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Tue March 19, 2013
Doctors Lose on Database, Comp Votes
A bill that would require doctors to check with the state's drug database before writing a prescription for addictive medications passed today in a House panel despite the opposition of organized medicine.
The House Health Quality Subcommittee also passed two other controversial bills, one on abortion and one on workers' compensation.
The former requires health professionals and facilities to report it when an infant is born alive during an attempted abortion. The bill gives the state automatic custody.
The other bill, which has sparked an intense lobbying battle between big-money interests, is intended to reduce employers' costs in workers' compensation by taking the profit out of physicians' sale of "repackaged" drugs.
Here are details:
Rep. Mike Fasano, R-New Port Richey, pushed for adoption of the Florida Prescription Drug Monitoring Program, which happened in 2009 when he was in the Senate. Since then he has pushed to make it successful.
His bill, HB 831, drew support from law-enforcement groups but was opposed by the Florida Medical Association and specialty groups of physicians and surgeons during debate Tuesday. It would do three things:
- Reduce the number of days allowed for reporting on the writing or filling of a controlled drug to the database from seven to two.
- Remove the prohibition on state funding for the database. So far, it has been supported through grants, but the end of some grant funding has made future operations uncertain.
- Require that prescribers of addictive painkillers and other controlled drugs check the electronic database before writing a prescription. That would reduce the danger of being fooled by a "doctor-shopper" who pretends to have symptoms in order to score drugs that are worth a lot of money in street sales.
A report in December by the Department of Health's 2012 report on the database -- officially called E-Forcse for Electronic-Florida Online Reporting of Controlled Substances Evaluation -- said the database has had a definite impact in reducing doctor-shopping and deaths from prescription drugs.
But pharmacists, who are supposed to check the database before filling a prescription for a controlled drug, have been better at enrolling in the database than the prescribers, the report showed.
Chris Nuland, a lobbyist for the American College of Physicians and the American College of Surgeons, told the committee that while the databank is a "wonderful tool," its use should not be required in every case.
"It adds an extra layer of hassle, an extra layer of cost," he said. A lobbyist from the Florida Medical Association, Rebecca O'Hara, voiced the same fear.
But Fasano said it takes only seconds, and that doctors are checking it when they prescribe controlled drugs only 2 percent of the time.
The bill passed 10 to 1, with Rep. Daphne Campbell, D-Miami-Dade, voting no.
HB 605 by Rep. Matt Hudson, R-Naples, would make the price of drugs for injured workers in the workers' compensation system the same, whether the drug came from a pharmacy or from a doctor's office. Some doctors have been able to develop an income stream by "repackaging" or "relabeling" drugs and marking up the price.
That practice cost Florida employers an extra $27 million in the past year, according to a estimates from an industry-led institute. Florida's Insurance Commissioner Kevin McCarty says repackaging needs to be curtailed because it is inflating the cost of drugs for workers.
The repackaging industry cropped up because of a loophole in the law, said Tammy Perdue, lobbyist for Associated Industries. "This is really a glitch bill," she said.
Hudson's bill passed the subcommittee unanimously, belying the fact that it has been unsuccessful in previous years. It is opposed by some medical groups and by Automated Healthcare Solutions, a South Florida drug-repackaging company.
The issue has been a reliable source of campaign cash, with employer groups on one side and Automated Healthcare Solutions joining medical groups on the other side.
Sen. Alan Hays, R-Umatilla, has a companion bill in the Senate.
HB 1129, called the Infants Born Alive bill, involves an exceptionally rare event: An attempted abortion that results in a live birth.
Just such a case occurred in 2006 at a Miramar abortion clinic. See the Health News Florida account, Doctor Loses License in Bagged-Fetus Case.
It was presented by one of its sponsors, Rep. Cary Pigman, R-Avon Park, an emergency-room physician.
The bill requires health professionals and facilities to report any such birth and transport the infant to a hospital. The controversial clause gives custody of the infant automatically to the state, rather than to the mother, assuming that the attempt at abortion means she has surrendered the child.
But some members of the committee said they can imagine a scenario in which a woman undergoes an abortion on the advice of a physician -- because her own health is at risk or the fetus is thought to be dead -- but would very much want custody of her child if it is born alive.
However, the bill passed 10-2. The Senate companion is sponsored by Sen. Anitere Flores, R-Miami-Dade.