It is time again to grapple with that pesky problem known as Physician Dispensing, and the battle raging on the topic here in Florida. I won't go into detail about what physician dispensing is, but if you need that background info you can find it here. And here. And here. And here. And here. And of course, my personal favorite, here.
As I prepare to go to Boston to attend the Physician Dispensing Summit, I find myself wondering about what items and strategies will be discussed there to address this controversial problem. Almost certainly the issue of simply refusing to pay outlandish bills will come up.
I am not a lawyer. I don't even play one on TV. I would never even suppose to convey this article as some kind of advice or recommend its content as a strategy, but I wonder, with our Florida legislature's seeming inability to address the issue, if simply refusing to pay the bill is an option that might have a successful effect.
A Business Insurance article from several weeks ago tells us this may already be a strategy that some are employing. It tells us that medical reimbursement disputes for workers compensation cases increased almost 400% this last year over the year prior. Specifically, the Florida Department of Financial Services Division says that this was “driven largely by reimbursement petitions for physician-dispensed prescription medications”.
In 2010 – 2011 fiscal year there were 3,777 petitions filed with the Office of Medical Services, which is part of the workers' comp division and which resolves medical reimbursement disputes between insurers and healthcare providers. In FY 2011-2012, that number soared to 15,000. The state reported that of those, 12,718 were Reimbursement Dispute Petitions from practitioners, and that “most of those petitions included disputes over physician-dispensed or “repackaged” medications”.
Sounds like somebody isn't getting paid for their overpriced meds.
Interestingly, the workers comp panel that compiled this report said that “Florida lawmakers could help reduce reimbursement disputes by passing legislation to limit price differences between repackaged drugs and non-repackaged prescriptions.”
Now why didn't we think of that?
Florida Statute 440.13 in its current form may provide the support for these refusals to pay. Section 12, item (c) of that statue reads:
“As to reimbursement for a prescription medication, the reimbursement amount for a prescription shall be the average wholesale price plus $4.18 for the dispensing fee, except where the carrier has contracted for a lower amount. Fees for pharmaceuticals and pharmaceutical services shall be reimbursable at the applicable fee schedule amount. Where the employer or carrier has contracted for such services and the employee elects to obtain them through a provider not a party to the contract, the carrier shall reimburse at the schedule, negotiated, or contract price, whichever is lower. No such contract shall rely on a provider that is not reasonably accessible to the employee.”
Admittedly, this language leaves certain things to interpretation, but if carriers do indeed have contracts in place regarding pharmaceutical services, then the section that reads “and the employee elects to obtain them through a provider not a party to the contract, the carrier shall reimburse at the schedule, negotiated, or contract price, whichever is lower” seems to hold some sway over the issue.
And of course this would explain the existence of the ridiculous language within HB 483, a bill currently before the Florida House that would alter 440.13 to remove the right of employers or their representatives to direct pharmaceutical fulfillments, as well as prevent their denying use of providers based solely on their status as dispensing physicians.
We continue to hold out hope that another house bill, HB0605 and its partner legislation in the Senate, SB662, will collectively result triumphant in this battle. Those bills would simply restrict pricing on repackaged drugs to that of all other comparable medications. Period. This shouldn't be that difficult, Christ, even Illinois, the state that puts the “function” in “Dysfunction” managed to pull that simple task out last year. Florida legislators should take note of that.
Until that time, however, it will be intriguing to see if our industry just finally says, “We're mad as hell, and we're not going to take it anymore. And oh yeah, we're not paying, either”. I suppose there will be the annoyance of those irritating collection calls, but it may be a small price to pay.
Besides, that is why God invented voicemail.