Gov. Crist Should Veto Sneaky Last-Minute Budget Bill That Hurts Injured Workers

By Sanford Silverman, M.D.
President-Elect of the Florida Society of Interventional Pain Physicians

This year was supposed to be different. With the stain on the Florida legislative process caused by the Ray Sansom saga just starting to dry, lawmakers promised a budget process conducted fully in the sunshine. This new transparency would best serve the taxpayers – and would provide all sides with an opportunity to weigh in on issues that affect them and get a chance to have their voices heard.

Apparently, old habits die hard at the Capitol.

This year, just before midnight as the budget negotiations were coming to a close, some lawmakers engaged in the worst kind of special interest sausage-making and slipped in language to a budget bill (HB 5603) that will benefit a few powerful workers’ compensation insurance interests at the expense of hard-working Floridians.

The victims of this year’s Tallahassee ‘midnight special’: injured workers.

Currently, injured workers, many of whom live on extremely tight budgets, can get their injury-related prescriptions dispensed by the physician authorized to treat them, without having to lay out cash.

The other day I had to send a patient to a pharmacy to get his medication. Instead of receiving the medication without cost like he would in our office, the pharmacy told the patient he had to pay out of pocket to receive the medication.

This is just a taste of what’s to come if this bad bill becomes law.

HB 5603 will require thousands of injured Floridians – teachers, police officers, construction workers, and firefighters, to name a few – to fill injury-related prescriptions at a pharmacy, pay for them out of pocket, and then wait the long months to hopefully get some of their money reimbursed.

Under this change, many of these expensive prescriptions will cost the workers hundreds of dollars. It’s clear, injured working Floridians who can’t afford to pay higher out-of-pocket costs when they are injured simply won’t fill their prescriptions. They will suffer the physical pain or the consequences of delaying or denying treatment.

Under this legislation, well-intended physicians, who laid out millions of dollars under the existing system to purchase pharmaceutical products to dispense to injured workers, will have to destroy their inventory of medications at an estimated cost of $45 million. And the medical office staffs that currently administer these pharmacy programs — an estimated 7,500 medical workers — will be out of jobs.

This is all because this issue did not get a full public airing or appropriate debate and lawmakers did not get the complete picture of the significant consequences of this policy change.

Physician dispensing of medications is one of the most safe and efficient processes within the healthcare delivery system. Physicians typically only dispense to patients in their practice, people with whom they have an existing relationship. The physician has access to their history and is most familiar with the patient’s present illness, and they know specifically what medications the patient needs or may already be taking.

The patients can walk out of their doctors’ offices with their prescription filled, significantly reducing the opportunity for non-compliance or dispensing errors. In addition to improved accuracy and convenience, there is data that indicates cost savings through dispensing a higher percentage of generic medications when physicians are actively involved in the dispensing process.

In a letter to Gov. Crist requesting a veto of the bill, the presidents of the Florida Orthopaedic Society and the Florida Medical Association said, “We do not feel a decision that may impact the physician-patient relationship should be made in the dying hours of session without debate.” They’re correct.

There may be legitimate arguments in support of amending how repackaged drugs are reimbursed in Florida. That’s a discussion that belongs in a public legislative forum.

Doctors look forward to working with the Legislature in the future to address this issue through an appropriately open and deliberative process. Unfortunately, in this case, no testimony was received and the people who will pay the price for this change had no opportunity to comment.

A decision that impacts thousands of injured workers, undermines the doctor-patient relationship and adds to unemployment during the worst economy of our lifetimes should not be made in the dark, during the waning hours of session without debate. For all these reasons, I urge the Governor to bring this issue into the sunshine by vetoing HB 5603.

Dr. Sanford Silverman is President-Elect of the Florida Society of Interventional Pain Physicians