Study ‘Raises Concerns’ About Unnecessary Drugs
Reforms addressing physician dispensing might need to target specific drugs in addition to prices, suggests a new study.
A review of workers’ comp claims in Florida points to evidence that physicians allowed to dispense medications prescribed unnecessarily strong opioids.
The Workers Compensation Research Institute looked at claims both pre- and post-reforms to curb physician dispensing in Florida. The results surprised the researchers.
“If the pre-ban strong opioids were necessary, researchers would expect that workers who received weaker physician-dispensed pain medications after the ban would later need strong opioids (that can be dispensed only at a pharmacy).
But only 2 percent of those with weaker physician-dispensed pain medications in the first six months after the ban received strong opioids at a pharmacy in the next six months,” the report said.
“This raises concerns that a significant proportion of pre-reform physician-dispensed strong opioids were not necessary, which means injured workers in Florida were put at greater risk for addiction, disability or work loss, and even death.”
The researchers looked at the prescribing behaviors of physicians after Florida banned physician dispensing of strong opioids.
They found no material increase in pharmacy-dispensed strong opioids but instead an increase in the rate of patients receiving physician-dispensed weaker pain medications — nonsteroidal anti-inflammatory medications such as ibuprofen.
The percentage receiving weaker opioids increased from 9.1 to 10.1 percent.
The study comes as policymakers in several states focus on the prices charged by physician dispensers compared to pharmacies for the same medications.
But increasingly there is speculation that economic incentives associated with physician dispensing lead to unnecessary medications prescribed for injured workers.
“When we compare pre- and post-reform prescribing practices, it appears that physician-dispensers not only reduced their dispensing of strong opioids but also reduced prescribing of strong opioids,” said Richard Victor, WCRI’s executive director.
“Since Florida has banned physician dispensing of strong opioids, the lessons of this study are relevant for the other states concerned about eliminating unnecessary costs in their system while protecting injured workers from unnecessary medical care.”