Bill to curb costly drug-dispensing by doctors stuck in committee

Legislation that would curb the practice of physicians directly dispensing prescription drugs to workers' compensation patients — often at sky-high prices — remains stuck in a House committee as time is running out in Annapolis.

The proposal would limit the amount of medication a physician can sell directly to a patient to a 30-day supply. Proponents say the limit could help curb excessive workers' compensation costs.

While supporters of the bill are confident it could pass the Senate, they are worried that it might never get that far. It is one vote short of being moved from committee to the full House of Delegates for a floor vote. The measure has the support of local governments as well as the powerful insurance industry, but it has run into opposition from doctors, trial lawyers and organized labor.

"It's as heavily lobbied as probably any bill in the past few years," said Del. Dereck Davis, a Prince George's County Democrat who chairs the House Economic Matters Committee. The annual 90-day General Assembly session ends April 7.

Supporters say the bill would put a modest limit on physicians' discretion in dispensing drugs to workers' compensation patients — a practice some consider overly costly to insurers and employers. But doctors contend it would interfere with a practice that is convenient for patients and helps physicians closely monitor whether drugs are working.

There has been drastic growth in recent years in the direct dispensing of prescription drugs by physicians, especially those who work in pain centers that specialize in workers' compensation cases. Companies have sprouted up that buy drugs in bulk from pharmaceutical companies and repackage them in smaller quantities that can be dispensed through a medical office.

Along the way, both the repackager and the medical practice often benefit from a large markup. The commonly prescribed painkiller Vicodin, which costs about 37 cents a pill at a typical pharmacy, costs an average of $1.46 when dispensed by a physician, according to the Massachusetts-based Workers Compensation Research Institute. Six states have banned such repackaging.

Patients in workers' compensation cases have little reason to complain about the price since employers and insurers typically cover 100 percent of the cost. But insurance companies and local governments that self-insure are looking to the General Assembly for a remedy.

Economic Matters is one of two committees that would have to approve the bill before it could move to the full House. Supporters are confident they have the votes there, but they are still hunting for the elusive 12th vote it would take to spring the measure from the House Health and Government Operations Committee.

Del. Peter A. Hammen, the Baltimore Democrat who chairs the health committee, has yet to hold a vote. A supporter of the legislation, Hammen said Friday that he intends to delay until he can persuade one more member of the committee to come aboard.

"We're overpaying for these prescriptions," he said. "It's very costly to local governments."

Sen. Thomas M. Middleton, chairman of the Senate Finance Committee, said another factor driving the bill is a concern that large profit margins give doctors an incentive to overprescribe such potentially addictive drugs as the painkiller Oxycontin.

"It's a serious, serious problem," said Middleton, a Charles County Democrat.

Opposition to the bill has united two powerful groups who typically fight each other — physicians and trial lawyers. But some unions also are opposed, saying a curb on physicians ability to dispense medications could prompt doctors to stop treating workers' compensation patients.

"The bottom line for us is no more obstacles for the injured worker," said Donna Edwards of the Maryland-District of Columbia AFL-CIO.

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