After years of struggling to rein in the cost of physician-dispensed drugs, Florida workers’ compensation insurers finally have a compromise with physicians and drug companies that is projected to reduce costs by some $20 million.
Florida lawmakers today approved the compromise (SB662) that for the first time will place a cap on what physicians can charge for the prescription drugs they provide injured workers.
Under the agreement, the reimbursement rate will be capped at 112.5 percent of the average wholesale price of the drug plus an $8 dispensing fee. Insurers, however, will have the right to contract with a physician for a lower fee.
Pharmacies reimbursements will be maintained at a drug’s average wholesale price plus a $4.18 dispensing fee.
The deal is expected to reduce overall insurance costs by 0.7 percent or about $20 million based on the projected 2012 premiums collected by workers’ compensation insurers and self insurers. That is some $7 million less than the original bill, which would have set physician reimbursement rate at the pharmacy rate.
Associated Industries of Florida General Counsel Tami Perdue said the compromise is a win for employers who could see lower rates due to the deal.
“This legislation will provide injured workers with the care they need without imposing indefinite and unwarranted costs to employers,” said Perdue.
Before the new deal on repackaged drugs, Florida had seen a steep increase in prescription drug costs, which in turn has been blamed for rising workers compensation rates.
According to the Workers Compensation Research Institute, the average prescription cost per claim in Florida was $536, making it the second highest among 17 states the WCRI studied. In 2007-2008, many of the most common drugs dispensed by physicians were 40 percent to 80 percent higher than what pharmacies received for the same prescription.