Yesterday’s meeting in Boston was very, very productive. The audience included trade groups, insurers, TPAs, large employers, physicians, researchers, regulators, analysts, PBMs, and media, all focused on the single issue of physician dispensing.
Among the sessions was a report on a just-completed study of the impact of dispensing on claim outcomes – very compelling and highly revealing.
Here were some of the other highlights:
AIA CEO Leigh Ann Pusey led off with the keynote; the fact that Ms Pusey took the time to prepare for and attend the Summit is revealing indeed; her members write over a hundred billion dollars of insurance premiums and are dealing with critical, industry-altering issues including Dodd-Frank, TRIA, and the sequester. She was very knowledgeable and detailed the work AIA is doing both internally and with other groups and associations. Suffice it to say that this is a very high priority for AIA and their members.
Dan Reynolds, managing editor of Risk and Insurance moderated an excellent panel on the issue of patient safety. Pharmacists, a physician, and the nation’s leading authority on prescription drug monitoring programs provided insights into the risks inherent in physician dispensing. Notably, John Eadie of Brandeis’ PDMP Center for Excellence revealed that most states require/request dispensing physicians access the PDMP prior to dispensing scheduled drugs. He provided a guide for finding out how different states address the issue; I’ll provide a link in a later post.
Sedgwick’s Kimberly George noted that, where appropriate, the giant TPA uses physician dispensing as a data point in assessing and rating physicians. This can affect the volume of patients directed to specific practitioners.
For me, the major takeaway was CWCI’s analysis of the impact of physician dispensing on claim costs and outcomes. Alex Swedlow’s concise presentation noted that after reform eliminated the upcharge for repackaged drugs;
- each physician-dispensed repackaged drug prescription added $545 to the average medical benefit costs.
- paid medical benefits on claims with physician-dispensed repackaged drugs averaged $7,297, or 37.3 percent more than the $5,316 average for claims without these types of prescriptions.
- indemnity payments on claims with physician-dispensed repackaged drugs averaged $5,039, or 28.2 percent more than the $3,930 average for claims without physician-dispensed repackaged drugs.
- claims with physician-dispensed repacked drugs averaged 50.3 paid TD days – 8.9 percent more than the average of 46.2 days for claims without repackaged drugs.
The research, conducted by Swedlow, John Ireland, and Laura Gardner, destroys physician dispensers’ claim that better outcomes and lower costs result from physician dispensing.
Undoubtedly, dispensing advocates will now roll out their PR flacks and physician shills in an attempt to refute CWCI’s study results, methodology, impact, and applicability to other states.
Good luck with that.
Swedlow, Ireland, and Gardner are three of the most respected researchers in this industry. Their expertise, insight, intellectual rigor, and objectivity are beyond question.
With the release of CWCI’s excellent work, we can now refute every claimed benefit offered up by physician dispensers – leaving no doubt as to the only real benefit of the practice:
taking hundreds of million of dollars from taxpayers and employers to do nothing other than line the pockets of dispensing docs, dispensing companies, their investors, and their partners.
What does this mean for you?
Read the study here.
Send it to regulators, employers, policyholders, legislators, lobbyists, attorneys – anyone and everyone. Get the word out.
