If only we could get a kiss when our legislature is through with us.

Last year the state of Florida tried to get a handle on the soaring cost of physician dispensed medications, only to have the effort crash and burn in an embarrassingly spectacular fashion; a failure that was specifically driven by a massive infusion of special interest money. The original bill, SB 668 was well intentioned, but the legislative process eventually sullied the effort and ultimately derailed it before ever bringing it for a vote.

One thing you can say for our legislators in Florida, they will give you what you paid for. Unless you're the taxpayer. In that case you can just screw off. This year, the legislature is at it again, this time with a bill that will not only fail to address the underlying problems, but one that will make the issue worse for the employers who ultimately pay the bills in this state.

So, what's the problem with physician dispensing? In my view, the issue is twofold. To be perfectly honest with you, I don't think that physicians should be allowed to fulfill their own prescriptions. In addition to removing critical checks and balances, doing so introduces a profit incentive for the physician that is not necessarily in line with the best interest of the patient. While most doctors are indeed reputable people doing the best for their patient, Florida's storied pill mills, tales of doctors being paid to write prescriptions, and anecdotal stories tell us that some physicians will indeed look beyond the needs of their patient in order to fulfill their own. And what a profit that effort can bring.

That brings us to the second problem with physician dispensing. Doctors who set up these services do so with the help of companies that repackage and distribute the medications for them. They also handle the billing, making it a simple endeavor for the physician. The repackaging and relabeling effort takes these medications off of the average wholesale price guides, and leaves the physician and their partners free to set new, greatly inflated prices for the medications they dispense.  Last spring I had the chance to speak with Florida Senator Alan Hays, the man behind the ill fated SB 668, and one of the few legislators in the state willing to take this issue head on. Senator Hays reeled off just a few examples of how this price structure impacts the end cost for these drugs. Two of those examples were:

Meloxicam – 15mg (60) Physician cost: $ 8.33   Amount billed to Workers' Comp: $437.48
Carisoprodol 350mg (120) Physician cost: $15.63   Amount billed to Workers' Comp: $523.98

Indeed, markups for repackaged drugs in Florida can run more than 700% above costs for comparable drugs from a traditional pharmacy. These are amounts billed to workers' comp and other insurers, which we all ultimately pay for. Estimates for the total costs of this to Florida employers ranges from $30 million to $65 million per year.

So what are our brilliant legislators in Tallahassee working on? They are currently considering HB 483, sponsored by Miami Representative Jose Felix Diaz. HB 483 “prohibits employer or carrier from refusing to authorize physician to treat injured employee solely because physician is dispensing practitioner; provides for authorized physician to dispense & fill prescriptions; prohibits DFA, employer, or carrier from determining which pharmacy, pharmacist, or dispensing practitioner claimant must use”. Additionally, HB 483 “specifies amount of credit provider must give to carrier or self-insured employer for certain repackaged or relabeled prescriptions”. That credit? $15 on any repackaged medication that costs more than $25. So to be clear, a prescription that might cost several hundred dollars more will earn you a $15 credit. Plus you'll have to pay someone to manage all these credits….

So let me put this in a manner that more people can directly relate with. Some people will be more offended by my analogy than the actual abuse it represents, but so be it:

Let's say Florida has a burgeoning rape problem. The legislature gathers to consider ways to stop the rapes from occurring. The law they ultimately craft ends up eliminating rape by legalizing it. Furthermore, you may no longer lock your doors at night, preventing the rapist access to your home. Also, the rapist may return whenever they please. You cannot control that. But, to compensate you, the rapist must leave a mint on your pillow when they are through.

The good news here is you will get a mint every time you are raped.

Offended? You should be – but not by what I wrote. You should be angry enough to call your legislator and demand that they address this issue in the manner that represents the interest of all Floridians, not just those who have donated heavily to their campaigns and causes. Tell them the bill they SHOULD be supporting is HB 0605 (Hudson) and its partner bill in the Senate SB 662 (Hays). Those are tougher bills providing actual pricing limitations designed to curb this abuse.

Other states have stepped up to deal with this, and now it is Florida's turn. Call your rep today and demand that they do the right thing. We have enough to worry about without paying for others' largess, and we certainly do not need a mint on our pillow.

You may find a list of Florida Legislators here.

A list of Florida Senators may be found here.

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