by Samantha J. Bily, Esq.
In 2011, Georgia capped the reimbursement rate for physician-dispensed prescriptions to the average wholesale price to address payors’ concerns with high prices associated with physician-dispensed medications, which often cost 30% more than pharmacy-dispensed prescriptions. While the reform led to an initial decrease in costs, a recent study by the Workers’ Compensation Research Institute shows that the long-term effect has been negligible.
According to the study, Georgia’s litigation reform has done little to reduce the rate at which prescription medications are dispensed in-house. Further, the study shows that many physicians are now dispensing new higher-priced strengths of medications like cyclobenzaprine and tramadol, raising the average price paid per pill for the drugs.
The research suggests that for reducing prescription costs in workers’ compensation claims, payors might find better results focusing on what medications are being prescribed and in what doses, and the medical necessity of the same.