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WCRI – Physician Dispensing Costs and Consequences

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Physician Dispensing Costs and Consequences

Picture Of Physician Dispensing Costs
Wikimedia commons – National Cancer Institute

WCRI – Physician dispensing costs and consequences major findings

  • Most reforms are price focused
  • Prices paid for physician dispensed drugs decreased substantially after post-reform
  • Fewer physician dispensed drugs after reform
  • Reforms may not be sustainable due to new drug strengths

18 states made changes to rules – reforms

Informs were mainly price focused

Not all reforms may have worked – Illinois had a large price increase post-reform on such drugs as Vicodin(r).  CA had increase in Cyclobenzaprine.

Price difference between physician dispensed and non-physician dispensed were reduced after reforms, but is still yet a sizable difference.

One of the main concerns is the sustainability of the reforms.

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Does Physician Dispensing Lead to Unnecessary Opioid Use?

Florida banned Schedule II and III controlled substances was banned effective July 1, 2011.   Florida Pill Mill Bill (House Bill 7095)

Amount of physician dispensing of stronger opioids – fell in Florida from 3.9%to .5% post reform.  NSAID’s and weaker opioids that were physician dispensed remained flat or increased slightly.

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Pharmaceutical Trends, Lessons, and Injured Workers Outcomes in the California Workers Compensation System 

Physician dispensed  Zantac had a 900% cost increase over pharmacy dispensed during a pre-reform period.

Physician dispensing did not delay return to work periods when compared to pharmacy dispensed medications.

Pharmaceutical Practitioner

Workers Comp is a different world from health insurance in reference to physician dispensed medications.   The physician vs. pharmacy dispensed medications has been a long-standing turf war ever since doctors made house calls.

Q&A Session WCRI – Physician Dispensing

A great point was brought out that another area of cost shifting is WC as health pays much less for physician dispensed medications.

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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