Physician Dispensers Are Getting Desperate

posted on 02/21/2013

Joe Paduda


Oh this is getting fun!

On Jan. 24, WorkCompCentral published a column ostensibly written by a physician attacking me for exposing the dangers, both physical and financial, inherent in physician dispensing of repackaged drugs. I say ostensibly because the column reads like it was ghostwritten by one of the industrys shills, perhaps one of Ron Sachs interns. (Rons the guy physician dispensing company AHCS hired to call reporters to tell them they were suing me.)

By the way, I LOVED the column.

It was an amazing combination of pronouncements from an arrogant-beyond-belief doctor, with a really nasty and personal attack on me, my motives and my ethics.

Alas, it was so poorly done, with so many logical fallacies and nonsensical arguments based on nothing more than fact-free opinion that I cant believe a real doctor actually wrote it. After all, doctors are supposed to believe in science; you know, research, medical evidence, facts, logic supported by data those kind of things. Yet the column didnt have any of those, instead it was a mishmash of unsupported claims based on our experience and never directly addressed the key issues I raised in my piece, e.g., retail pharmacies have much more complete access to patient data, and docs who dispense dont.

(BTW, a Summit on Physician Dispensing will be held in Boston on Feb. 25-26. Sponsored by PMSI and Progressive Solutions, the Summit is free of charge and is held the day before WCRIs annual conference in the same hotel. This is an invite-only event; there are a few slots open. Email me for details.

The ostensible author, one Dr. Rafael Miguel, offered not a single shred of evidence to support his claims of better outcomes and enhanced quality of care. When not denigrating pharmacists, mischaracterizing my statements and accusing me of profiting from defeating physician dispensers (more on that below), Dr. Miguel/the intern hid the total lack of data supporting his claims behind the omnipotence of the god in the white coat, as if his title is proof enough and we non-physicians should meekly listen and obey.

You can tell the physician-dispensing industry is in desperate straits when they use surrogates to question the motives of their opponents, fabricating reasons why anyone would dare interfere with their ability to suck money out of taxpayers and employers by charging outrageous amounts for the drugs they prescribe and dispense to workers comp claimants.

Thats known as diversion; when you cant refute a critic, yell really loud about what a bad person they are.

Well, lets look at Dr. Miguel.

Dr. Miguel is a dispensing physician using Rx Development Associates. A quick check of their website reveals frequent mention of one of the key benefits of physician dispensing; additional revenue for the physician. RxDA also touts how easy it is to sign up and use their system to generate big profits, without interrupting or burdening staff members. Thats in direct conflict with Dr. Miguels assertion that physicians must recover the costs and time to provide this service to workers compensation patients.

Lets look at Dr Miguels scripts. Hes dispensed fluoxetine, etodolac, omeprazole and gabapentin, among other meds. One of those scripts, omeprazole, is commonly used for heartburn. Omeprazole, also known as Prilosec, can be bought over the counter for about a buck a pill; Dr. Miguel charged about $10 pill. Thats not opinion or hyperbole, its fact. Miguel charged about 10 times more for the drug than it would have cost over the counter.

Dr. Miguel/the intern contends docs cant buy drugs for the same price retail pharmacies do, and thats why they have to charge so much more. Again, he offers no evidence of this. In fact, if Dr. Miguel had tried, he could have found repackaging companies clamoring to sell him drugs at very low prices.

Finally, allow me to address Dr. Miguel/the interns questioning of my motives, and contention that my efforts to combat physician dispensing are what can only be described as an attempt to fatten Mr. Padudas personal bottom line.

As I have noted many times, I am co-owner of CompPharma, an association of workers comp pharmacy benefit managers. It makes no difference (financially) to me if physician dispensing dies off, explodes or just stumbles along. I dont get a nickel more or less.

My public battle with the industry and its advocates has cost me tens of thousands of dollars in legal fees not to mention hundreds of uncompensated hours.

Yes, PBMs will benefit if physician dispensing ends, but I am not a PBM, nor do I own a PBM, nor do I get paid based in any way on their volume of business.

What Miguel/the intern cant understand is some people just have principles, standards that they live by, ethics that require them to speak out when they see others doing wrong.

And physician dispensing of repackaged drugs is wrong.

Joe Paduda is owner of Health Strategy Associates and co-owner of CompPharma, a consortium of pharmacy benefit managers. This column was reprinted with his permission from his Managed Care Matters blog.


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