Lyme Disease Education & Support Groups of Maryland
January 23, 2014
Dear Delegate XXX,
We are contacting you out of concern not only for Lyme and tick borne disease patients, but for all residents who are employed, or who ever will be employed in the State of Maryland. HBO280 will limit insurance coverage for medications dispensed by licensed physicians to a maximum of 30 days for workers injured on the job. Additionally, medications would only be covered if dispensed within 30 days of the initial injury or occupational disease, not beyond that point.
Workers who contract Lyme and tick borne diseases, as well as firefighters, police, etc., require medications immediately when injured (life and death examples- Rocky Mountain Spotted Fever, Ehrlichiosis, smoke inhalation, burns, shootings, etc.). That need for medications typically does not end in 30 days, especially when someone experiences a serious injury or occupational disease.
Some injuries require medications that can not be dispensed by an insurer’s contractor or local pharmacies (compounded, IV's, injections, etc.). Some medications require monitoring by a doctor when administered due to known or unknown allergies and potential serious side affects. HB0280 compromises patient safety and encourages non-compliance with a treatment plan by eliminating easy, immediate access to, and coverage for medications.
According to the Journal of General Internal Medicine, between 28 percent and 31 percent of new prescriptions are never filled when patients DO have health insurance, leading to serious health conditions. Doctor dispensed medications have improved prescription fill rates dramatically and increased patients' compliance leading to better outcomes. The system currently in place in Maryland reduces hospital admissions and readmissions, decreases pharmacy callbacks and eliminates handwriting errors, which in turn saves lives.
The American Medical Association requires physicians to “prescribe drugs, devices, and other treatments based solely upon medical considerations and patient need and reasonable expectations of the effectiveness of the drug, device or other treatment for the particular patient.” Some doctors offices are incorporating the use of x-rays in their practices. Some perform blood tests and provide other services for patients. Dispensing medications also serves to enhance patient care and can save money. Administering a drip IV antibiotic, for example, outside a doctor’s office requires home health care services to be engaged and regular nurse monitoring, increasing costs and risks for the patient.
A Journal of American Pharmacies study concluded dispensing errors are a problem on a national level, at a rate of about 4 errors per day in a pharmacy filling 250 prescriptions daily. An estimated 51.5 million errors occur during the filling of 3 billion prescriptions each year.
Medication errors are among the most common medical errors, harming at least 1.5 million people every year. Medication error morbidity and mortality costs are estimated to run $77 billion dollars per year. Patient safety is a major public health concern. When doctors prescribe and dispense medications patients have an added safety net in place and medical errors are reduced.
If passed this bill, HB0280, will add to an injured worker's burden by forcing them to navigate through a complex insurance system involving the employer, insurer, sub-contractors, pharmacies and even doctors offices. According to Dr. Marc Love of the Spine Center in Maryland, “In worker’s compensation cases, the system can be so bureaucratic and complicated that an injured employee could wait days before receiving needed medication through a pharmacy. We instituted it [in-practice pharmacy] because we were having significant difficulty providing the care for workers’ compensation patients.”
Injured workers in Maryland have waited weeks, months and even years to have doctor prescribed medications approved or to be reimbursed for medications purchased at local pharmacies, forcing them to go without, and in turn, negatively affecting their recovery. If more doctors were encouraged rather than discouraged or prohibited from dispensing necessary medications, patient care could improve immensely. The current system in Maryland allows injured workers to receive covered medications conveniently at the point-of-care (if the provider dispenses medications) and shifts the burden of wading through the bureaucracy to trained professionals in billing offices.
HB0280 greatly reduces or eliminates competition in the market place. The American Medical Association’s (AMA) official stance on the subject states, “Physicians may dispense drugs within their office practices provided such dispensing primarily benefits the patients.” Advantages for doctors include greater patient satisfaction, improved medication tracking, enhanced medication compliance and reduced pharmacy and insurance company call back administration expenses. In terms of costs related to doctor dispensed medications, in 2011 generics accounted for a higher proportion of the number of prescriptions dispensed by physicians (82%) than of total prescriptions (76%).
The American Medical Association Code of Ethics encourages competition and promotes freedom of choice. The unsettling act of striping consumers of their rights by legislating when and where people can or can not purchase their covered medications must be considered. The American Medical Association (AMA) states:
“In all instances, physicians should respect the patient’s freedom of choice in selecting who will fill their prescriptions as they are in the choice of a physician and, therefore, have the right to have a prescription filled wherever they wish. (See Opinions 9.06, "Free Choice," and 8.03, "Conflicts of Interest: Guidelines.") Opinion 8.06 - Prescribing and Dispensing Drugs and Devices
HB0280 Policy Notes (last year- no update provided) indicates the ONLY purpose of this bill is to save insurers more money. There is no provision to improve patient care or assist doctors in the care of the injured.
The State’s largest workers compensation insurer (IWIF/Chesapeake) reported assets of $1,844,770,793 in 2012. It claims it reduced medical costs by $5.5 million dollars in one year alone (2012) by establishing a monitoring system to track and intervene in the dispensing of medications by prescribers (the purpose of HB0280), by reducing fees paid to doctors, and by the use of “in-patient care guidelines”, which is a cost-saving measure utilized by insurers that often puts profits before patients and limits treatment choices to the least expensive options.
The NCCI’s Workers Compensation Prescription Drug Study: Update 2013 determined prescription costs for one-to-two-year-old claims compose only around 3% of total medical costs, but costs on claims more than 11 years old make up more than 40% of the incremental costs. Eliminating insurance coverage for medications dispensed by a doctor past 30 days, as is the goal of HB0280, will severely affect an injured worker’s ability to obtain needed medications and adhere to a treatment plan.
Savings to insurers, based on the study, is minimal, and will average less than $100 per claim, which is the amount costs have increased for doctor dispensed medications over the past 10 years- $10.00 per year. This minimal increase in cost can be directly related to the increase in the number of prescriptions workers are prescribed, not from doctor’s taking advantage of the system. Costs for prescriptions were up from an average of 5.3 prescriptions in 2003 to 5.9 prescriptions over the same 10 year period. Eleven states, Maryland included, are considered to have “high costs” for prescriptions. This is not driven by doctor dispensed medications. Therefore, eliminating coverage and saddling injured workers with an additional financial burden is not at all relevant or appropriate.
Please do not deny anyone who is hurt on the job coverage for potential life-saving treatment as prescribed and dispensed by their doctors. We hope and pray legislators will say NO to this bill and allow the coverage injured worker’s currently receive to remain in tact in order to protect all Maryland residents.
As always, we appreciate you taking to time to listen to our concerns and acting in the best interests of the residents you represent and the ones we all care about. We hope you and your staff have a productive legislative session and a wonderful year besides.
And don't forget, do a tick check!
Lucy Barnes, Director
Lyme Disease Education and Support Groups of Maryland
631 Railroad Avenue
Centreville, MD 21617