A number of states have changed rules on reimbursement for physician-dispensed pharmaceuticals, but in some states physician prices actually increased.

That’s according to a study from the Workers Compensation Research Institute which compares results in post-reform states with the situation in states where there were no reforms or where only pre-reform experience was observed.

The study “A Multistate Perspective on Physician Dispensing, 2011–2014” sought to gauge the impact of price-focused reforms on the frequency and costs of physician-dispensed prescriptions, and while it finds physicians dispensed fewer prescriptions after price-focused physician dispensing reforms went into effect, results of the reforms weren’t uniform.

In fact, as of 2014, it reports, physician dispensing was still common, accounting for a major portion of the cost of prescriptions in several states, including California, Florida, Illinois, Maryland and Pennsylvania.

While reforms cut prices for existing drug products in all post-reform states, in some states — including California, Florida and Illinois — physician’s prices went the other way, rising for a number of drugs that are often used in the treatment of injured workers.

Increases came about because doctors frequently dispensed new drugs with higher prices. In fact, in doing so, some physician-dispensers were able to bypass reimbursement rules which target doctor-repackaged drugs; as a result, they were paid considerably more for those than for existing strengths of the same drug.

That brings into question just how effective and sustainable those states’ price-focused reforms are, particularly since “the increased physician dispensing of higher-priced new drug strengths and formulations,” the study says, actually “offset the price reduction for existing products, driving up the average price per pill paid for physician-dispensed prescriptions.”

In most of the non-reform or pre-reform states examined by the study, however, except for Iowa and Maryland, physician prices either rose or didn’t change much. In many of those states, the study says, the cost share of physician-dispensed prescriptions remained the same or increased.

The study also reveals the dispensing pattern of specific drugs commonly dispensed by doctors in several states, including Florida, Indiana, Kentucky and Tennessee, underwent noticeable changes. The shift seen in the prescription distribution of physician-dispensed prescriptions for common drugs, it reports, suggests that reforms limiting doctors’ ability to dispense certain drugs had a direct impact on patterns of physician dispensing.

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Price-focused reforms not uniformly effective for physician-dispensed drugs

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