In-Office Pharmacy Dispensing

[drusso]

Anyone doing this? I like the idea of saving my patients a RX co-pay and kicking Big Pharma/Big Hospital in the Nuts.

A physician's breakthrough against prior authorization

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[DODOCSS]

Yes

Margin is in WC

 

[VA Hopeful Dr]

Used to.

 

[lobelsteve]

Shady as hell. Worse than false hope stem cell salesman. Worse than the arbitrage of SOS.

 

[VA Hopeful Dr]

Shady as hell. Worse than false hope stem cell salesman. Worse than the arbitrage of SOS.

If you're selling at cost, how is it shady?

 

[Ducttape]

I think it puts a flag on your clinic, because of the history of clinics offering such services and profiting significantly.

Pills Pulled from Florida Pain Clinics After New Law

“Pill Mill” Red Flags and Strategies to Avoid Them - Lexology

under RED FLAGS:

• The doctor prescribes a large volume of opioids, as reflected in data maintained by the state's prescription drug monitoring program ("PDMP").

• The doctor has an extremely high patient volume, which regularly results in long lines of patients waiting outside the practice to see the doctor and an overcrowded parking lot.

• The doctor either fails to conduct patient medical examinations or conducts only cursory ones during initial and follow-up visits.

• Patient visits with the doctor are brief, typically lasting five minutes or less; or patients do not see the doctor at all, and receive prescriptions that non-medical staff members write (by using prescription pads that are "pre-signed" by the doctor).

• Patients are not required to provide medical histories or treatment records (including diagnostics records) at any time during their treatment.

• Most of the doctor's patients are prescribed controlled drugs, and the doctor never suggests alternate treatment methods such as non-narcotics drugs, physical therapy, or surgery.

• Patients travel from long distances -- sometimes in groups -- to see the doctor, bypassing other pain management practices on the way.

• The pain management practice owns an "in-house" pharmacy or rents space to a nearby pharmacy, resulting in the pharmacy filling the majority of the prescriptions the practice issues (which may be evidence of an alleged kickback scheme or that the doctor believes his prescriptions will not be scrutinized by the pharmacy).

• Prescriptions are unsupported by patient records (or are supported by falsified records) and objective diagnostic testing confirming the patient's complaints of pain, including MRI's, xrays, or CT scans.

• The doctor does not monitor patients for "drug diversion" by checking PDMP data or ordering urine drug screens, or ignores signs of diversion (such as drug screens returning negative for the presence of an opioid in the patient's system, patient's routinely "losing" prescriptions, or patients requesting refills before the prescription runs out).

• The doctor ignores clear signs of drug-seeking and addiction, and fails to refer patients to specialists for drug rehabilitation or psychiatric evaluation.

• The practice is a "cash-only" business that does not accept medical insurance.

• The doctor engages in suspect prescribing practices, such as: giving a patient a month-long prescription every two weeks; prescribing different opioids for the same patient during the same visit (e.g., prescribing a patient a 30-day supply of both Oxycodone and Hydrocodone); prescribing certain combinations of drugs, such as the "Holy Trinity" (the combination of an opioid, muscle relaxer, and anti-anxiety drug); prescribing controlled drugs that are not appropriate to treat the patient's complaints; and continually increasing a patient's dosage or prescribing a more powerful opioid without medical justification.

(I did not highlight anything above...)

 

[VA Hopeful Dr]

I think it puts a flag on your clinic, because of the history of clinics offering such services and profiting significantly.

Pills Pulled from Florida Pain Clinics After New Law

“Pill Mill” Red Flags and Strategies to Avoid Them - Lexology

under RED FLAGS:
(I did not highlight anything above...)

So the OP article said this specifically:

I was told that the same 100 mL bottle of ciprofloxacin that would have cost $135 at the pharmacy could be purchased directly by me for under $20. It arrived at my office the next day, and I sold it to my patient’s mom at cost, thus bypassing the insurer and the pharmacy benefit manager (PBM) entirely.

When I did in-office dispensing I marked everything up 10% to cover the cost of pill bottles and labels.

I also did nothing controlled.

If you do those 2 things (no controls, no or very small mark up), I fail to see what's wrong with dispensing. And I say that as a doctor who no longer does dispensing, so I have no dog in this fight anymore.

 

[drusso]

Shady as hell. Worse than false hope stem cell salesman. Worse than the arbitrage of SOS.

If it increases access, at less cost, and same quality I don't think anyone could fault me...What would be the push back? Ditto for imaging center, etc. Hospital pharmacies are being too greedy with pharmacy and imaging.

 

[lobelsteve]

No margin, no mission?

Just another profit center like stem cells?

Why would anyone spend the time and effort to make sure they were not making money off of a service line.

Leads to fraud and poor prescribing. I have reviewed several cases of WC pharmacies in offices where everyone was getting Darvocet/Soma/Diclofenac due to profit on those meds being highest, not necessarily good for patients.

 

[jettavr6]

We've looked at the numbers. It can be done if one has the space and only with your most highly dispensed medications. Profit margin is extremely low, but it can be a tremendous cost savings for patients as well as convenient. Medications (Cymbalta, flexeril, etc.) As we build our new place, we are considering it as a "value add service."

 

[drusso]

We've looked at the numbers. It can be done if one has the space and only with your most highly dispensed medications. Profit margin is extremely low, but it can be a tremendous cost savings for patients as well as convenient. Medications (Cymbalta, flexeril, etc.) As we build our new place, we are considering it as a "value add service."

I feel bad for my patients and *ALL* taxpayers who are getting rooked by unaccountable pharmacy benefit manager middlemen...

Taxpayers may be paying twice for the same Medicaid drug services

"Then his team came across what essentially was a second middleman, given $20 million annually to perform services seemingly already provided by the existing middleman. And in a possible conflict of interest, the second, possibly redundant middleman and the managed-care organization that hired it are owned by the same multibillion-dollar corporation."

 

[VA Hopeful Dr]

No margin, no mission?

Just another profit center like stem cells?

Why would anyone spend the time and effort to make sure they were not making money off of a service line.

Leads to fraud and poor prescribing. I have reviewed several cases of WC pharmacies in offices where everyone was getting Darvocet/Soma/Diclofenac due to profit on those meds being highest, not necessarily good for patients.

I (and pretty much all the other DPC docs who do it) do it as a service to the patients.

 

[jettavr6]

We found out a few months ago that one of our employees was taking neurontin 300mg tid for a peripheral neuropathy. She is on a "managed" medicaid program and her prescription went from $20 a month to $300 a month. Understandably, she was distraught. I made some phone calls to a few pharmacies, and the cash price of the medication is just around $15-$18. That was the sentinel moment that we decided to explore in office dispensing of non narcotic commonly prescribed medications.

 

[drusso]

We found out a few months ago that one of our employees was taking neurontin 300mg tid for a peripheral neuropathy. She is on a "managed" medicaid program and her prescription went from $20 a month to $300 a month. Understandably, she was distraught. I made some phone calls to a few pharmacies, and the cash price of the medication is just around $15-$18. That was the sentinel moment that we decided to explore in office dispensing of non narcotic commonly prescribed medications.

It's not fair that the health system pharmacies and PBM's take advantage of patients and scam the system with 340B subsidies which is basically SOS d(f) for pharmacies. The health systems pocket the margin and squander it on real estate, inflated salaries, and independent MD practice acquisition. How greedy do they have to be? Especially when a patient could get the same RX at a quarter of the cost without a copay dispensed at the point of care?

Heated And Deep-Pocketed Battle Erupts Over 340B Drug Discount Program

"In contrast, those supporting the cut, including drugmakers, argue that the program has grown beyond its original intent because hospitals have pocketed the discounts to pad profits — not to help indigent patients."

 

[Doctodd]

how do i do it? Based on stupid pharmacy calls wasting my and my staff's time, that in itself is incentive enough. So tired of all the middle men who dont have to work like we do with no skin in the game.

Steve....dont think he is asking about controlled substances since they arent legal to carry/dispense anyway....at least in FL. It would be contrary to every link and post russo makes about docs getting busted. Neurontin, Mobic, Pamelor, Flexeril, Robaxin, Trazodone, Omeprazole are all fine candidates and usually cost less than their drug copays!!!!

 

[SSdoc33]

It's not fair that the health system pharmacies and PBM's take advantage of patients and scam the system with 340B subsidies which is basically SOS d(f) for pharmacies. The health systems pocket the margin and squander it on real estate, inflated salaries, and independent MD practice acquisition. How greedy do they have to be? Especially when a patient could get the same RX at a quarter of the cost without a copay dispensed at the point of care?

Heated And Deep-Pocketed Battle Erupts Over 340B Drug Discount Program

"In contrast, those supporting the cut, including drugmakers, argue that the program has grown beyond its original intent because hospitals have pocketed the discounts to pad profits — not to help indigent patients."

the hosptitals arent the enemy with drug costs. the pharmaceutical companies themselves are.

everyone is taking a piece, from the retail pharmacies, private doc offices, hospitals, and the middlemen. but the biggest fish to fry is big pharma. dont be penny-wise and pound-foolish

 

[Ducttape]

“There was never any concern about its size until, basically, pharma decided it had gotten too big and started investing in a public relations and lobbying campaign to reform it,” von Oehsen said, adding, “We just don’t have the money they have, and it’s kind of discouraging.”

 

[hyperalgesia]

I feel like the people who are gonna abuse in-office pharmacy are not gonna ask about the ethics of it. Those guys are full $peed ahead!

 

[guitar45]

Nobody who is dispensing meds has addressed issues with Board of Pharmacy requirements.....isn't that an issue? Do you have to pay for additional licenses, pharmacy-type fees, etc?

 

[VA Hopeful Dr]

Nobody who is dispensing meds has addressed issues with Board of Pharmacy requirements.....isn't that an issue? Do you have to pay for additional licenses, pharmacy-type fees, etc?

State dependent. I didn't.