill had changed the financial picture, making NCCI’s cost figures irrelevant. Lovgren responded that no, there was no significant impact on cost, but that didn’t seem to bear much weight
A number of potential speakers from all manner of employer, taxpayer, and payer advocacy organizations waived their chance to speak but voiced support for Sen. Hays’ bill (restricting overcharging for physician dispensed medications).
A physician advocated for physician dispensing said he couldn’t dispense at the costs set by the Hays bill as he has to hire additional staff and buy software etc and therefore the bill killed physician dispensing
David Deitz, MD spoke directly to the physicians’ claims that physician dispensing increases compliance, noting there are no studies supporting that claim. He also noted that Liberty Mutual does not oppose physician dispensing but rather repackaging. Another Senator cut off Dr Deitz, and the Committee did not allow any of the other dozens of supporters to speak. That’s too bad, as Dr Deitz knows this subject very well.
There was some very brief discussion, but the bill passed out of Committee by a substantial margin
This is a big step, a critically important one, but only a step. There’s much to be done to get this bill passed by the Senate and signed into law.
We’ll keep you posted.
Thanks to Carol Gentry of HealthNews Florida for the head’s up.
Jan
19
