Physician Dispensing in Comp the Right Way

Tuesday, January 18, 2011 | 0

By Joe Paduda
CompPharma and Health Stategy Associates

A commenter (thanks Greg) on my post Jan. 11 re NCCI's research on physician dispensing noted, "Going after the physicians, who are making efforts to recoup their steadily declining reimbursements, does not seem like the best strategy."

Greg's got a good point. There are many docs and occ-med clinics that are dispensing medications for the right reasons, and not looking to make exorbitant profits. While their intentions are honorable, there are a couple concerns that bear mentioning.

First, as noted Jan. 10, (and other times here on the Managed Care Matters blog) the proponents of physician dispensing often cite increased patient compliance, reduced hassle for the patient, and increased generic dispensing as justification/rationale for dispensing meds to the patient from the doctor's office. I've not seen any studies that support the claim of increased compliance. (I've seen claims that refer to studies, but not the studies themselves.) That said, I'll stipulate that compliance is likely better when docs dispense drugs.

But, in addition to the higher costs perpetuated by repackagers and physician dispensing technology/services companies, there's another potential concern with physician dispensing. Work comp claimants are usually treated by docs that haven't seen the claimant before the occupational injury. While the WC doc certainly asks about prior medical history, current medications and the like, it is not uncommon for patients to forget which meds they take or be unable to accurately identify their drugs.

Not so big an issue if the claimant goes to their usual pharmacy, where the system will identify any potential conflicts and notify the dispensing pharmacist (assuming the claimant doesn't go to a new pharmacy).

Potentially a bigger issue arises if the treating doc doesn't get the full story, prescribes and dispenses meds that conflict with the claimants' other meds. While there are some databases and sources of prescription data that docs may be able to tap into (or so I'm told), I don't know if many of the physicians dispensing meds are doing so today or, for that matter, even know of these resources.

That's not to say the pharmacist's database is foolproof it most certainly isn't. However, it's a lot better than no database - or not accessing a database at all.

In my view, physician dispensing can be appropriate if:

• the price is pegged to the original manufacturer's AWP, not some fabricated price from a repackager or dispensing services company;
• the medications are appropriate and consistent with generally approved standards of care; and
• the physician accesses the appropriate databases to verify the medication prescribed is safe for that particular patient.