 At least, that’s how things are expected to play out.
But a little-known loophole in Illinois’ workers’ compensation system is being
used to exploit vulnerable workers for personal profit, at the expense of
workers’ health.
Through a process called physician dispensing, Illinois doctors can not only
prescribe drugs but also sell them to injured workers. Research shows that when
physicians are allowed to do this, they prescribe 3.2 times the quantity of
opioid drugs they would prescribe otherwise.
Why? Illinois physicians can sell “repackaged” pills at exorbitant markups,
averaging between 60 percent and 300 percent.
This bizarre system may help explain why a recent state study found that workers
in Illinois spend as much as twice as long away from work after an injury as
workers in Iowa, Wisconsin and Indiana.
But beyond the dollars, cents and data, the potential human costs are alarming.
Overprescribing opioids for pain can come with life-threatening consequences.
Ron Vlasaty, executive vice president of Illinois-based Family Guidance Centers
Inc., has seen the consequences of opioid addiction firsthand. His organization
sees 2,000 patients each day; 1,500 of them are on methadone to treat opioid
addiction.
“We have patients who used to work, were injured, were prescribed a painkiller,
and eventually became addicted,” Vlasaty said. “They lost their job, lost their
money, and then they came to us. We’re the last stop before jail or death.”
Pete McLenighan is the executive director at Stepping Stones, a drug treatment
facility that has served Joliet-area residents for 45 years. Over the last three
years, McLenighan has seen a measurable increase in people seeking treatment for
prescription opioid addiction.
“Incentives matter,” McLenighan said. “What they created was an incentive for
the doctor to profit from that rather than simply writing a scrip because they
think it’s necessary. That’s a real cause for concern.”
In 2011, lawmakers tried to take away those incentives. But doctors created a
workaround.
When lawmakers enacted rules to make reimbursement rates for physician-dispensed
drugs the same as for pharmacies, physicians altered the dosage of existing
drugs and presented them as new, more expensive drugs. That’s repackaging in a
nutshell.
Take hydrocodone-acetaminophen, commonly known as Vicodin. It’s one of the most
popular painkillers prescribed to injured workers.
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 A January 2015 study from the Workers Compensation Research
Institute revealed that after the new rules took effect, doctors
began prescribing a previously rare dosage of the drug at $3.04 a
pill – double to quadruple the price for the same drug in other
existing strengths.
The study was unable to find any medical justification for the new
dosage, and concluded financial motives were likely at play.
Doctors profit from this system. Injured workers suffer.
Illinois workers who receive repackaged opioid medication spend an
average of 85 percent longer off work, according to a study from
Johns Hopkins University. Not only is that a poor outcome for
workers, but it also comes at a total cost to employers (including
medical costs and payment of lost wages) of more than $22,000 per
injury-related event.
It’s no wonder Illinois workers’ compensation costs are the highest
in the Midwest. Just ask Curtis Hawkins.
Hawkins is a longtime truck driver who recently started his own
trucking authority in East Peoria. He was shocked by his first year
of workers’ compensation premiums. With a total payroll of $98,000,
he paid more than $20,000 in workers’ compensation insurance. And
that was with no injuries.
“Stuff like this, it just kills you,” Hawkins said. “It makes the
day-to-day struggle a lot harder.”
Clearly, the system is broken.
Two states offer possible solutions for Illinois. Texas bans
physician dispensing, except in rural areas where pharmacists are
not easily available.
Indiana bans physicians from dispensing drugs more than eight days
after an accident. This way, painkillers can be provided in an
emergency, but patients must refill their prescriptions at
pharmacies rather than in their doctors’ offices.
For the sake of workers and employers alike, Illinois lawmakers must
act to fix its system. Opioid addiction is not a partisan issue.
Austin Berg is a writer for the Illinois Policy Institute. He wrote
this column for the Illinois News Network, a project of the
Institute. Austin can be reached at aberg@illinoispolicy.org.
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