Physician Dispensing and Opioid Use
At the 2016 WCRI Annual Issues & Research Conference, Dongchun Wang and Vennela Thumula from WCRI discussed physician dispensing and opioid use. The studies they discussed have not yet been published, so the results are subject to change.
In the last few years, 20 states have implemented reforms targeting the pricing of physician dispensed medications. (ID, NV, CA, AZ, KS, OK, MI, IL, IN, TN, MS, AL, GA, FL, SC, NC, PA, DE, CT)
- In most states studied, prices paid per pill for physician-dispensed drugs decreased after the reforms.
- While there were fewer prescriptions dispensed by physicians, this practice still continued.
- In Illinois and Florida, there were substantial increase in prices paid to physicians for dispensing certain drugs after the reforms targeting this practice. That is because the physician dispensing shifted to new formulations and strengths that were not covered by the fee schedule.
- Pricing for pharmacy-dispensed drugs remained stable during the study period, so the price changes were unique to physician-dispensed medications. There was also not a change in pharmacy dispensing of new formulations and strengths during the study period. The change in medications dispensed was also unique to physician dispensing.
- California also saw a significant change in the drugs being dispensed using physician dispensing. This was also seen as shifting to new strengths that were not covered by fee schedules.
Variation in Opioid Use
- Across all study states, three out of four injured workers with pain medications received at least one opioid prescription. The high was 86% in Arkansas.
- Amount of opioids per claim was significantly higher in LA, NY and PA compared to other study states. Louisiana was well above all other states in the number of opioid prescriptions per claim and the percentage of patients using opioids long term.
- NY and PA had higher opioid dosages than other study states.
- 29% of pain medications dispensed in Massachusetts were for Oxycodone, which is a high dosage opioid.
- In many states, opioids and benzodiazepines were used together commonly. Patients in WI, MI, CT and MA who received opioids also received benzodiazepines. Using these drugs in combination significantly increases the the risk factors associated with the drugs.
- Amount of opioids per claim decreased in most states from 2012-2014. The biggest drops were in MA, OK and MI, where the decrease was over 20%.
- Frequency of drug testing for opioids users increased significantly. The 12-state median of patients who were drug tested went from 34% to 43% during the study period. The number of drug tests per patient also increased significantly.