Physician Dispensers Are Getting Desperate

Thursday, February 21, 2013 | 0

Oh this is getting fun!

On Jan. 24, WorkCompCentral published a column ostensibly written by a physician attacking me for exposing the dangers, both physical and financial, inherent in physician dispensing of repackaged drugs. I say ostensibly because the column reads like it was ghostwritten by one of the industry’s shills, perhaps one of Ron Sachs’ interns. (Ron’s the guy physician dispensing company AHCS hired to call reporters to tell them they were suing me.)

By the way, I LOVED the column.

It was an amazing combination of pronouncements from an arrogant-beyond-belief doctor, with a really nasty and personal attack on me, my motives and my ethics.

Alas, it was so poorly done, with so many logical fallacies and nonsensical arguments based on nothing more than fact-free opinion that I can’t believe a real doctor actually wrote it. After all, doctors are supposed to believe in science; you know, research, medical evidence, facts, logic supported by data – those kind of things. Yet the column didn’t have any of those, instead it was a mishmash of unsupported claims based on “our experience” and never directly addressed the key issues I raised in my piece, e.g., retail pharmacies have much more complete access to patient data, and docs who dispense don’t.

(BTW, a Summit on Physician Dispensing will be held in Boston on Feb. 25-26. Sponsored by PMSI and Progressive Solutions, the Summit is free of charge and is held the day before WCRI’s annual conference – in the same hotel. This is an invite-only event; there are a few slots open. Email me for details.

The ostensible author, one Dr. Rafael Miguel, offered not a single shred of evidence to support his claims of better outcomes and enhanced quality of care. When not denigrating pharmacists, mischaracterizing my statements and accusing me of profiting from defeating physician dispensers (more on that below), Dr. Miguel/the intern hid the total lack of data supporting his claims behind the omnipotence of the god in the white coat, as if his title is proof enough and we non-physicians should meekly listen and obey.

You can tell the physician-dispensing industry is in desperate straits when they use surrogates to question the motives of their opponents, fabricating reasons why anyone would dare interfere with their ability to suck money out of taxpayers and employers by charging outrageous amounts for the drugs they prescribe – and dispense – to workers’ comp claimants.

That’s known as “diversion”; when you can’t refute a critic, yell really loud about what a bad person they are.

Well, let’s look at Dr. Miguel.

Dr. Miguel is a dispensing physician using Rx Development Associates. A quick check of their website reveals frequent mention of one of the key benefits of physician dispensing; additional revenue for the physician. RxDA also touts how easy it is to sign up and use their system to generate big profits, “without interrupting or burdening staff members.” That’s in direct conflict with Dr. Miguel’s assertion that physicians “must recover the costs and time to provide this service to workers' compensation patients.”

Let’s look at Dr Miguel’s scripts. He’s dispensed fluoxetine, etodolac, omeprazole and gabapentin, among other meds. One of those scripts, omeprazole, is commonly used for heartburn. Omeprazole, also known as Prilosec, can be bought over the counter for about a buck a pill; Dr. Miguel charged about $10  pill. That’s not opinion or hyperbole, it’s fact.  Miguel charged about 10 times more for the drug than it would have cost over the counter.

Dr. Miguel/the intern contends docs can’t buy drugs for the same price retail pharmacies do, and that’s why they have to charge so much more. Again, he offers no evidence of this. In fact, if Dr. Miguel had tried, he could have found repackaging companies clamoring to sell him drugs at very low prices.

Finally, allow me to address Dr. Miguel/the intern’s questioning of my motives, and contention that my efforts to combat physician dispensing are “what can only be described as an attempt to fatten Mr. Paduda's personal bottom line.”

As I have noted many times, I am co-owner of CompPharma, an association of workers’ comp pharmacy benefit managers. It makes no difference (financially) to me if physician dispensing dies off, explodes or just stumbles along. I don’t get a nickel more or less.

My public battle with the industry and its advocates has cost me tens of thousands of dollars in legal fees not to mention hundreds of uncompensated hours.

Yes, PBMs will benefit if physician dispensing ends, but I am not a PBM, nor do I own a PBM, nor do I get paid based in any way on their volume of business.

What Miguel/the intern can’t understand is some people just have principles, standards that they live by, ethics that require them to speak out when they see others doing wrong.

And physician dispensing of repackaged drugs is wrong.

Joe Paduda is owner of Health Strategy Associates and co-owner of CompPharma, a consortium of pharmacy benefit managers. This column was reprinted with his permission from his Managed Care Matters blog.