All of a sudden a classic David and Goliath struggle is emerging in the Legislature, with the Florida insurance industry muscling up against the minority of physicians in the state who don't send workers' compensation patients to pharmacies but dispense repackaged drugs to injured workers at the point of care -- in their own offices.
The insurance industry claims that physicians overprice for this service. It claims that if the price of physicians' drugs were capped, it would save the state some $62 million in workers' comp rates.
Florida has since 2003 placed a cap on pharmacy-dispensed drugs at three times the drug manufacturers wholesale price, plus a $4.18 dispensing fee, according to a spokesperson from the insurance commissioner's office. But it does nothing to cap the amount physicians can charge insurers if they directly dispense drugs to their patients.
The physicians, meanwhile, insist the $62 million is an invention of the National Council on Compensation Insurance Inc., which cannot show how it came up with its bottom line. In fact, the physicians claim the figure is a moving target -- that NCCI said, in March 2010, the savings would be $34 million; in April 2010, $100 million; and since March 11, 2011, $62 million.
"Which is it?" asks Tom Panza, a Florida attorney for Automated Health Care Solutions, which represents the physicians. "If they didn't pull these numbers out of a hat, thenshow me the beef. I defy you to find out how NCCI arrived at one of those figures, let alone all three. I've asked them to show me, I can't get a straight answer."
AHCS, which operates in 42 states, supports physicians by providing proprietary software that allows them to dispense medication in their own offices.
Insurance regulators this fall approved an average 8.9 percent increase in workers' comp rates for 2012. They attributed the need for 2.5 percent of it to doctor dispensing.
Panza claims the 2.5 percent figure is absurd. "It is supposedly justified in a 1,000-page report," he said. "First I was told the report isn't a public record, then I wasn't shown it until one day before the Oct. 11 hearing. I can assure you, there is no mention of 2.5 percent, no documentation at all, anywhere in it."
NCCI did not return Sunshine State News' phone calls on Friday asking for a copy of the report and cost analysis.
What puts the insurance industry in the cat bird's seat in this fight, what makes it such a Goliath, is that Insurance Commissioner Kevin McCarty and powerful insurance and business lobbies like the Florida Chamber of Commerce and Associated Industries of Florida all are backing proposed House and Senate bills for the 2012 legislative session that would limit amounts doctors can charge.
Similar bills during the last two years were introduced and died, one during the 2011 session, the other in 2010 -- a bill that passed but was vetoed by Gov. Charlie Crist. The 2012 sponsors, Alan Hays in the Senate (SB 668) and Matt Hudson in the House (HB 511) -- Republicans both -- have said they believe their bills will sail through.
Of the 19,000 doctors in Florida authorized to serve workers' compensation patients, only 5,800 of them -- or only about one-third -- can dispense medicine in their offices.
Because Florida is a carrier-directed state, the state can order a workers' comp patient to see a specific doctor.
What that means is that, theoretically, the state can always -- that is, 100 percent of the time -- choose to send its workers' comp patients to doctors who don't dispense drugs, who send their patients to pharmacies to fill their prescriptions instead.
"This is why we don't need a cap," argues Panza. "We have a failsafe. The state is already in charge of the whole show. If dispensing physicians are so greedy, why doesn't the state just skip right over them?"
Gerald Frazier, a retired Miami-Dade County orthopedic physician who said he has treated literally hundreds of workers' comp patients over his 42-year career, told Sunshine State News why he believes the state actually encourages physicians who dispense their own drugs.
"Patients have better outcomes when they see doctors who can take care of them from soup to nuts," Frazier said. "They get back to work faster, so employers are happy. They're less likely to need long-term care. And you know at least they've got their prescription. Doctors who send patients to a pharmacy have no idea if they're going to get that order filled."
Ultimately, though, the fight is likely to be over the truth in numbers: How much are physician-dispensed drugs really costing the state?
According to the Office of the Chief Financial Officer, in 2010 the total bill in Florida for all physician-dispensed workers' comp meds was $63.3 million. Panza says, "If we assume we can save $62 million of that, it will leave us $1.3 million to run one-third of a workers' comp program in the fourth largest state in the nation. That comes to about $2.60 for every prescription. It is totally, utterly absurd."
The House Insurance and Banking Subcommittee is due to workshop HB 511 at 9 a.m. Wednesday in 102 House Office Building, The Capitol. Panza said he will take another run at the windmill then.
Reach Nancy Smith at nsmith@sunshinestatenews.com or at (850) 727-0859.
