Physician Dispensing: Costs and Consequences
At WCRI 2015, the panel of Vennela Thumula (WCRI), Dongchun Wang (WCRI) Alex Swedlow (CWCI) and Artemis Emsilie (myMatrixx) tackled this topic.
Eighteen states have made changes to their rules regarding physician-dispensed physicians with a focus on pricing. Four states (PA, NC, TN, FL) also put limits on the timeframe that physicians could dispense.
According to WCRI studies, the prices paid for physician dispensed medications decreased significantly after the regulations on this were reformed. However, the prices paid under physician dispensing post reforms were still significantly higher than the same drug from a retail pharmacy.
The exception was Ilinois which saw the costs of physician dispensed medications increase after reforms. This appears to be due to a change in prescribing patterns as physicians shifted to reformulated medications which reimbursed at a much higher rate. So it was this change in prescribing patterns that caused the cost increase, not the reform bill.
Another study focused on whether physician dispensing increased opioid use. The results of this study were somewhat inconsistent. The frequency of prescriptions for stronger opioids appear to have dropped after physician dispensing reforms. There was a corresponding increase in pharmacy dispensed stronger opioids but overall the number of prescriptions dropped. However, the frequency of physician dispensed NSAIDs and weaker opioids increased slightly post reform which lead to more of these medications being dispensed. Overall, there appears to be a drop in the total opioid prescriptions after physician dispensing reforms, but the change was not as significant as you would expect it to be.
A study by CWCI focused on whether there was an issue with injured workers having adequate access to retail pharmacies. This showed access was clearly not an issue as almost all injured workers had multiple pharmacies within a short distance of their home. The CWCI study also showed a greater delay in return to work and an increase in overall claims costs when there were physician dispensed medications. This increase in costs was not simply the increased cost of medications, but also increased disability and more frequent office visits.
The final speaker focused on differences between workers’ compensation and the commercial marketplace with regard to physican dispensing. The biggest difference is that on the group health side the process is integrated. The focus is on speeding the care to the patient, not increasing the overall costs. The group health physician checks the insurance formulary and drug utiliation protocols prior to dispensing. In workers’ comp, these different processes are siloed. The main reason for physician dispensing in workers’ compenstion is the increased profits to the physicians, not integrated speed of patient care.
Finally, audience members reminded everyone that the focus around management of opioids needs to focus mostly on the appropriateness of the medication, not who is doing the dispensing.
There was a recent New York Times article on this subject that I encourage readers of this blog to review: https://nyti.ms/1AiU74h