Dr. Pendyke’s Miracle Salve
In a 1964 episode of The Andy Griffith Show, Opie was conned into selling a Miracle Salve in order to win a pony. This cream was purported to cure crow’s feet, poison ivy, athlete’s foot, prickly rash, the spring itch, and the mange. Barney (with Gomer in tow) went to Mount Pilot disguised as veterinarian Dr. Pendyke, in order to reverse the scam on the manufacturer of this worthless compound. As you might expect, Barney and Gomer’s sting went badly, and 1,000 jars of the salve ended up on Andy’s front porch.
Fast forward to last month, as written in Philly.com, and we have a group of Philadelphia pain management doctors being sued for prescribing almost $5 million worth of allegedly fraudulent pain creams.
Many of the defendants either managed or partly-owned the pharmacies where the compound creams were dispensed. In Pennsylvania workers’ comp, prescription reimbursements are typically capped at 110% of AWP. But due to a weakness in the system, carriers were being billed for $5,000 to $8,000 per tube. These providers make the Miracle Salve company look like amateurs.
Here’s the takeaway in order to do better:
- Limit, when available, physician dispensers and rogue pharmacies in your approved provider networks;
- Aggressively institute pharmaceutical UR.
The battle is not won when payors contest how much to pay for a compound. The battle is won when you challenge the appropriateness of the prescription in the first place.
Call us. We can do better.
William Faris, JD
Chief Executive Officer