|By Rob Perez, The Honolulu Star-Advertiser|
|McClatchy-Tribune Information Services|
They say the huge markups have accelerated over the past few years and are expected to spread even more if nothing is done.
Physicians said insurers are highlighting extreme examples to undermine a longstanding practice that leads to better patient compliance with treatment regimens, shorter periods away from work and lower overall medical costs.
A bill that would have placed a cap on prices for repackaged and compound drugs passed the state House last year but died in a
The committee was headed by Sen.
They emphasize that most
"What we are against, and what this legislation seeks to address, is the problem caused by the few who seek to take advantage of the rest, the few who unreasonably inflate the costs of such medications to increase their profits at the expense of everyone else," wrote attorney
Opponents said changes sought by insurers would effectively cripple physicians' drug-dispensing practices, and prompt some to stop seeing workers' compensation patients altogether, further dwindling an already small number. They contend that the changes would also hurt many injured workers who would be unable to afford out-of-pocket charges that pharmacies typically require when filling prescriptions for workers' comp patients. Injured workers don't have to pay anything when getting the drugs from their doctors because they are covered by insurance.
The effects of the proposed changes would be especially devastating in rural areas and on the neighbor islands, physicians said.
"If that went through, I couldn't afford to do workers' comp," said Dr.
"This is an underhanded attempt to make it impossible for doctors to dispense," added Dr.
Doctors who dispense their own medication typically purchase drugs from so-called repackers, who buy in bulk and sell smaller repackaged quantities to physicians. But because the repackers don't have the buying power of the national pharmacy chains, they can't get discounts as good as the chains, which helps explain why physician-dispensed medications typically are slightly higher in price than the identical pharmacy-issued ones, the doctors say.
But when repackers make bulk purchases, they are able to repackage the drugs for sale to physicians and assign a new wholesale price. That loophole has resulted in some extraordinary markups, according to insurers.
In the most extreme example, the council said 30 pills of repackaged Diazepam, an anti-anxiety drug, cost
A 2011 study by the
Injured-worker advocates, however, cite data from the same study showing that prices per prescription and claim on average were higher for pharmacy drugs.
The study also found that the higher per-pill physician prices may serve as incentives for doctors to issue more prescriptions.
In most states where physician dispensing is uncommon, Carisoprodol, a muscle relaxant, was prescribed to less than 5 percent of injured workers, according to the study. But that rate roughly doubled in
In those two states, the physician dispensers were paid an average of
She said her agency is seeing markups similar to what the insurers council cited, and "this appears to be a growing problem."
But workers' comp physicians and injured-worker advocates contend that insurers are exaggerating to control the medication market and boost healthy profit margins while diverting attention from a problem of access to quality care.
"All the insurance companies know how to do is deny, deny, deny until the (worker) gives up," said Puana, who runs the neighbor island pain clinic.
What extra a physician may earn through dispensing helps offset the high bureaucratic costs of dealing with an antiquated workers' comp system, doctors say.
"If there's an injustice here, there's a dual injustice," Rhoads said. "If workers who are injured at work are being denied care because insurers want to make more money, that's an injustice."
Angievi Pestana, 47, a
For her, the benefit of receiving her anti-inflammatory medications from her doctor is clear.
"It saves me time and the trouble of having to stand in long lines at the pharmacy," Pestana said.
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