Florida’s legislature is working thru several workers’ comp bills – and the news isn’t good.  A PDMP bill has been emasculated; Florida’s prescription drug monitoring program won’t require physicians check the system before prescribing drugs.

And while there’s ongoing negotiations on a bill addressing physician-dispensed drugs, at this point it looks like Florida’s employers will have to pay more for physician-dispensed drugs than they would if those drugs were dispensed by retail pharmacies.

This is a fluid situation and may well change – and we can only hope it does. We are also wondering where the retail pharmacies and food/drug combos are in the discussion; there is no evidence that physicians pay more for their drugs than drug stores do, so forcing employers and taxpayers to cough up millions to line the pockets of dispensers and their enablers is nothing more than extortion.

That said, it is clear that the Florida Medical Association has once again ignored their Hippocratic oath to do no harm; according to Mike Whitely’s piece in WorkCompCentral the FMA  got the bill’s sponsor, Rep. Mike Fasano R New Port Richey, to “drop a requirement that Florida physicians consult the PDMP before prescribing drugs on Schedules II and III of the US Drug Enforcement Administration’s controlled substances list.”

Notably Rep. Fasano appears to have removed that requirement in hopes that in so doing the bill would have a better chance of passage.  That said, the FMA’s position is short-sighted and self-serving.  According to the vice chair of the FL PDMP Foundation, it “makes sense for doctors to check the database and it takes 30 seconds.” [emphasis added].

So.  Thirty seconds is more important to the FMA – and their members – than preventing doctor-shopping, reducing criminal behavior, and saving lives.

Lest you think I’m being hyperbolic, doctor shopping kills people. And speaking about the Tennessee law requiring docs check the PDMP database before prescribing, “There’s no question the law there will reduce overprescribing and doctor-shopping, said Gary Zelizer, director of government affairs for the Tennessee Medical Association. Yet reducing over-prescribing, doctor-shopping, and the resulting deaths and injuries is less important than saving 30 seconds.

For those interested in doctor-shoppers’ views on PDMPs, read this.  Abusers hate PDMPs that mandate physician checks of the PDMP before prescribing.

According to the NYTimes, the FDA’s ongoing investigation into compounding pharmacies:

“found numerous unsafe practices at about 30 compounding pharmacies, the same type of facility responsible for the tainted drug that caused a deadly meningitis outbreak last year.

Among the problems found were unidentified black particles floating in vials of supposedly sterile medicines, rust and mold in clean rooms where such drugs are made, improper air flow, and clothing that left workers’ skin exposed.” [emphasis added]

If they aren’t, workers’ comp payers and medical management firms should be paying very close attention to these inspections.  There are three problems with compounds – they tend to be very costly, there is zero evidence that they help the healing process, and there is a wealth of evidence (see above) that compounds can be very dangerous – if not lethal.

Workers’ comp claimants harmed by compounds will incur expenses to address that harm – expense that will have to be covered by the workers’ comp payer.

The payer may also have to provide death benefits for claimants killed by compounds.

States that currently have a compounding problem are likely to see it grow – as it has in California.  States enjoying a compound-free experience are almost certain to be targeted by compounders and their enablers.

The list of FDA-inspected compounders is here.

Way more dangerous than we’ve been led to believe by compounding pharmacies and their supporters. A report in the Washington Post by two investigative journalists highlights shoddy practices and unsanitary conditions at three pharmacies that have sickened and killed patients.

Unfortunately compounding is a growing phenomenon, especially in workers’ comp.  Research from CWCI and other sources indicate that despite the lack of any evidence-based research justifying widespread use, compound meds are becoming a larger part of pharmacy spend.  Fortunately, we can observe what’s happened in California to forecast the future for compounding in other states.

California recently tried to address the issue thru bill AB 378, which specifically focused on the ingredient cost; the net? the number of scripts dropped 35% (from 3.1% of all scripts to 2%)…however the cost per script zoomed.  Compounds now account for one out of every eight dollars spent on drugs…

(see CWCI’s February 2013 report for details on what happened and why)

In his blog, David DePaolo reported on a criminal case involving payments to physicians for prescribing compounds;

“The complaint, filed by the owners of a medical billing company in the U.S. District Court in New Hampshire, alleges that Cyrus Sorat is a part owner of Health Care Pharmacy and Deutsche Medical Services in Tustin, Calif., and paid 208 doctors to prescribe compound drugs to injured workers needing topical analgesics. Sorat promised to pay the doctors an unreported fee for each prescription they wrote, and also agreed to handle billing and recover receivables on behalf of the physicians, according to the complaint.”

While cases such as these are unusual, the increased use of compounds, and specifically the changes in the compound drugs dispensed are clearly intended to maximize reimbursement.

Make no mistake – this isn’t about patient care or return to work or excellent medicine, it is about enriching a few at the expense of employers and taxpayers, while not caring one whit about possible patient safety issues.

Workers’ comp – the last refuge of scoundrels and charlatans.  Again.

 

 

 

The good folks in Louisiana are rejoicing over a recent court decision in a case involving LUBA Workers’ Comp; here’s the interpretation from Jeffrey Napolitano of Juge Napolitano Guilbreau Ruli & Frieman PLC, a legal firm in Metairie, LA…

the court found “a wholesale pharmacy distributor, who contracts with physicians to provide pharmaceuticals to the physicians on a consignment basis for dispensing to their workers compensation patients, has no right of action to bring suit against the employer/insurer for payment for pharmaceuticals. [emphasis added] The court held that only the employee or healthcare provider has a right to brig suit for payment for providing medical services to an injured workers under the workers compensation act.”

While the Pelican State may have a reputation as a bit of a hellhole for workers comp payers, this latest shows that there’s always good to be found – if you have a good enough case and a smart enough attorney.

Kudos to LUBA for fighting the good fight.

Unfortunately, we can expect physicians to start billing for themselves, or figuring out some equally creative way to suck more money out of employers and taxpayers.

What does this mean for you?

The briefest of respites…