Efficient and effective prescription drug dispensing to the injured worker
By Rafael Miguel, M.D.
Outside of our families, is there any relationship as important as the one between physicians and their patients? The physician is the one person with whom patients share their most intimate concerns, problems and physical information – some of which they may not divulge even to their spouses.
Physicians study and train for countless hours over many years to prepare for what is often regarded as the most challenging of occupations. Endless hours and financial resources are invested in specialized staffs, offices and clinics to assist physicians in delivering care, often to patients injured on the job.
But now, for the fourth year in a row, an organized attack in the Florida Legislature on physicians’ practices is under way. The proponents of this proposed legislation want to intervene in the respected physician-patient relationship by significantly curtailing, and in many cases eliminating, the ability of physicians to dispense medications to injured workers being treated under workers’ compensation insurance. The motivation to do this is purely financial.
When physicians directly fill prescriptions in the office, injured workers receive the medicines they need quicker, easier and more reliably, and billing is automatic. Physicians address questions or concerns about potential drug interactions and provide medication administration instructions at the time of dispensing. The treating physician will ultimately treat any side effect. Physicians can talk with patients about how the medicines being prescribed will be affected by the patient’s diet and activities at the time of dispensing. Further, injured workers often have transportation issues and are in no shape to travel much less wait in a pharmacy. Retail pharmacies maintain databases with information on a person’s health insurance benefits but not their employer’s workers’ compensation coverage, creating more delays.
Many of these workers are from lower income brackets and live paycheck to paycheck. If they think they may have to come up with money to obtain medicine(s), they may try to wait until payday, making their condition worse. They may even try to go without the medicine, making their condition and pain much worse and more expensive to treat in the long run. How do we put a cost on that?
Make no mistake; physicians cannot buy medicines in the bulk amounts that retail pharmacies purchase. They must recover the costs to provide this service to injured workers. Additionally, the meager 1.1 percent estimated as the projected savings from changes to physician dispensing could be more than eaten up by worsened medical outcomes for injured workers. Furthermore, consider that between 2003 and 2010 – a period where physician prescription dispensing increased significantly – pharmacy costs in lost work time claims filed in workers compensation cases dropped by 5.8% and the number of lost work time claims decreased by 36%. Additionally, Florida’s workers’ compensation rates are 56 percent lower today than in 2003. Can we point to any other line of insurance where such dramatic improvement has taken place?
Florida lawmakers should reject attempts to interfere in the doctor-patient relationship and physicians’ rights to deliver safe, quick relief and recovery to injured workers.
Dr. Rafael Miguel is a Brandon physician who treats injured patients in the workers’ compensation system. He is also the Program Director of Pain Medicine Program for the Departments of Anesthesiology and Neurosurgery at the University of South Florida College of Medicine in Tampa.