Physician Dispensing…the Rest of the Story!
Comp policymakers across the country are debating how much to pay doctors for dispensing prescriptions to injured workers.
In analyzing Georgia’s new workers’ compensation reform, the Workers’ Compensation Research Institute explained that by correlating the cost of physician dispensed prescriptions to the average wholesale price (AWP), resultant prices paid to dispensing doctors fell dramatically.
Unless you read the study closer, you might think this is a big win for the insurance/employer community.
And now, for the rest of the story.
Joseph Paduda (principal of Health Strategy Associates) writing on his weblog Managed Care Matters digs a little deeper and draws these conclusions about Georgia, post reform:
AWP is still 20% to 40% higher than prescription costs available through select PBMs.
Doctors’ office prescribing/dispensing patterns included more expensive versions of similar drugs.
Dispensing doctors wrote scripts for over-the-counter medicines that could be procured less expensively off-site, without a prescription.
Joe Paduda has it right when he answers the question about doctor dispensing — “It’s the money!!”
There are several steps to take when it comes to effective prescription dispensing control:
Limit your claimant/patient to a specific pharmacy network/PBM.
Constantly evaluate your PBM’s transparency, pricing and formulary.
Establish early and aggressive Pharmaceutical UR/Peer Review on unusual and inappropriate prescription patterns.
Joe Padudua’s analysis should be a wake up call.
Call us. We can do better.