What started as an attempt to reign in excessive costs by restricting the extreme markups often employed by dispensing physicians in Florida has turned into a freakishly convoluted mess that hog ties carriers, assures massive physician dispensing profits, and does virtually nothing to solve the problem it set out to fix. In my view, it makes the problem worse.
SB 668, headed to a final approval in the Florida Senate this week, is barely recognizable from its original form, and is a tremendous example of all that can go wrong in the legislative creation process.
The bill started out designed to restrict dispensing physicians, treating patients under workers compensation, to the same wholesale prices followed by pharmacy operations, plus a $4.18 dispensing fee. But as our friend Joe Paduda and others have so ably documented, a huge amount of cash from special interests in the state poured into legislators coffers, changing the landscape on this bill entirely.
In its current, and apparently final form, SB 668 will now:
Establish that the carrier may not refuse to authorize a physician to treat an injured employee solely because the physician is a dispensing practitioner.
Establish that, for purposes of dispensing and filling prescriptions for medicines, the department, employer, or carrier, or an agent or representative of the department, employer, or carrier, may not select the pharmacy, pharmacist, or dispensing practitioner that the claimant must use.
Makes no restriction on the price of repackaged or relabeled drugs, but establishes that if a prescription has been repackaged or relabeled, the provider shall give a $15 credit to the insurance carrier or self-insured employer for each prescription that costs more than $25.
(So a drug that sells for $40 from a pharmacy might cost $275 from Dr. Feelgood. But the payer can look forward to that $15 credit!)
It’s kind of like having your mugger give you cab fare home. On the positive side, the victim gets cab fare every time they get mugged.
The bill also establishes a progressive series of fines for an insurance carrier or self-insured employer that improperly denies or delays payment of a valid claim for reimbursement of a prescription medication.
And of course, despite the failure to establish any real savings and ignoring the onerous costs it will create, the bill carries the almost obligatory requirement that carriers reduce their rates 2.5%.
SB 668 will only add layers of paperwork and administrative expenses, while hamstringing payers efforts to control costs, at the same time forcing an unsustainable reduction in rates. It makes no sense, at least not for all of us employers who will eventually be picking up the tab.
According to Paduda, "this serves notice to insurers, employers, and their advocates that we’ve been outthought, outspent, and outmaneuvered by companies with demonstrated prowess in taking money from employers to enrich themselves with no demonstrable benefit to injured workers."
SB 668 is bad legislation, bad for employers, and bad for the state of Florida. People who want to see this remedied better start now for next years legislative process. The other side is organized, and funded to not just to beat the band, but buy it too.