Legislation to curb the practice of physicians directly dispensing prescription drugs to workers' compensation patients has passed the state House of Representatives on a unanimous vote.
House Bill 1846, sponsored by Rep. Marguerite Quinn (R-Bucks), aims to remove a legal loophole that allows doctors to dispense repackaged prescription drugs directly to injured workers — often, critics say, at sky-high prices.
According to a news release from House Majority Leader Rep. Mike Turzai (R-28), drug-distributing firms purchase large quantities of drugs (1,000 to 10,000 tablets) and repackage them into single prescription sizes (14 to 28 tablets). As part of the repackaging process, drugs are assigned a new national drug code and inherit a new and typically higher average wholesale price.
"Although Pennsylvania's pharmacy fee schedule currently sets the maximum reimbursement rate at 110 percent of the AWP for workers' compensation pharmaceuticals, the artificial and inflated AWP of repackaged drugs allows doctors, middlemen and drug distributing firms to earn millions of dollars in the name of 'patient convenience,'" the news release said. "To maximize profitability, some health providers have begun to write long-term prescriptions for the drug they dispense, exacerbating the problem for insurers."
The legislation proposes the following.
• Require physicians to include the original drug manufacturer's national drug code on bills they submit for reimbursement.
• Cap the maximum reimbursement rate drugs and professional pharmaceutical services at 100 percent.
• Prohibit the use of repackaged national drug code numbers.
• Limit physician dispensing to drugs needed in the first 15 days following initial treatment.
Advocates say reducing the size of initial prescriptions given to injured workers would mitigate abuse of potent and addictive painkillers.
Estimates from the state Department of Labor and Industry and the Insurance Federation of Pennsylvania project the bill would reduce workers' compensation prescription costs by as much as 15 percent and reduce total costs in the state's $3.3 billion workers' compensation insurance system by a full percent.
The bill now heads to the state Senate for consideration.