Similar attempt over the last several years have either failed to make it through both chambers or was vetoed in 2010 by then-Gov. Crist.
The issue has become one of the hottest in workers' comp as those on either side are passionate about their arguments. Proponents of physician dispensing say it helps ensure patients get and take their medications while opponents contend it does not produce better outcomes and drives up costs unnecessarily to the workers' comp system.
Reimbursement for prescription drugs is typically the average wholesale price plus a $4.18 dispensing fee. However, repackaged drugs are assigned a different AWP than that suggested by the manufacturer, "which is often substantially higher than the manufacturer's AWP," according to a legislative summary of the proposal. "As such, the cost for a prescription filled with repackaged drugs in the workers' compensation system is generally much higher than it would have been if the prescription had been filled with the same drug that had not been repackaged."
NCCI, the rate-making organization in Florida, has estimated that reimbursements for repackaged or relabeled prescription drugs add $27.3 million annually to the Florida workers' comp system and that eliminating the higher reimbursements for them would decrease system costs by 1.1 percent. A report to the Florida Department of Financial Services said total workers' comp system costs as a result of the markups were $250 million over the last five years.
H.B. 605 would provide the same rate of reimbursement for repackaged or relabeled drugs as for non-repackaged drugs. It says reimbursement for repackaged or relabeled drugs would be calculated by multiplying the number of units of the drug dispensed by the per-unit AWP set by the original manufacturer of the drug, which may not be the manufacturer of the repackaged or relabeled drug, plus the dispensing fee, unless the carrier has contracted for a lower amount. It "expressly prohibits the price of repackaged or relabeled drugs from exceeding the amount that would otherwise be payable had the drug not been repackaged or relabeled," according to the summary.
The legislative summary also noted:
- The 10 most frequently dispensed repackaged drugs have an average markup of 54 percent to 625 percent.
- Physician-dispensed drugs account for 62 percent of all prescription drug dollars; the second-highest percentage of the 23 states in one study.
- Physician-dispensed repackaged drugs account for 36 percent of overall prescription drug costs. (By comparison, repackaged drugs dispensed by pharmacies account for approximately 4 percent of overall drug costs.)
- Since 2008, more than 95 percent of reimbursement dollars for repackaged drugs were paid to dispensing physicians. In 2011, 97.9 percent of the reimbursement dollars spent was a result of dispensing physicians.
If approved, the bill would take effect July 1. At press time, the proposal had passed a House subcommittee and been sent to another. An identical bill was before a Senate panel.
Read more at the WorkersComp Forum homepage.
April 8, 2013
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