Loophole in workers' compensation system allows doctors to prescribe drugs from their offices
More Illinoisans die from an opioid overdose than from the barrel of a gun. But imagine the public outcry if a state-run program was passing out weaponry to civilians.
Enter Illinois' workers' compensation system, which contains a little-known loophole that puts injured workers at risk of drug addiction and overdose.
Doctors treating injured workers in Illinois through the workers' comp system can sell the drugs they prescribe directly out of their office. And that comes with life-threatening consequences.
A study from Johns Hopkins researchers reveals that when physicians are allowed to do this, they prescribe more than three times the quantity of opioid drugs they would prescribe otherwise. And workers are off the job for 85 percent longer.
Perhaps even more concerning, those researchers couldn't find a single legitimate medical reason why this is happening in Illinois. They concluded that financial incentives were the likely culprit. We'll get back to that in a minute.
Fortunately, state government already has taken major steps to address the rising body count of opioid addiction.
Take Illinois' Prescription Monitoring Program, or PMP, which requires pharmacies filling prescriptions to record the recipient's name, address and the drug supplied to a state database. These numbers are reported on a daily basis.
Pharmacies comply with this requirement. But many physicians selling drugs out their office do not, according to Randy Malan, the PMP's clinical director. Malan said physician-dispensing sites are not registered in the database.
So, what if there was a bad actor in that system?
“We wouldn't know,” Malan said.
This blind spot means that if a doctor tried to treat an injured person receiving physician-dispensed drugs from elsewhere, she might not be able to make a holistic judgment of the patient. That lack of information easily could lead to a vulnerable worker receiving a “holy trinity,” Malan said. He's referring to the dangerous drug cocktail of an opioid such as Vicodin, a muscle relaxant such as Soma and a benzodiazepine such as Xanax. This combination can be lethal.
Unfortunately, physician dispensing is not a niche industry in the Land of Lincoln. In fact, it's booming.
Physician-dispensed drugs account for more than 60 percent of the cost of prescriptions covered by workers' comp in Illinois, according to the Workers Compensation Research Institute, or WCRI. And that cost share is increasing.
“This appears to have been driven by the significant increase in the price per pill for physician-dispensed prescriptions,” WCRI experts wrote in a July 2016 report.
That is a shocking result. It means efforts in 2012 to curb costly markups at physician-dispensing sites had the exact opposite effect.
Five years ago, Illinois began tying the price of physician-dispensed drugs to their average wholesale price in order to limit high markups. But soon after this policy change, physicians started prescribing new, obscure and sometimes more powerful dosages of familiar drugs. This effectively made the price controls moot.
For example, shortly after the new rules took effect, doctors began selling a previously nonexistent strength of hydrocodone-acetaminophen, commonly known as Vicodin. While it was nowhere to be found in pharmacies, this new strength was the most common form physicians dispensed in 2014.
Why? Physicians could sell it at more than $3 a pill — triple the price of the typical dose at the pharmacy.
This practice doesn't just present an immediate danger to workers. It's also a threat to their families and communities. Just because an injured worker is overprescribed opioids doesn't mean he will use all of them. In fact, data from the federal Centers for Disease Control and Prevention show most people who abuse prescription medications get them for free from friends and relatives, not drug dealers.
For these reasons and more, 21 states have taken steps to curtail physician dispensing within workers' compensation laws or more broadly. Illinois has not.
Thankfully, House Bill 2892 offers a way forward. This bill, filed by state Rep. Barbara Wheeler, R-Crystal Lake, would ban physician dispensing within the workers' comp system while allowing limited exceptions for areas without access to a nearby pharmacy.
It's a reform that addresses a major worker health issue, not to mention saves on workers' comp insurance costs for Illinois businesses trying to keep afloat. How often does such a simple fix pop up in Springfield?
Opioid addiction isn't a partisan issue. Lawmakers should act to address the state's role in promoting it as soon as possible.
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