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Apr
22

A tough week for work comp in Florida

Florida’s legislature is working thru several workers’ comp bills – and the news isn’t good.  A PDMP bill has been emasculated; Florida’s prescription drug monitoring program won’t require physicians check the system before prescribing drugs.

And while there’s ongoing negotiations on a bill addressing physician-dispensed drugs, at this point it looks like Florida’s employers will have to pay more for physician-dispensed drugs than they would if those drugs were dispensed by retail pharmacies.

This is a fluid situation and may well change – and we can only hope it does. We are also wondering where the retail pharmacies and food/drug combos are in the discussion; there is no evidence that physicians pay more for their drugs than drug stores do, so forcing employers and taxpayers to cough up millions to line the pockets of dispensers and their enablers is nothing more than extortion.

That said, it is clear that the Florida Medical Association has once again ignored their Hippocratic oath to do no harm; according to Mike Whitely’s piece in WorkCompCentral the FMA  got the bill’s sponsor, Rep. Mike Fasano R New Port Richey, to “drop a requirement that Florida physicians consult the PDMP before prescribing drugs on Schedules II and III of the US Drug Enforcement Administration’s controlled substances list.”

Notably Rep. Fasano appears to have removed that requirement in hopes that in so doing the bill would have a better chance of passage.  That said, the FMA’s position is short-sighted and self-serving.  According to the vice chair of the FL PDMP Foundation, it “makes sense for doctors to check the database and it takes 30 seconds.” [emphasis added].

So.  Thirty seconds is more important to the FMA – and their members – than preventing doctor-shopping, reducing criminal behavior, and saving lives.

Lest you think I’m being hyperbolic, doctor shopping kills people. And speaking about the Tennessee law requiring docs check the PDMP database before prescribing, “There’s no question the law there will reduce overprescribing and doctor-shopping, said Gary Zelizer, director of government affairs for the Tennessee Medical Association. Yet reducing over-prescribing, doctor-shopping, and the resulting deaths and injuries is less important than saving 30 seconds.

For those interested in doctor-shoppers’ views on PDMPs, read this.  Abusers hate PDMPs that mandate physician checks of the PDMP before prescribing.


6 thoughts on “A tough week for work comp in Florida”

  1. Hi Joe, I really like your blog!

    One correction – doctors do pay for prepackaged medications quite a bit more than a drug store does because drug stores/pharmacies have the ability to buy them in bulk directly from manufacturers. They have licensing to handle/count pills, basically put them in a bottle. Physicians have to buy their meds from repackagers (think a middle man who is licensed to buy product from manufacturer and ‘repackage’ it – put in bottles in various quantities and seal them, which allows them to set a new NDC). A physician cannot touch the actual pills/tabs. Every repackager can set their own price somehow.

    Have a good day!

    1. Natalie – that is incorrect.

      Repackagers set the price for their drugs, and physicians dispensing drugs can pick the repackagers based on price. There are a very few repackagers who sell drugs to dispensing physicians at prices that are low enough for the docs to sell the drugs at prices comparable to retail pharmacies.

      If doctors want to, they can easily find repackagers that don’t gouge payers. Alas most are far more interested in profits than doing the right thing for patients.

      1. That makes sense 🙂 I didn’t know that, and I bet a lot of physicians simply don’t know that either, I don’t think they all want to take advantage of the system… They just go with a repackager that comes with a dispensing company and I’m sure the dispensing companies want to use the most expensive ones since they get a percentage.

        Thanks!

  2. Your characterization of concerns the physician community has with mandates to check the PDMP prior to prescribing controlled substances is unfortunate. The vast majority of organized medicine has been overwhelmingly supportive of the development and use of the PDMP as a means of curtailing doctor shopping and the crisis we have in Florida with prescription drug abuse. The mandated use of the database in every clinical setting is where the concern lies. For episodic treatment of patients, for instance an orthopaedic surgeon treating a fracture, there are significant concerns over making clinical judgements for prescribing based on data in the PDMP that may not be current, valid, or may otherwise be irrelevant to why the patient is presenting for treatment. Mandatory review of the database for pain management professionals that have long term oversight and jurisdiction over the pain management needs of patients is the most appropriate use of the database. That has been the consistent position of the Florida Orthopaedic Society throughout this debate. The FMA, Specialty Societies, and other stakeholders continue to work to address the prescription drug crisis in Florida in a manner that respects the needs of patients with legitimate concerns versus those those with criiminal or other nefarious intentions. Encouraging the ongoing use of the PDMP is something our oganizations will continue to champion.

    1. Mr Cobbe – thanks for your thoughtful comment.

      I’m not sure why my characterization of the FMA is unfortunate. I did not characterize the entire physician community, but rather the FMA specifically.

      Moreover, if the FMA wanted to exclude specific care situations from PDMP checks, why did they not get Rep Fasano to do just that?

      I do disagree with your statement that ” Mandatory review of the database for pain management professionals that have long term oversight and jurisdiction over the pain management needs of patients is the most appropriate use of the database.”

      Frankly, if physicians are interested in stopping doctor shopping and related abuse/misuse, that’s not going to do it. I remain puzzled why physicians are not willing to spend the 30 seconds to check the database, when the evidence clearly indicates mandatory checks have a dramatic effect on opioid abuse.

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Joe Paduda is the principal of Health Strategy Associates

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