For more than a decade, insurance companies and physician groups have battled it out over the true meaning of Florida statutes: Are doctors considered phar
macists, allowed to dispense medications to injured workers, often at a higher price?
A Florida appeals court this week may have finally answered that question, giving a multimilli
on-dollar win to employers and carriers that have spent years trying to undo state workers’ compensation regulations that have allowed physician dispensing.
“This is huge. It’s not often you see a complete vindication like this,” said Jerry Fogel, a consultant with Imagine Clinical who has been at the center of the dispensing debate for years.
The 1st District Court of Appeals on Wednesday overturned a Florida Division of Administrative Hearings decision that had upheld a state Division of Workers’ Compe
nsation regulation issued in 2023. That regulation, initially contemplated in 2020, reversed years of regulatory sentiment that the wording of Florida law does, in fa
ct, allow insurers to deny reimbursement when physicians dispense medications to injured workers.
That 2023 rule has now been struck down. It’s unclear if the appellees in the case, including the F
lorida Department of Financial Services, the Florida Medical Association, and Prescription Partners LLC, will try to appeal to the state Supreme Court, or if the rule will now be revamped.
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Those organizations and their lawyers could not be reached for comment Thursday. Rumors quickly circulated that efforts already were underway to change the law before the Florida legislative session is set to end March 13.
The place where injured workers obtain their prescriptions may not seem like a big deal. After all, workers’ compensation rates for most employers have fallen dramatically in Florida and nationwide over the last two decades. But
insurers involved in the case said medical costs could be lower—and outcomes could be improved—if doctors stayed out of the medication-selling business. It’s a potenti
al conflict of interest and physicians are not always trained on a wide range medications like pharmacists are, insurance groups have said.
Ending the dispensing practice will now save workers’ comp insurers as much as $43 million o
ver the next five years, the Florida Insurance Council and the American Property Casualty Insurance Association said in an amicus curiae brief filed with the appeals court.
The groups pointed to studies by the Workers’ Compensation Research Institute that suggest that many drugs are more expensive when doctors dispense and bill for them: The pain reliever Vicodin is, on average, $1.41 per pill if d
ispensed at a doctor’s office versus 52 cents at a pharmacy. Mobic painkiller is as much $5.86 per pill, compared to $3.19, the brief notes.