Despite a majority contingent of speakers testifying on behalf of dispensing physicians, HB 511 -- a bill limiting how much dispensing physicians can charge for their repackaged drugs -- sailed through the House Insurance and Banking Subcommittee on Wednesday.
Fort Lauderdale Democrat Evan Jenne was the lone dissenter.
It was a first-round victory for the insurance industry and its business community support group, in particular the Florida Chamber of Commerce and Associated Industries of Florida.
Calling HB 511 "a bill that creates an even playing field" -- meaning physicians shouldn't make any more profit than, say, Wal-Mart -- sponsor Matt Hudson, R-Naples, reiterated that his bill "does not keep physicians from dispensing drugs. They can continue to do so. They just have to play by the same rules as the pharmacies."
Since 2003 those rules mean a cap of three times the drug manufacturers' wholesale price on pharmacy-dispensed drugs, plus a $4.18 dispensing fee.
Hudson said that if his bill passes, it will save the state and businesses some $62 million in workers' comp rates. He said that $62 million represents 2.5 percent of the average 8.9 percent increase in workers' comp rates that insurance regulators approved this fall.
But one after another, a stream of physicians and their representatives disputed Hudson's statements.
Among them was Tom Panza, a Florida attorney for Automated Health Care Solutions, which represents the physicians. "The $62 million is bogus," Panza said. "I have no idea where it came from and neither does anybody else.
"The National Council on Compensation Insurance produced a 1,000-page report they said contains the justification for this. ... We've been through it cover to cover, there is no 2.5 percent figure anywhere in it. I've asked anybody at NCCI to show me where it is and they can't. They can't because it isn't there."
Panza said the $62 million is entirely arbitrary. "First they said the savings would be $34 million, then they said $100 million and now they're saying $62 million. I can't get a straight answer. ..."
He said the total bill in Florida for all physician-dispensed workers' comp meds last year was $63.3 million. "If we assume we can save $62 million of that, it will leave us $1.3 million for repackaged drugs. That's completely impossible -- and it shows how wrong that $62 million number is."
Miami-Dade County dispensing physician Gary Kelman, who said he has attended "hundreds, perhaps thousands" of workers' comp patients over the course of his career, told the subcommittee, "Doctors won't be able to continue dispensing repackaged drugs if you make them charge the same as Wal-Mart or Walgreen's. They can't afford it.
"Those big box companies buy in millions of pills at a cut rate. We buy all generics to keep the price as low as we can, but we just don't have the ability to buy in bulk and do the packaging ourselves," he said. "I'm telling you now, if this bill passes, most of us won't (dispense drugs) anymore."
Kelman explained the importance of being among the 5,500 workers' comp doctors who dispense repackaged drugs. He said the majority of his patients show up with muscular and skeletal injuries. The first 90 to 120 days is critical to get the best outcome for the patient.
"You want to make sure he has his medicine on the spot," Kelman said. "That, plus rehab, is the whole course of treatment for these patients. You don't want to wonder if he'll go to the pharmacy right away to get his prescription filled. That's when these patients don't get better, when they're left to their own devices. That's when they start to get angry and think no one cares about them."
During his time at the podium, Panza also told the subcommittee that the cap is unnecessary.This is a self-regulating industry, he said. There are 5,500 doctors in the state who dispense medicine to workers' comp patients and 19,400 doctors who don't. "In Florida, if an employer doesn't want his employee to go to a doctor who dispenses drugs, he can tell him not to. He can dictate wherever that employee goes."
After some subcommittee members questioned the $62 million in savings the bill will bring to the state, and after Hudson was unable to identify where in the NCCI report the figure was contained, Teye Reeves, director of business climate and quality-of-life policy for the Florida Chamber of Commerce, told the subcommittee $62 million was the result of a complicated formula that involved losses and other considerations.
"It was never meant to be interpreted as a dollar-for-dollar exchange," Reeves said.
Except for Rep. Mack Bernard, D-West Palm Beach -- who said he would vote for the bill in spite of the "mysterious" $62 million savings -- there was little discussion among committee members before the vote was taken.
Asked why HB 511 is needed when employers or carriers can tell injured workers not to go a doctor who dispenses drugs, bill sponsor Hudson said, "How would employers or carriers know who dispenses drugs and who doesn't?"
He claims it's a simple process to register to dispense at point of service. Any doctor, he said, can fill out the papers to qualify in a matter of a day. Besides, he said, employers aren't privy to a list of who dispenses and who doesn't.
Panza claims Hudson is wrong. The list of physicians licensed to dispense medicine in Florida, he said, is public record, easy to obtain from the Department of Health and completely up to date.
Doctors must submit an HCFA 1500 form to seek reimbursement for dispensed meds, he said, and the form includes the practitioner's name. And every medical bill for drugs dispensed from a doctor's office includes the medical provider's name and license number. "There is no mystery who is dispensing medicine and who isn't."
Sen. Alan Hays, R-Umatilla has filed a companion bill, SB 668. Similar bills were introduced and died, one during the 2011 session and one in 2010, which passed the Legislature but not Gov. Charlie Crist's veto pen.
Reach Nancy Smith at nsmith@sunshinestatenews.com, or at (850) 282-2423.
