On Monday, March 28, 2011, the Wall Street Journal published an article titled, “How Can You Help the Medicine Go Down?”  The article states, “Medication can do great things for people – but only if they take it. And a lot of people aren’t taking it.” The article continues, “Half of patients in the developed world don’t properly take their drugs for chronic conditions, according to the World Health Organization. The additional costs for treating diseases that progress unchecked run into the hundreds of billions of dollars a year.  One study estimates nearly 90,000 people die prematurely in the U.S. each year because of poor adherence to high-blood-pressure treatment alone.”

That means that 246 people in the U.S. die every day from failure to take just high blood pressure medicine. How many others die every day from failure to take other chronic care medications; hundreds, thousands? The Harvard Medical Journal published an article in February 2010, titled, “Primary Medication Non-Adherence: Analysis of 195,930 Electronic Prescriptions.”  The Harvard study found that only 72 percent of prescriptions for new medications were filled, and found even higher non-fill rates for “newly prescribed medications treating chronic conditions such as hypertension (28.4 percent), hyperlipidemia (28.2 percent), and diabetes (31.4 percent).”

Those findings suggest that if an internal medicine doctor in Florida sees 30 chronic care patients per day, 10 of them are not filling the prescriptions written to treat those conditions. The Harvard study states that, “Medication non –adherence is related to greater morbidity and mortality in chronic disease, and has been estimated to increase healthcare costs by over $170 billion annually in the United States.”

Let’s do the math. The 2010 census reflects that the U.S. population is about 309 million and the Florida population is about 19 million; so Florida represents 6.1 percent of the U.S. population. Using the Harvard study figures, medication non-compliance costs Floridians 6.1 percent of $170 billion dollars, or $10.4 billion dollars in increased Florida healthcare costs. The simplest method of reducing medication non-compliance, improving health, and reducing healthcare costs, is for all patients to get their medication in their physicians’ offices.

Fortunately, more and more Florida physicians are turning to dispensing as a way to improve patient health and their bottom line. According to the Florida Department of Health’s June 30, 2010 Annual Report, there were 42,845 active in state MD licenses, and 3,989 active in state DO licenses, for a total of 46,834.  As of May 13, 2011, the FDOH stated that 6,223 Florida MD’s and DO’s were registered to dispense; more than 13 percent of all active Florida physicians.

Under Florida law, Florida physicians are authorized to dispense prescription medications to their patients in the regular course of their practice. A physician registered with FDOH to dispense may also register ARNP’s and PA’s under their supervision to dispense. Once properly registered, a physician complying with FDOH requirements can legally dispense prescription medications to their patients for patient convenience, medication compliance and physician profit.

On the last night of the just completed session, the Florida legislature unanimously passed Conference Bill 7095 that regulates both prescribing and dispensing of controlled substances. The legislative history and committee hearings indicate that the bill was intended to address “pill mills.” The statute was effective as of July 1, 2011, and prohibits a Florida physician from dispensing any Schedule II or Schedule III medication for profit, except in connection with the performance of a surgical procedure, and even then, the dispensing is limited to a 14 day supply of the Schedule II or III medication.

While the new law contains onerous requirements for physicians who prescribe or dispense Schedule II or III medications for chronic nonmalignant pain, it does not affect the right of physicians to prescribe and dispense any other prescription medication; including those in Schedules IV and V and all legend medications. The legislature’s stated desire to regulate pill mills does not affect the ability of Florida physicians to provide other types of prescription medications to their patients.

Dispensing provides patient convenience, better patient compliance and better medical outcomes.  It also provides an additional revenue stream to offset the constant onslaught of government and provider reimbursement cuts for physician services.

STANLEY T. PADGETT graduated with honors from Duke University School of Law and joined the Florida Bar in October of 1982.  For the last six years, he has consulted with business owners and wealthy individuals, including physicians, on asset protection and taxation issues. In addition to continuing that practice, he has become actively involved in helping physicians dispense medications to their patients, and currently serves as the CEO of FPP Health Solutions, LLC (“FPP”).  FPP is the exclusive Pharmacy Services Provider to the FMA. www.fpphealthsolutions.com. Mr. Padgett may be contacted at spadgett@fpphealthsolutions.com.

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