Can physicians compound medication?

[MM4646]

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My father is a pharmacist, and is part owner in a speciality pharmacy. I am currently a 4th year medical student, and was thinking of the possibility of one day maybe running his pharmacy. The only problem is, he compounds oncology medication from time to time, and I wanted to know the legality behind if a physician will be allowed to compound and dispense medication?

If not, are there courses we can take to compound medication? Is there a particular residency one can do, where he learns to compound medication? I was not taught how to compound medication in medical school, so I do not know how.

I know about the ethical issues, with a physician dispensing and prescribing medication at the same time. I would not be working as physician then, I would be working more as a pharmacist. Any help would be appreciated.

I know this maybe a touchy subject because I asked a pharmacist earlier about this, and they said, you work on being a physician, and leave the compounding to us. I do not want to step on anyone's shoes, I would just like to keep my options open.

Thank you for your replies.

Michael

 

[DHG]

I thought you had to have a PharmD or BS in Pharmacy and be liscensed as a pharmacist to compound or to dispense in a retail setting. I know Physicians can give samples and emergency medicine but the rest is in the licensed pharmacists court? This is what I thought but someone correct me if this is wrong. 😕

 

[bananaface]

Compounding is a duty reserved exclusively to pharmacists. It's actually the only exclusive duty we have.

 

[DHG]

Compounding is a duty reserved exclusively to pharmacists. It's actually the only exclusive duty we have.

So hypothetically, a physician could open a pharmacy and work behind the counter in place of a pharmacist? I didn't know that.

 

[bananaface]

So hypothetically, a physician could open a pharmacy and work behind the counter in place of a pharmacist? I didn't know that.

They can certainly dispense and counsel. Whether they are able to dispense for profit or not is determined by each state. In WA they can't profit off dispensing. They also are prohibited from owning a pharmacy in the vicinity of their practice.

States define what is and is not a pharmacy. If there is no pharmacist on staff, I'd think the establishment would fall under some other title.

 

[DHG]

They can certainly dispense out of their office. Whether they are able to do so for profit or not is determined by each state. In WA they can't profit off dispensing. They also are prohibited from owning a pharmacy in the vicinity of their practice.

So what about physicians that are not practicing, but own a pharmacy ....can they work behind the counter then in the place of a pharmacist? I know this is a dumb question, I'm just confused. If so do they have to have a pharmacist liscense or does their MD or DO licsense cover it? This may be the most irrelevant question of the century, I was just wondering...

 

[bananaface]

So what about physicians that are not practicing, but own a pharmacy ....can they work behind the counter then in the place of a pharmacist? I know this is a dumb question, I'm just confused. If so do they have to have a pharmacist liscense or does their MD or DO licsense cover it? This may be the most irrelevant question of the century, I was just wondering...

To work as either a pharmacist or physician one must be licensed. If a physician is unlicensed and not practicing, he or she is no different than a layperson and cannot engage in healthcare professionally. If he or she is licensed as a physician, whatever he or she practices has to fall under "medicine". Whether or not a physician could practice medicine in the pharmacy setting depends on state law. My state limits pharmacy staff to pharmacists, pharmacy technicians, and pharmacy assistants. Some states allow pharmacy activities to go on in some form with no pharmacist present. I am thinking of rural hospitals in AK where the local retail pharmacist goes to the hospital pharmacy once a day to stock their med kits and things like that. Compounding certainly could not go on without a pharmacist present.

 

[DHG]

To work as either a pharmacist or physician one must be licensed. If a physician is unlicensed and not practicing, he or she is no different than a layperson and cannot engage in healthcare professionally. If he or she is licensed as a physician, whatever he or she practices has to fall under "medicine". Whether or not a physician could practice medicine in the pharmacy setting depends on state law. My state limits pharmacy staff to pharmacists, pharmacy technicians, and pharmacy assistants.

Okay let me try one last time because I suppose I'm not being clear...what I'm asking (apparently not very well ) is this:

Is it possible for a licensed physician to work at a pharmacy in the capacity of a pharmacist, and if so do they have to have an additional pharmacists liscense? I know this is not something that would happen often... the only scenario I could think of was if the physician owned the pharmacy. Are you saying that it varies by state? Is there any state that the above scenario is possible?

 

[bananaface]

Okay let me try one last time because I suppose I'm not being clear...what I'm asking (apparently not very well ) is this:

Is it possible for a licensed physician to work at a pharmacy in the capacity of a pharmacist, and if so do they have to have an additional pharmacists liscense? I know this is not something that would happen often... the only scenario I could think of was if the physician owned the pharmacy. Are you saying that it varies by state? Is there any state that the above scenario is possible?

They can't work in the capacity of a pharmacist, because a pharmacist has the ability to compound while a physician does not, by federal law. If they want to be a pharmacist, they have to go to pharmacy school, not medical school.

Theoretically, a pharmacy may be able to employ a physician to do things like counsel, dispense, etc as a physician if state law allows. I don't know of any specifically that do. But, I do know that some states allow hospital pharmacies to operate without a pharmacist actually being on duty.

 

[DHG]

They can't work in the capacity of a pharmacist, because a pharmacist has the ability to compound while a physician does not, by federal law. If they want to be a pharmacist, they have to go to pharmacy school, not medical school.

Theoretically, a pharmacy may be able to employ a physician to do things like counsel, dispense, etc as a physician if state law allows. I don't know of any specifically that do. But, I do know that some states allow hospital pharmacies to operate without a pharmacist actually being on duty.

Hmm. OK. So if the pharmacy didn't compound, could the physician legally act in the capacity of a pharmacist? Maybe in the same states were there's no pharmacist required to be at the hospital pharmacy? You don't have to answer this, banana if you don't want to, I know I'm driving you nuts... just wondering stuff out loud Another reason I was wondering was that if this were possible, physicians could work as "floating" pharmacists if they were motivated to earn some easy extra money, if it were legal for them to work in the pharmacy in place of a pharmacist.

 

[bananaface]

Hmm. OK. So if the pharmacy didn't compound, could the physician legally act in the capacity of a pharmacist? Maybe in the same states were there's no pharmacist required to be at the hospital pharmacy? You don't have to answer this, banana if you don't want to, I know I'm driving you nuts... just wondering stuff out loud Another reason I was wondering was that if this were possible, physicians could work as "floating" pharmacists if they were motivated to earn some easy extra money, if it were legal for them to work in the pharmacy in place of a pharmacist.

You can't say they are acting in the capacity of a pharmacist unless they are a pharmacist. A physician's scope of practice is defined state by state. If their state authorized duties overlapped with some pharmacist duties AND they were allowed to practice in a pharmacy setting, they could theoretically be hired to practice those aspects of medicine inside of a pharmacy.

 

[WSU2007]

Of course it depends on the state, but I believe most states Boards of Pharmacy require a Pharmacy License (RPh) in order to practice as a pharmacist. Physicians do have a dispensing license in the state of MI but restricted to the scope of their medial practice, i.e dispensing meds they prescribe to their patients, unless it is a compound of course. The answer is no , not likely can an MD be a floter RPh on the weekends or whatever for extra cash

 

[bananaface]

Of course it depends on the state, but I believe most states Boards of Pharmacy require a Pharmacy License (RPh) in order to practice as a pharmacist. Physicians do have a dispensing license in the state of MI but restricted to the scope of their medial practice, i.e dispensing meds they prescribe to their patients, unless it is a compound of course. The answer is no , not likely can an MD be a floter RPh on the weekends or whatever for extra cash

Yeah. I think the best they could possibly get would be a position as auxiliary staff.

 

[Shovingit]

What if someone had an MD and a PharmD? Then they would be able to work as a pharmacist and prescribe?

 

[aya01]

What if someone had an MD and a PharmD? Then they would be able to work as a pharmacist and prescribe?

I would assume that as long as he/she remained a practicing, licensed physician/pharmacist, then he or she would be able to do both.

 

[sdn1977]

I agree w/ Banana & WSU....in CA a physician may neither own nor practice as a pharmacist unless he/she is licensed as a pharmacist. A practicing MD may not own a pharmacy even if he/she is a pharmacist. I know many instances of MD/Pharm.D or DDS(DMD)/PharmD or JD/Pharm.D & in those instances, they may practice as a pharmacist & many do when attending school (most often the Pharm.D. was obtained first). However, it is often a moot point after the MD/DDS etc is earned because those degrees often provide more reimbursement even when moonlighting during residency or practicing as a locum tenens. As many posters pointed out, it can vary state by state.

 

[bananaface]

The idea behind not letting practicing physicians own pharmacies is to encourage only responsible prescribing habits. If a physician could make money by having their pharmacy fill unecessary scripts, he or she might be tempted to do so.

 

[MM4646]

Thanks for all the replies (and questions DHG 😉 ), this cleared up a lot of things.

My father is an MD/Pharm.D, but he works in the capacity of a pharmacist. So a physician cannot compound medications at all, but would he at least be able to dispense medications and oversee activity in the pharmacy with an MD degree? I live in NY btw. I know physicians can dispense sample drugs, but what would happen in this situation?

If I can't legally "supervise" the pharmacy, I would hire a pharmacist who can, but at least I would be able to do certain things like dispense medication.

I will be matching for an EM residency and will be working for a hospital. Running the pharmacy would just be a side thing I do if I can even do it. But I am definitely not planning on doing it without a pharmacist, I just wanted to know what I actually can do in NY with an MD degree in a pharmacy?

I agree w/ Banana & WSU....in CA a physician may neither own nor practice as a pharmacist unless he/she is licensed as a pharmacist. QUOTE]

I know a few pharmacies in NY that are not owned by pharmacists, but are actually owned by lay people, but there is a pharmacist on staff. Maybe CA is different, I don't know.

 

[Aznfarmerboi]

I am not sure what the regulations in your state is but in NYS, a physician cannot practice pharmacy (dispensing) without a pharmacy license. They can counsel of course =).
The following link below are the regulations for our state. You can google up yours by typing in board of education + (state name) + pharmacy.


http://www.op.nysed.gov/part63.htm

 

[sdn1977]

Thanks for all the replies (and questions DHG 😉 ), this cleared up a lot of things.

My father is an MD/Pharm.D, but he works in the capacity of a pharmacist. So a physician cannot compound medications at all, but would he at least be able to dispense medications and oversee activity in the pharmacy with an MD degree? I live in NY btw. I know physicians can dispense sample drugs, but what would happen in this situation?

If I can't legally "supervise" the pharmacy, I would hire a pharmacist who can, but at least I would be able to do certain things like dispense medication.

I will be matching for an EM residency and will be working for a hospital. Running the pharmacy would just be a side thing I do if I can even do it. But I am definitely not planning on doing it without a pharmacist, I just wanted to know what I actually can do in NY with an MD degree in a pharmacy?

I agree w/ Banana & WSU....in CA a physician may neither own nor practice as a pharmacist unless he/she is licensed as a pharmacist. QUOTE]

I know a few pharmacies in NY that are not owned by pharmacists, but are actually owned by lay people, but there is a pharmacist on staff. Maybe CA is different, I don't know.

A nonpharmacist can own a pharmacy in CA - ie an individual or corporation, however, an MD cannot own a pharmacy. An MD can be a member of this corporation however, but cannot be the individual. This was specifically prohibited because the temptation to prescribe, then "promote" a specific pharmacy was a common occurrance in "the old days". Although this is not a common occurrance today due to insurance restrictions on patients, it is still a very real conflict of interest, particularly in situations as you describe - compounding pharmacies. Some physicians may prescribe a compounded item, and only one pharmacy within a realistic distance compounds it...well then...there is a conflict of interest. It is much better for all - the prescriber and the compounder to have some distance from each other. In my state, CA....a pharmacy may be owned by a nonpharmacist, as I described, but there must be a "pharmacist in charge" which is a legal designation for everything - EVERYTHING that goes on in the pharmacy. Do you recall one of the compounding pharmacy's errors - a breakdown in aseptic technique? (it was triamcinolone compounded for injection into a joint). Well..it was a tech who actually made the error, however, it was the pharmacist in charge who took responsibility and whose malpractice insurance who took the charge. Be very careful....check your NY laws and be sure to carry plenty of insurance and never, ever force your pharmacist to do something he/she doesn't want or feel comfortable doing!

 

[PharmacyJan24]

It is my understanding that only a pharmacist can engage in the practice of pharmacy.

As an MD, you could own the pharmacy, as well as do manager duties like hire and fire, however you could not take on the dispensing role, be it a compound or a regular rx.

For example, if a patient brought in an rx for lipitor, no one but a pharmacist can verify and dispense that rx.

What gets confusing is that if an MD has an office and wishes to provide pharmacy services to his/her patients they are sometimes allowed to do that- depending on the state and patient preference. What you cannot do is take over your fathers business without having a pharmacist there during all operating hours.

You can definately be the owner, you just cant do the pharmacists job. You could work like a technician (counting, labeling, customer service) but a pharmacist would ultimately have to be on site to dispense medications.

I read all the posts here, and most were probably making this point, I just dont like legal talk. So this is my 2 cents.

Good luck in your future!

 

[ultracet]

It is my understanding that only a pharmacist can engage in the practice of pharmacy.

As an MD, you could own the pharmacy, as well as do manager duties like hire and fire, however you could not take on the dispensing role, be it a compound or a regular rx.

For example, if a patient brought in an rx for lipitor, no one but a pharmacist can verify and dispense that rx.

What gets confusing is that if an MD has an office and wishes to provide pharmacy services to his/her patients they are sometimes allowed to do that- depending on the state and patient preference. What you cannot do is take over your fathers business without having a pharmacist there during all operating hours.

You can definately be the owner, you just cant do the pharmacists job. You could work like a technician (counting, labeling, customer service) but a pharmacist would ultimately have to be on site to dispense medications.

I read all the posts here, and most were probably making this point, I just dont like legal talk. So this is my 2 cents.

Good luck in your future!

perhaps that's how your state works..
but not in the laws i know...

an MD can act in the role of the dispensing pharmacist (i don't know anything about compounding)
if someone comes in with an rx for lipitor...
the physician can verify it

at that point... the pharmacy has to be a licensed pharmacy (where some MD-dispensing MDs run into trouble)

 

[sdn1977]

It is my understanding that only a pharmacist can engage in the practice of pharmacy.

As an MD, you could own the pharmacy, as well as do manager duties like hire and fire, however you could not take on the dispensing role, be it a compound or a regular rx.

For example, if a patient brought in an rx for lipitor, no one but a pharmacist can verify and dispense that rx.

What gets confusing is that if an MD has an office and wishes to provide pharmacy services to his/her patients they are sometimes allowed to do that- depending on the state and patient preference. What you cannot do is take over your fathers business without having a pharmacist there during all operating hours.

You can definately be the owner, you just cant do the pharmacists job. You could work like a technician (counting, labeling, customer service) but a pharmacist would ultimately have to be on site to dispense medications.

I read all the posts here, and most were probably making this point, I just dont like legal talk. So this is my 2 cents.

Good luck in your future!

Respectfully PharmacyJan24, you have some misinformation. In CA an MD CANNOT be an owner of a pharmacy! He/she can be part of a corporation which owns a pharmacy, but a practicing MD is not legally able to own a pharmacy in my state - again, check the state laws in the state you want to practice in - they could very well be different from CA. The MD can be a practicing pharmacist if the MD has received a degree from an accredited school of pharmacy & has passed the state board exam in the state in question. (See the old post on the MD considering going back to become a pharmacist). However, to own a pharmacy, the MD would have to be a non-practicing MD (which means he/she has no financial gain from the dual roles).

When it comes to dispensing out of physicians offices, that does not happen much any longer other than samples because physicians can no longer bill for medications. Most insurances require a NABP license # (National Association of Boards of Pharmacy) for reimbursement - again...comes down to the legal ability of a physician not being able to own a pharmacy. The most recent "compounding" used to be with oncologists. Up until a few years ago, they "mixed" (diluted) the chemo and administered it in their offices - however, few do this now because they are not paid for the drug or for administration. Thats why most outpt chemo is done through outpatient clinics. Drugs are too, too expensive for a physician to keep. Even a small pharmacy has an inventory of several hundred thousand dollars.

I apologize for all the legal talk - but...pharmacy is one of the most regulated professions. Legal talk is as much part of what we know & do as medical talk.