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The practice of patients getting their prescriptions filled at their doctors’ offices fell under scrutiny more than a decade ago, as workers compensation payers noticed how the medications were costing significantly more than what was doled out at a traditional pharmacy.
The Cambridge, Massachusetts-based Workers Compensation Research Institute has estimated some medications were costing upwards of five times the cost of a pill dispensed at a pharmacy.
Enter the era of reform.
By 2007, several states had initiated reforms mostly targeting what a doctor could be paid for repackaging a drug. By 2017, 22 states had made the leap to reform how much a doctor could collect. To date, eight states do not allow the practice of physician dispensing.
In Illinois, for example, prescription reimbursement rates are set to match the average wholesale price, or AWP, often a benchmark for pharmacy reimbursements — a change also seen in other states, including Pennsylvania, Georgia, Florida, Nevada and Michigan.
In Florida, doctors are also prohibited from dispensing certain kinds of opioids. Pennsylvania doctors are limited on quantities of drugs they can dispense.
Meanwhile, California put medications on a pharmacy fee schedule. Kansas requires doctors to gain a preauthorization to dispense any drug.
States that enacted reforms to rein in the high cost of drugs dispensed by physicians to injured workers face an uphill battle as some doctors find loopholes in the regulations.