Business Insurance | By Louise Esola | 9/4/2017

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.

These loopholes mean that workers compensation prescription costs remain stagnant or are rising in some states, leading to calls for additional restrictions on physician dispensing, experts say.

Take the case of cyclobenzaprine, a common muscle relaxer that had been on the market since late 2011 and usually prescribed in 5-milligram and 10-milligram doses. In the arena of injured workers, it’s among the most commonly prescribed medications, data shows.

The drug fell under price-control regulations in some states that aimed to reduce the cost-per-pill at the doctor’s office, historically much costlier — as high as five times the cost — than what is packaged at a retail pharmacy.

Enter cyclobenzaprine’s new strength in late 2011: 7.5 milligrams.

The new strength fell outside the scope of the pricing regulations, meaning doctors could prescribe it and still collect at the higher price.

That’s what happened in Florida by 2014, where researchers with the Cambridge, Massachusetts-based Workers Compensation Research Institute found that 41% of the physician-dispensed cyclobenzaprine prescriptions were for the 7.5-milligram strength, per the institute’s most recent examination of the trend.

The new strength is seen by some as a benefit to those who found the weaker dose ineffective and the 10 milligrams too strong, said Fred Ganjian, Burbank, California-based director of sales and marketing at BRP Pharmaceuticals at Bryant Ranch Prepack Inc., which helps physicians dispense medications directly to patients.

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