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Physicians frequently dispense prescription drugs with new strengths or formulations to injured workers in states that have enacted legislation to restrict drug repackaging, says a study by the Workers Compensation Research Institute.
Despite reforms aimed at controlling repackaged drug costs in states like California and Florida, health care providers are dispensing new strengths of various drugs at higher costs, including cyclobenzaprine, a muscle relaxant, tramadol, an opioid, and a new formulation of the topical anesthetic lidocaine, according to a study released Thursday by the Cambridge, Massachusetts-based WCRI.
California in March 2007 capped the maximum reimbursement amount for physician-dispensed drugs at the amount the drugs would cost if they were dispensed at pharmacies.
However, shortly after being introduced to the market in late 2011 and early 2012, 7.5-milligram cyclobenzaprine and 150-milligram tramadol extended release were dispensed by some physicians in the state, according to the study, which notes that the new strengths weren't seen among pharmacy-dispensed prescriptions.
The study found that, when dispensed by physicians in first quarter 2014, 7.5-milligram cyclobenzaprine cost $3.01 per pill. Meanwhile, prices paid for existing strengths were significantly lower — at $0.38 per 5-milligram pill and $0.39 for each 10-milligram pill — when dispensed by physicians.
About 55% of physician-dispensed prescriptions for cyclobenzaprine were for the new 7.5-milligram strength in the first quarter of 2014, compared with 6% in the first quarter of 2012, according to the study. Similarly, 47% of physician-dispensed prescriptions for tramadol were for a new 150-milligram formulation in the first quarter of 2014, compared with 0% in the first quarter of 2012.
The study found that 150-milligram tramadol extended release pills cost $8.05 per pill when dispensed by physicians, while 50-milligram tramadol regular release cost $0.24 per pill.
In Florida, topical pain patches dispensed by physicians represented 2.3% of prescriptions and 14% of payments among physician-dispensed prescriptions in the first quarter of 2014, according to the study. Lidocaine-menthol, a more expensive formulation of lidocaine introduced in 2013, represented 75% of topical pain patches.
The study, which looked at medical claims for 22 states with prescriptions filled from the first quarter of 2012 though the first quarter of 2014, highlighted similar findings in Illinois, Pennsylvania and Tennessee.
States have pursued several different approaches to restrict costly physician dispensing of medications, particularly opioids, often with mixed results.