Impact of Reform on Physician Dispensing and Prescription Prices in Georgia

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July 1, 2013 Related Topics: Medical Costs, Physician Dispensing, Prescription Drugs and Opioids

This study examines early results of Georgia’s reform, effective April 2011, which changed the reimbursement rules for physician-dispensed prescriptions. The reform capped the reimbursement amount for physician-dispensed prescriptions for a repackaged drug to the average wholesale price (AWP) of the original drug product used in the repackaging process while continuing to allow physicians to dispense prescriptions.  

The impetus for the reform was to reduce the costs of physician-dispensed drugs, but not to limit physician dispensing.  Before the reform, prescriptions dispensed at the doctor’s office were typically paid at a much higher price than when the identical medication was dispensed at the local pharmacy.  

The study uses pre- and post-reform data from payors in Georgia that represent 34 percent of the claims in the state. The pre-reform data consist of claims from 3,132 injured workers with more than one week of lost time. These claims arose between April 1, 2010, and September 30, 2010, with 17,967 prescriptions filled through March 31, 2011. The post-reform data consist of 2,998 claims that arose between April 1, 2011, and September 30, 2011, with 15,804 prescriptions filled through March 31, 2012.

Impact of Reforms on Physician Dispensing and Prescription Prices in Georgia. WC-13-21. July 2013. 

 

Copyright: WCRI

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