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COLUMN
Efficient and Effective Drug Dispensing to Injured Workers
posted on 01/24/2013

Dr. Rafael Miguel

Editors note: This column is published in rebuttal to Joe Padudas column, "The Fla. Medical Assn.s New Tagline: Profits Before Patients," which ran in WorkCompCentral on Dec. 19.

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 the most challenging of occupations. Endless hours and financial resources are invested in specialized staffs, offices and clinics to assist doctors in delivering care.

Physicians sometimes are called to answer by governing authorities, the courts or their own profession to defend their practices or their care. Fortunately, these are rare occurrences and usually done for appropriate reasons.

Recently, physicians were challenged by someone who is neither a government authority, jurist nor a member of our profession. Joe Padudas opinion piece alleging that physicians put profits before their patients attacks me and many of my colleagues in what can only be described as an attempt to fatten Mr. Padudas personal bottom line and those of his clients.

Mr. Paduda is part of an effort to restrict Florida physicians ability to directly provide medications to workers compensation patients. These patients are often badly injured and in severe pain. When physicians directly fill their prescriptions in the office as they are being seen, injured workers receive the medicines they need quicker, easier and more reliably. 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 persons health insurance benefits but not their employers workers compensation coverage and benefits. By contrast, the injured workers case manager is frequently present in the office at the time of visit, acknowledging the prescriptions and plan. This latter scenario eliminates the delay for injured workers getting their prescriptions filled as pharmacies work to verify workers compensation benefits. These delays lengthen recovery time and subject the injured worker to needless additional pain and suffering: How do we put a cost on that?

Mr. Padudas assertion that its dangerous for physicians to dispense medications directly to their patients is downright insulting to the tens of thousands of dedicated physicians practicing in Florida. Mr. Padudas logic is that pharmacists are somehow in a better position to know whats best for patients than the doctors who personally evaluate the patient and prescribe the medications thats absolute nonsense.

Instead of attacking physicians, maybe Mr. Paduda should explain to your readers his personal stake in this issue and how the pharmacy benefit managers he represents would financially benefit if doctors are discouraged or prevented from dispensing medications directly to their patients.

Our experience is that injured workers receive their medications more reliably, recover faster and return to work sooner when physicians can directly administer and deliver medicines. The physician who prescribes and dispenses is the one who will handle any question or concern about potential drug interactions and treat any side effect, not the pharmacist. Faster return to the job benefits the employer and saves money for Floridas workers compensation system. Outcomes improve when doctors can talk with patients about how the medicines being prescribed will be affected by the patients other prescriptions, diet and activities.

Make no mistake, physicians cannot buy medicines in the bulk amounts that retail pharmacies can and must recover the costs and time to provide this service to workers compensation patients. But consider that between 2003 and 2010 a period where physician prescription dispensing increased significantly pharmacy costs in lost-time claims dropped by 5.8% and the number of lost-work time claims decreased by 36%. Further, Floridas workers compensation rates are 56% lower than in 2003. Can we point to any other line of insurance where such dramatic improvement has taken place?

Mr. Padudas arguments simply ring hollow and are self-serving, at best. 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 professor and director of the Pain Medicine Program for the Departments of Anesthesiology and Neurosurgery at the University of South Florida College of Medicine in Tampa.
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