Immediate Fix Required

For some time now we have been getting tidbits of information about the implementation of the new drug prescribing law that our lawmakers designed to alleviate the epidemic of drug addiction and abuse in our fair state. When the law was proposed it was simply stated that physicians would have to submit their prescriptions through the state monitoring system known by the acronym KASPAR which is already in use for pharmacies. I thought that requirement would not be too onerous and supported this legislation. However, as is often the case, the devil is in the details.

Regulations written to implement the legislation have produced some undesirable side effects just as some drugs do. One of the most undesirable effects places the gathering of information on drug use and abuse on the physicians themselves. Now, for the most part physicians were not favorable to the legislation due to its increased costs in time and money spent. But, it seemed reasonable. Now we find that the doctors will be required to obtain a urine sample for analysis from any person who receives a long term, defined as one lasting over 3 months, prescription for any scheduled substance. This is placing too much of the enforcement duties on the physicians and will drive their costs up to an unacceptable level. Additionally, the patient will have to bear the costs of the drug analysis which is reported to be over $500 per test. The analysis will test for proper levels of the drug prescribed and presence of any other scheduled drug. What this does is take a prescription that costs, in many cases, $10 or less and drives the cost to the consumer up to about $180 per month. That is not only unacceptable, it is ridiculous on its face. A more problematic issue is how the insurance companies will treat these tests. There are already reports of insurance companies rejecting responsibility for paying for the tests because they are not medically necessary and that is a hard point to argue against. I strongly suspect that Medicare and Medicaid will reject those costs leaving our most vulnerable in a position of being able to afford co-pays but unable to pay for the qualifying tests. It seems that when we try to pass legislation to prevent illegal activity that it is always the most vulnerable who pay the highest price.

This is what happens when you put a bunch of lawyers together to try to solve a problem. The solution is often to just try to write a law to make something illegal and then write a law to fill in the blanks. It should be recognized that perfection using an imperfect system is not an achievable goal, however, just because we can't achieve perfection should not prevent us from doing what we reasonably can.

Doctors are professionals who do not need their every move scrutinized by an agency that measures results by enforcement actions. They are at cross purposes because any agency has to prove that it is necessary and if no actions are taken then maybe it is a waste of taxpayer money. I still maintain that it is reasonable for doctors to submit prescriptions through KASPAR and expect an expeditious reply that will cause no inconvenience or harm to the patient. If the requirements of compliance are to be borne by the patient then action should be taken to remove those requirements. After all, it is not the patient who is primarily breaking the law, it is prescription abusers and doctors who write prescriptions illegally. The use of KASPAR will reveal who those miscreants are except for the ones who travel out of state to procure those drugs. In those cases not even KASPAR or any other state law will help.

Of course, we understand the desperation of the people of Kentucky to deal with the epidemic of drug abuse that our state endures. We understand that the costs to Kentucky are enormous and must be contained but to do that on the backs of those who are unable to bear the costs is just a reprehensible way to do business. Now, the Governor says the regulations are due to come under review around the first of next year but that is just not soon enough. That will leave the people of Kentucky at the mercy of inequitably applied regulations that cause them pain and suffering and even a day or a week of such treatment is too much. If you have ever known anyone who suffers from chronic pain then you know that to deprive them of the necessary medication is nothing short of torture and to do that just to try to implement a flawed law is unconscionable.

Physicians are trying to deal with this difficult issue while also attempting to deliver timely, quality health care. They are already inundated with compliance paperwork in addition to the requirements of the insurance companies. They do not deserve to have any more requirements placed on them than is necessary. Submitting prescriptions through KASPAR is requirement enough and even that should promise an answer before the patient leaves the office. This will catch all but a very small number of the illegal prescription shoppers and should be sufficient. Some doctors are already saying they will cease writing these prescriptions entirely to avoid the costs of compliance and the zeal of enforcement agencies. One can hardly blame them but I would urge them to consider the desperation of their patients and go the extra mile.

Finally, for the patients themselves. My family has a few people that have prescriptions for scheduled drugs and if those people are forced to pay the expected amount for drug testing that would effectively stop them from receiving medically necessary medication. I have seen this up close and know what deprivation of those drugs does when their disease is not treated. It is not pretty. Diseases such as these can be extremely painful and emotionally desperate and may require substantial medication. Don't put the burden on their backs. Their load is heavy enough.