It has become a rare occasion for a drug rep to walk into my office. I admit to looking forward to the days where I received a cheap plastic .50 cent pen. Maybe, it is my pen fetish who knows. Since, the "gifting" of these trinkets has stopped I have also noticed a general decline in the number of non patient visitors to my office.
Some offices might prefer this. If the rep was "cool" or cute - I did not mind the small interruption as it changed up the "routine" of the day.
I can not recall the last time a drug rep came into my office - no, it's not the alzheimer's or senile dementia kicking in, I think the pharm industry has curbed their detailing of doctors. That, or no one likes me.
In any event, the one people who seem to gravitate to my office are drug compounding reps. These drug compounding companies are coming out of the woodwork in droves.
Wonder why? Well, I just found out after a patient brought in an EOB.
They get paid somewhere between 750 - 2500 dollars on average for the scripts they are pushing to Podiatry.
Can someone please tell me the last time they collected that amount on any surgical procedure they performed? Now, if you did - consider the amount of time you expended on that surgery. Please, don't forget about your 90 day global period....
How long do you think it took the pharmacist to whip up a batch of "anti-inflammatory potion number 3"? You do realize when they make a batch , they do just that.....then place them in little tubes and sell them for 750-2500 bucks.
I am having visions of mafia drug lords.....there was some movie with Denzel Washington where they were pushing "magic blue". Is it any different?
The repercussions on the health care industry for this "abusive practice" could be astounding. (even if the raw materials cost 700-2300 dollars.)
Who is paying for all this?
I admit - I have written for these products. However, completely unaware of the cost of the product. Are they worth it? Do they work? These may be some important questions. I have had some positive feedback, some negative, and some indifferent...... of course, this may be completely arbitrary as if I wrote for a compound, I could of tried topical voltaren first....
What amazes me is there does not seem to be any "restrictions" on this type of service. They seemingly are flying below the radar. I have not encountered any necessary pre-authorization requirements.
One could have a case of a patient who desperately needs an MRI and you have to go thru hurdles to get one approved but a compound topical antiinflammatory can be prescribed for 2500 bucks without the blink of an eye.
Here is another thing to ponder: Mrs. Smith, a sweet old lady, on Medicare with many health problems presents to your office with chief complaint of ankle pain. She informs you she has tried everything but nothing seems to help. You decide to try "product x" you heard about at the Podiatry dinner you were at the prior week. The product is a compound topical antiinflammatory. You feel good - you feel you are able to help the patient, don;t have to worry about GI side effects etc...and maybe, just maybe, Mrs. Smith ankles will feel better.
Mrs. Smith returns to the office a month later. She informs you - her ankles actually feel a little better...(was it the medication? placebo effect? ) BUT, and here is the very big but - she is upset you just ate into her donut.
That's right - you can't forget about the donut.
So what happened? What happened is that Mrs. Smith has a certain amount of money that insurance will pay for her medications, after that maxes out, then she becomes liable. (her donut is eaten and now she is in the donut hole.) So, effectively, when I thought I was doing her "a solid" - essentially, I carved 800 bucks off her, now she is pissed I ate her donut. In this particular case, the patient actually had told me the medication made her condition feel better...but she did not care. Why? her heart medication, her diabetes medication etc took preference. The ankle pain was chronic and she had learned to live with it.
Compounding pharmacies - big scam or good medicine? you decide.

(The above story is a TRUE story, the name of the patient, the condition of the patient has been altered, to respect the privacy of the patient. Though, Mr. Goldberg told me he didn't care if I repeated the story on the Internet, I made him sign a waiver though just in case, cause I know his son is a lawyer.)
  • Comments (2)
  • Nope, did not get that one.  Many would jump at it I'm sure; to make money in any way possible- that's the mantra of many a doctor (too many, to be sure).  For not doing so apparently, and for writing about it the way that you have, for bringing this to light, and warning the less wary- I commend you and your strong sense of ethics, Dr. K. 

    As for kickbacks, I heard an ad on the radio the other day:  "bring your car into us for body shop repair after an auto accident, and I (this shop) will give you back 10% of the insurance claim amount."  Apparently, such "transactions" (e.g., kick-backs or kick-over incentives) are in fact allowed (i.e., legal) in the fender-bender - car insurance - auto body business; but anything that even gives the perception, hint, or smell of kick-back or incentive in the world of medicine is hugely scandalous, immensely illegal, and of course the danger is that it could lead to anti-trust [monopolizing the market] violations.

    In defense of compounding pharmacies, they do provide a unique service that is frought with regulation expense, and paperwork.  Compounding is or can be exacting precision work, provides a service, and often comes with free delivery (to your clinic).  Items such as Cantharone/-idin, 10% NaOH, etc. can be obtained from such local or shipping compounder-apothacaries out there. 
       Furthermore, on the flip side of charging a significant fee for some of these compounded prescription items, all too many prescriptions now only reimburse at a profit margin of less than $2 plus the copay ($5 to ?? for generic, which most insurances now require the pharmacy to dispense).  That's what I'm being told by my fellow doc-apothacary pharmacy owners now. 
      Hence, many pharmacies especially the privately owned are just surviving, but those who wish to thrive have been forced to seek other profit enters.  (Sounds docs & clinics, too.  I mean consistently lowered reimbursements is either going to bring out the best or the worst in providers.)  Pushing that even further, the "creative" ones are trying to get you and I to 'help' them in building a bigger profit center out of compounding, especially those that reimburse well from private insurance companies... And they are willing to "share" in the profits it seems as incentive for helping them.  I am not saying that it is right to do so; but there you have it. 
         Now, a 'fax' scheme to get you and I to help them generate this said profit center in specific compound Rx's may just be a lure to put the handcuffs on you or I, who knows; then again, I could just be paranoid.   That could be the conspiracy theorist inside of me talking; but hey, isn't everything a conspiracy.

    Off topic, sometimes it seems that the marketing strategies some use and the ways some Podiatry and other specialty clinics used to "play the system" (e.g., giving gift cards to PCP staffs, etc.) in order to curry referrals used to be for fun & profit, but is largely sickening to me.


  • Today, I received a fax titled " Compound cream study".

    The fax informs me a study is being done to establish necessary safety level of compound creams so they can be cleared to be electronically pre-authorized.

    If you participate in this study you will be paid. if you provide patient education for 100 non medicare patients you will be paid 75,000 dollars.

    translation: write for 100 scripts, get a kick back.

    likely result: jail time with revocation of license.

    They send you a contract informin you - you are a medical director of your office and an independ contractor not affiliated with the pharmacy. You are being paid for your "research".

    Someone kindly explain how this is not a KICKBACK....I mean they are billing the insurance company and giving you back money.....

    I called the number and asked how this was not a kickback and how this did not sound legal....the person on the otherline could only respond saying things like "we do this all the time".....

    anyone else get this fax?