New study casts doubt on benefits of physician-dispensed meds
Injured workers in California who receive repackaged medications directly from their doctors' offices do not appear to have better outcomes than others, according to new research.
Researchers at the California Workers' Compensation Research Institute say physician dispensing costs the system more and results in more days away from work even after the implementation of reforms to curb price differentials.
The findings are included in CWCI's latest research brief and raise more concerns about the controversial practice of physician-dispensed medications. The authors suggest the findings dispel the idea that physician dispensing improves access to, and compliance with pharmacy prescriptions leading to improved medical and disability outcomes.
"The results associating higher medical and indemnity payments, and more days of disability with claims involving physician-dispensed repackaged drugs challenges the notion that these medications offer improved outcomes to injured workers and indicates that the use of these drugs is more of a cost driver than a cost saver in workers' compensation," according to a CWCI statement.
Part of the controversy around physician dispensing of repackaged drugs concerns the price. Prior to reforms in 2007, reimbursement for repackaged drugs "often exceeded the amount paid for equivalent pharmacy-based prescriptions by 500 percent or more," noted the authors.
The reforms adopted by the California Division of Workers' Compensation to the pharmacy fee schedule "largely eliminated the differential pricing," the authors said. "The effect was immediate, as both the volume of physician-dispensed repackaged drugs and the amounts paid for these medications declined by more than 90 percent by 2011."
Despite the change, overall amounts paid and days away from work increased after the reforms. The researchers analyzed more than 1.3 million open and closed claims with injury dates between January 2002 and December 2011. They divided them into pre- and post-reforms, as well as those with at least one physician-dispensed repackaged drug and those with none.
The researchers issued the following findings:
- Average paid medical benefits per claim with PDRDs were both higher pre- and post-reform. Before the reforms, the average claim with a PDRD was $5,524, compared to $4,747 for claims without a PDRD -- a 16.4 percent difference. Following the 2007 reforms, the average claim with a PDRD was $7,297, compared to $5,316 for other claims, a difference of 37.3 percent.
- Average paid indemnity benefits per claim were also higher pre- and post-reform for those with PDRDs. Pre-reform the costs were $4,229 for a PDRD claim, compared to $3,956 for other claims, a 6.9 percent difference. Post-reform the average cost for a PDRD claim was $5,039, compared to $3,930 for claims with no PDRD, a 28.2 percent difference.
- Average number of paid temporary disability days away from work was higher for claims with a PDRD both pre- and post-reform. Prior to the reforms, the average claim with a PDRD was 37.6 days compared to 36.3 days for other claims -- a 3.6 percent difference. After the reforms, the average number of paid days away from work was 50.3 for claims with PDRDs compared to 46.2 for other claims, a difference of 8.9 percent.
- The amount added to the average cost of a claim when a PDRD was involved increased following the reforms. Pre- reform, each PDRD prescription added $465 to the average cost of medical benefits per claim, while post-reform there was $545 added, a 17 percent difference.
Read more at the WorkersComp Forum homepage.
April 1, 2013
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