Since 2000, Titan Pharmacy in Astoria has been specializing in workers compensation cases, said co-owners and pharmacists George Rontiris and Peter Levis. About 90 percent of their business comes from injured workers, who head to the store on 31st Avenue, for their prescriptions whether or not their cases are contested - under review for validity by their insurance carriers.
However, Titan’s business could be in danger if the recently passed Workers Compensation Reform Act of 2007 goes into effect as planned on July 10. The bill includes a provision saying that insurance carriers would be able to specify which pharmacies and IMEs (Independent Medical Examiners) patients can use.
“Not a lot of pharmacies do what we do,” said Levis, explaining that Titan takes a risk in dispensing the pills because they know that the majority of workers comp cases are settled in favor of the hurt employees.
In addition, many of the drugs that injured workers need, like a non-narcotic pain patch Lidoderm, are costly and insurance carriers dispute whether they are necessary. Lidoderm costs $215 for 30 patches, and oftentimes patients use more than one-per-day.
Originally used to treat shingles, Lidoderm was later discovered to reduce pain, but it has not received an FDA approval for that specific purpose, so insurance companies frequently dispute its use, Rontiris said. In the end, they often have to pay.
If the new bill goes into effect, local pharmacies believe that the largest workers compensation insurance carrier - the State Insurance Fund (SIF) - will, in turn, direct patients to large, out-of-state Pharmaceutical Benefit Managers (PBMs), who may not pay for prescriptions while cases are contested or who choose not to cover prescriptions like Lidoderm or sleeping pills. In addition, the insurance companies will be able to pick where workers get tests like X-rays, MRIs, and CAT scans, performed.
“Unlike in the past, where you can go anywhere for the testing, you have to go to strangers that may or may not know you as a person and may or may not have any interest in you as a patient,” said Dr. Michael Hearns, an occupational environmental physician in Astoria who has specialized in workers compensation since becoming a doctor 13 years ago.
“This bill has a lot of far-reaching consequences. It will affect how the workers compensation system handles prescriptions,” he said.
Although Hearns said he will continue to prescribe medications like Lidoderm, he does not know if his patients’ insurance will pay for the meds.
However, two local politicians are working on bills in the State Assembly and Senate to counteract the provision regarding pharmacies. Senator George Onorato and Assemblymember Michael Gianaris have both proposed legislation to allow patients to choose where their pick up their prescriptions.
“The concern is that insurance carriers, who are concerned most with making a profit, that they will choose the pharmacy that does not pay the worker while they are being tested,” Gianaris said.
Politicians and pharmacists worry that patients like Astoria native Nick Pavlou, who pushed a mother and son out of the way of a falling crane in 2004 and bore the brunt of the impact himself, would then be pay out of pocket for their pills while awaiting a decision.
“I can’t live without my meds,” Pavlou said on Friday, May 25, explaining that he goes to the Titan several times per week to fill his prescriptions. “You can ask them, I never took as much as an aspirin until my accident.”
When the crane fell, Pavlou’s body was almost entirely crushed. His legs were crushed, his skull fractured, his spleen needed to be removed, and steel plates were inserted in his back. He spent eight months in the hospital, and today, he remains unable to work and relies on several medications to relieve his pain, lower his blood pressure, and prevent depression from setting in.
“Without that [pain medication], at night I go crazy,” Pavlou said.
“Under the new system, this guy would have been out of luck,” Rontiris said, explaining that carriers often dispute several of the medications that Pavlou takes.
“The clock’s ticking. We figured we’re going to go down fighting,” Rontiris said.
So far, Gianaris said that he has been met with approval for his bill in the Assembly.
“Now the question is when,” Gianaris said. “When will we be able to process the changes?”
