Why Repackaged Drugs Need Price Control

Saturday, November 4, 2006 | 0

By David J. DePaolo

The last vestige of physician profiteering in workers' compensation is in the cross hairs of the California Division of Workers' Compensation, and presages another national trend that physicians throughout the nation can expect -- the end of repackaged drugs.

As with the vast majority of "reform" issues, the only reason repackaged pharmaceuticals are now the subject of heavy handed regulation is because a minority has abused the privilege. Abuse begets attention. Attention begets investigation. Investigation begets outrage. Outrage begets regulation.

It is a simple formula seen over and over again.

The fear of the regulators is not entirely that unscrupulous physicians will cheat employers and carriers out of a couple bucks. There are many profitable ways of doing that.

The real fear of regulators is that unscrupulous physicians will cheat employers and carriers at the expense of injured workers -- indeed, is that not the fear that drove the implementation of ACOEM and other treatment guidelines?

The following is from a recent post in our California Professional Forums, and is illustrative of the real issue (edited for spelling, grammar and readability):

"I have a family friend who recently suffered the tragedy of loosing their only Son. The exact cause of death is unknown but it seems it may be drug related (i.e. as a result of prescribed drugs). I do not know all of the details. Apparently the decedent had been receiving treatment and benefits for 15+ years. DOI was 1991. Movie studio employee. From what I know in the past year or so the insurance carrier had sent him to new docs including pain management and Psych. Was recently prescribed Methadone as a detox method from previously prescribed meds as a result of industrial injury. If the reason for his death is identified to be as a result of these meds can his parents receive any death benefit? The parents are his Next of Kin and sole survivors."

Sure, the post asks a legal question, but the premise is disturbing to me, and should be to you: narcotics were over-relied upon for treatment of an industrial injury resulting in addiction, and ultimately the death of an injured worker. Whose to blame? The carrier, trust me, would just as soon stop this treatment to save a buck. The injured worker blindly follows the "professional advise" of his physician and drives ever deeper in to dependency.

Why are narcotics so heavily regulated in the United States? It is because narcotic victims have no control over their addiction. The reason our medical system makes the dispensation of drugs the province of pharmacies separate and apart from physician practices is to provide a check and balance. Pharmacists know drugs. That is their job. Physicians know ailments. That is their job. We have all heard stories, or know someone, who has been prescribed a drug by a physician, only to have the pharmacist note a contraindication. And yes, I have been a victim of physician indiscretion relative to pharmaceutical prescriptions in the past which was caught by the pharmacist ...

Dispensation of drugs is not the business of physicians.

A medical clinic owner that I know well said that her business has shifted dramatically over the past couple of years from treating injured workers for their injuries, to treating injured workers for their drug addictions as a consequence of their industrial injuries. It seems that physicians, with free reign over distribution of narcotics and opiate derivatives, and under the undue influence of Big Pharma, are more than willing to hand out pharmaceuticals in spite of obvious consequences because money is driving the medical decision.

Yes, it is at times convenient for a physician to dispense medication -- where medication is necessary immediately and/or the injured worker can not avail himself of a pharmacy in the short term, then certainly such dispensation is warranted.

But not over the long term. That an injured worker does not have a pharmacy within a reasonable geographic distance is not a good argument, not in this day and age of mail order. That repackaged drugs is the last bastion of profitability for industrial clinics is not a good argument, not in this day and age of managed care. Doctors prescribe drugs, and pharmacies dispense drugs -- that program exists for a reason and workers' compensation should be no different. The regulation of repackaged drugs is necessary to eliminate the abuse.

David J. DePaolo is the President and CEO of WorkCompCentral.

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