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Franklin Sands sides with docs over RX veto

Outgoing House Democratic leader Franklin Sands is asking incoming House Speaker Dean Cannon to not over-ride the veto of a House bill disliked by some docs. Cannon has defended the decision to over-ride the veto and let the bill become law. House leaders and statff say the measure would save the state and workers money. The docs have a different perspective (see below).

The request from Sands puts Cannon in an interesting spot: Does he stand by what House leaders say and let the bill become law? Or does he go along with the Dems in a spirit of bipartisanship? (He doesn't need to. Republicans have a super-majority).

The latter choice has a pecuniary aspect: Automated Healthcare solutions (which alone has given $1.6m to lawmakers and candidates, including a Cannon-related committee) opposes the bill and wants the veto to stand (more here). Automated Health is mainly a Republican contributor, and Sands says he's unfamiliar with the firm or anyone related to it. He said other physicians had urged a veto, but he's not saying who. "I would have to ask their permission," Sands said.

Here's Sands letter:

From:Franklin Sands []
Sent: Friday, November 12, 2010 3:51 PM

Mr. Speaker,

I am writing to request that HB 5603 not be included in the final list of possible veto overrides and allow for an appropriate and thorough review of the issue during the upcoming legislative session. 

I have talked with a number of Members who share my concern that HB 5603 may adversely impact thousands of injured workers, undermine the doctor-patient relationship and add to unemployment in Florida just as the economy struggles to recover.

Currently, injured workers, many of whom live on extremely tight budgets, can get their injury-related prescriptions dispensed by the physician authorized to treat them, without having to pay out-of-pocket.  Unfortunately, HB 5603 would essentially be a mandate that would take away a beneficial option from thousands of injured Floridians and force them to fill injury-related prescriptions at a pharmacy, pay for them out of pocket and then wait the long months to hopefully get some of their money reimbursed. 

HB 5603 discourages physicians from directly dispensing medications making it more difficult for injured workers to obtain the medications they need for a quick recovery.  The physician has access to his or her history and is most familiar with the patient’s present illness, and they know specifically what medications the patient needs or may already be taking.

There are also concerns that HB 5603 may add to unemployment as the economy struggles to recover.  HB 5603 punishes well-intended physicians, who laid out millions of dollars to purchase pharmaceutical products to dispense to injured workers – forcing them to destroy their inventory of medications at an estimated cost of $45 million.  Due to provisions of HB 5603, an estimated 7,500 medical workers who administer physicians’ pharmacy programs will be put out of work.

Because of these and other concerns, I urge you to allow this issue to be given the full debate that can only be achieved during next year’s regular session.


Franklin Sands

District #98

 Here's the Florida Osteopathic Society's May 10, 2010 veto letter:

 Dear Governor Crist:

The Florida Orthopaedic Society is writing to share our concerns with legislation that was passed during the 2010 Legislative Session, HB 5603, related to the dispensing of medications for workers compensation patients.  We urge you to veto this legislation.

Our primary concerns are 1) the lack of any debate on the impact of this legislation and 2) the absence of any implementation timeframe for physicians and industry to comply with the new packaging and pricing regulations.  

House Bill 5603 was amended on the final evening of the 2010 Legislation Session with language that rewrites the reimbursement mechanism for repackaged drugs.  There was no debate on the merits of this new language.  No testimony was received and most impacted parties were not afforded an opportunity to comment. There may be numerous legitimate arguments in support of amending how repackaged drugs are reimbursed in Florida.  We strongly believe those arguments should be made in the appropriate public forums.  We do not feel a decision that may impact the physician-patient relationship should be made in the dying hours of session without debate.

We are concerned that the current legislation will create a significant financial hardship on physician practices that have a large inventory of repackaged drugs already in their practices.  These are medications that have already been purchased by the practice to dispense to their patients.  The legislation does not provide any form of grace period or grandfathering in of those drugs already received by physicians that wait dispensing.  With an effective date of July 1st the legislation may make it illegal for physician practices to dispense these inventoried medications after this date as there may be concerns with the labeling of those prepackaged mediations.  If they are unable to dispense these medications the physicians may be required to destroy this inventory at substantial cost.

Additionally, the effective date of the legislation may have an unknown impact on the supply of repackaged medications from those distributors as they seek to comply with the new requirements. 

Physician dispensing has remerged in states across the nation for a myriad of reasons including patient convenience, patient compliance, and patient safety.  Our organization has many members who are currently providing this service to their patients.  We feel physician dispensing of medications is one of the most safe and efficient processes within the healthcare delivery system.  Physicians typically only dispense to patients in their practice.  These are patients with whom they have an existing relationship.  The physician has access to their history and present illness and they know specifically what medications the patient needs or what they may already be taking.  The patients can walk out of the door with their prescription filled, significantly reducing the opportunity for non-compliance or dispensing errors.  In addition to improved accuracy and convenience, there is data that indicates cost savings through dispensing a higher percentage of generic medications when physicians are actively involved in the dispensing process.

Taking into consideration these benefits we want to make sure that legislation that restricts the rights of patients and physicians to interact in this manner is carefully considered prior to adoption.  We are hearing from some in the dispensing and repackaging industries that this legislation may impact the ability of physicians to continue to dispense medications in their practice.  We do not feel the process in which this legislation was adopted took into account the concerns of any of the impacted parties including industry, physicians, or patients.

We appreciate the opportunity to raise our concerns with HB 5603.  We look forward to working with the Legislature to craft language that will address concerns that may exist with the pricing of repackaged medications.  We strongly believe that patients and physicians should have an opportunity to participate in that discussion. 

We urge your veto on HB 5603.


 Patrick M.J. Hutton, M.D., M.B.A.

President, Florida Orthopaedic Society