In-office dispensing - convenient or a hassle?

[SuckySurgeon7]

I have only seen FP offices give away samples, and I usually only hear about DPC practices engaging in this as a possible attraction to their company.

Is it really of any benefit to patients to dispense medications out of the office as an FP, or is it just a lot more risk with very little reward? I don't see saving $8 on some Flexeril that you bought directly from the manufacturer probably won't be a big deal to the patient, but if I have to create a totally separate space for the additional medications, buy a new software package to handle pharmaceutical labeling and dispensing logs, and count all the pills myself, I just don't see that as being very efficient. Is that why only DPC's do it?

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[VA Hopeful Dr]

I have only seen FP offices give away samples, and I usually only hear about DPC practices engaging in this as a possible attraction to their company.

Is it really of any benefit to patients to dispense medications out of the office as an FP, or is it just a lot more risk with very little reward? I don't see saving $8 on some Flexeril that you bought directly from the manufacturer probably won't be a big deal to the patient, but if I have to create a totally separate space for the additional medications, buy a new software package to handle pharmaceutical labeling and dispensing logs, and count all the pills myself, I just don't see that as being very efficient. Is that why only DPC's do it?

Pretty much.

 

[mabinante]

Sorry to dig this up but DPC practices are not the only ones dispensing meds. The UC I work at sells meds to its patients as well as another UC I rotated through as a medical student. I have a good family friend that was selling in office dispensing to physicians and was quite successful.

I don't see why it is that big of a deal: Get a small cupboard, order some meds, get some bottles and labels, AtlasMD to track inventory and a pill counter and BAM....Dispense medications to your patients. Huge savings to the patient and insurance and a big convenience to the patient that doesn't have to take their strep or flu to Target or Walmart and spread it around.

 

[Promethean]

I could see doing it for maybe a small handful of routine meds that I prescribed often and to a lot of patients, but I'd be concerned that it might seem as if I were prescribing meds because I had them on hand rather than because they were the agents that I thought would best benefit the patient in front of me. Indeed, even if no one else had that perception, I'd be afraid that I might actually be subtly influenced by having certain drugs on hand, especially if I had to be concerned about using them by their expiration dates, for instance. That isn't as big a motivator with samples, since the physician has no personal investment in the inventory. But if prescribing from a stock of medications that represent invested capital in the practice, where unused product represents a loss... that is a very different matter.

Avoiding perceived or real impropriety with regard to prescribing is worth the minor inconvenience of sending someone up the street to fill their script. Having a second set of eyes look at a prescription to verify its safety and appropriateness for a given patient is worth the minor loss of revenue from selling meds myself.

The only way I could see having an "inhouse" pharmacy would be if it were an entirely other entity. Basically if I could install a medication vending machine serviced by some third party vendor that actually owned and inventoried its contents, with offsite, real-time verification by a remote pharmacist, I could be down with that. I just don't foresee myself writing enough prescriptions to make it worth anyone's time to put something like that in my office.

 

[deleted87716]

In most states, the regulations are such that I can't imagine too many people finding in-office dispensing to be advantageous from an economic standpoint. At best, it's break-even, assuming you place little to no value on your time.

 

[simpler2]

We do some dispensing at my clinic. It is part of a multi clinic FQHC so we can get cheaper meds with 340b grant funding. Though we do have potential to make some extra income with med dispensing, we only do this for oral contraceptives, prenatal vitamins and albuterol. The reason is that it is VERY time consuming to do correctly and maintain compliance with the state board of pharmacy and their inspections. It does help our indigent patients and with the albuterol helps for the now common $50-70/inhaler that even insured patients have to pay now. I can't see it making any sense in a private practice setting unless you can run a small retail clinic at your site.

 

[VA Hopeful Dr]

I could see doing it for maybe a small handful of routine meds that I prescribed often and to a lot of patients, but I'd be concerned that it might seem as if I were prescribing meds because I had them on hand rather than because they were the agents that I thought would best benefit the patient in front of me. Indeed, even if no one else had that perception, I'd be afraid that I might actually be subtly influenced by having certain drugs on hand, especially if I had to be concerned about using them by their expiration dates, for instance. That isn't as big a motivator with samples, since the physician has no personal investment in the inventory. But if prescribing from a stock of medications that represent invested capital in the practice, where unused product represents a loss... that is a very different matter.

Avoiding perceived or real impropriety with regard to prescribing is worth the minor inconvenience of sending someone up the street to fill their script. Having a second set of eyes look at a prescription to verify its safety and appropriateness for a given patient is worth the minor loss of revenue from selling meds myself.

The only way I could see having an "inhouse" pharmacy would be if it were an entirely other entity. Basically if I could install a medication vending machine serviced by some third party vendor that actually owned and inventoried its contents, with offsite, real-time verification by a remote pharmacist, I could be down with that. I just don't foresee myself writing enough prescriptions to make it worth anyone's time to put something like that in my office.

This is hardly a problem limited to medication dispensing. In FFS, you make more for procedures than clinic visits. Does this mean that family doctors are injecting joints that don't need it or removing moles that are obviously benign? You're expected to use your best judgement in all things you do.

That said, I worried about exactly what you're describing when I was stocking my dispensary. I did 2 things so that inventory doesn't worry me anymore. First, I don't stock expensive medications, or if I do its in very small quantities. If a bottle of norvasc cost me $15 (which 1000 10-mg tablets does) and half of it expires before I can use it, I'm not really all that worried about it. I just had to throw away an unopened bottle of coreg. I'm out a whopping $5.34. Second, if patients do want something expensive I make 100% sure they want it. I had a guy who wanted Lidoderm patches. I explained that because it was expensive, I would bill him before I placed the order and he would be stuck with the whole thing. He was OK with that. Same thing with a guy who takes the low-dose Cialis once/day.

 

[cabinbuilder]

I've only seen it in places I've worked where the clinic is open 7 days a week but the one local pharmacy is only open 4 days a week. I could at least do antibiotics to cover the weekend.

 

[Promethean]

This is hardly a problem limited to medication dispensing. In FFS, you make more for procedures than clinic visits. Does this mean that family doctors are injecting joints that don't need it or removing moles that are obviously benign? You're expected to use your best judgement in all things you do.

That said, I worried about exactly what you're describing when I was stocking my dispensary. I did 2 things so that inventory doesn't worry me anymore. First, I don't stock expensive medications, or if I do its in very small quantities. If a bottle of norvasc cost me $15 (which 1000 10-mg tablets does) and half of it expires before I can use it, I'm not really all that worried about it. I just had to throw away an unopened bottle of coreg. I'm out a whopping $5.34. Second, if patients do want something expensive I make 100% sure they want it. I had a guy who wanted Lidoderm patches. I explained that because it was expensive, I would bill him before I placed the order and he would be stuck with the whole thing. He was OK with that. Same thing with a guy who takes the low-dose Cialis once/day.

Wow. I just have no concept of the wholesale prices of drugs, it seems. Thanks for the perspective.

 

[VA Hopeful Dr]

Wow. I just have no concept of the wholesale prices of drugs, it seems. Thanks for the perspective.

Everytime I order more drugs, I get a little more annoyed about pharmacy pricing. Would you believe Crestor is under $10 per month now?