Is this legal/safe?

[Roxicet]

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I went to an urgent care office recently (I'm in AZ), and saw a sign stating that patients could pick up their prescriptions right there in the office at a discounted rate. Upon asking a few questions, I found out there was not a pharmacist dispensing the medication, but instead the prescriptions were electronically generated, then various office staff filled the prescription, then it was checked by either a doctor or a PA (most often a PA). What happened to the safety check there? There are often typos on these electronically generated RXs that a pharmacist usually catches.

I know doctors can dispense samples out of their offices, but I didn't know they could fill prescriptions. What is your opinion? 😕

 

[pharmacyanalyst]

I went to an urgent care office recently (I'm in AZ), and saw a sign stating that patients could pick up their prescriptions right there in the office at a discounted rate. Upon asking a few questions, I found out there was not a pharmacist dispensing the medication, but instead the prescriptions were electronically generated, then various office staff filled the prescription, then it was checked by either a doctor or a PA (most often a PA). What happened to the safety check there? There are often typos on these electronically generated RXs that a pharmacist usually catches.

I know doctors can dispense samples out of their offices, but I didn't know they could fill prescriptions. What is your opinion? 😕

That's interesting. Our mail order facility is in Phoenix so I will ask about the dispensing laws out there. I definitely would not trust some urgent care doctor to check my meds for me.

 

[SpirivaSunrise]

Here are the statutes 🙂

http://www.azleg.state.az.us/FormatDocument.asp?inDoc=/ars/32/02532.htm&Title=32&DocType=ARS

 

[LizUMD]

I actually always assumed that this was illegal... that physicians were only allowed to dispense manufacturers' samples from their office. But these statutes seem to make no distinction between a physician and pharmacist for this situation. Am I misinterpreting here or is it true that physicians can really "pre-package" drugs for P.A.s to dispense?

(from the linked statute...)
G. Except for samples provided by manufacturers, all drugs dispensed by a physician assistant shall be:

1. Prepackaged in a unit-of-use package by the supervising physician or a pharmacist acting on a written order of the supervising physician.

2. Labeled to show the name of the supervising physician and physician assistant.

H. A physician assistant shall not obtain a drug from any source other than the supervising physician or a pharmacist acting on a written order of the supervising physician. A physician assistant may receive manufacturers' samples if allowed to do so by the supervising physician.

 

[azPharmD2B]

I attended a law CE recently that covered this. As soon as the compliance officer mentioned this every RPh in the place groaned. I won't be able to check my notes until I get home, but I do believe this is legal as of late last year.

 

[sleazye]

Physicians can get a license to dispense medications from their office (at least they can in Michigan and it sounds like other states allow this too). We just talked about it in class and it made me laugh to think about all the physicians on here who claim that pharmacists and other midlevels are taking over medicine because obviously there is some overlap on their part too. The problem is that many patients don't care because their pharmacist isn't providing a vital service to them anyway; they don't know what they're missing. A lot of patients will argue that at least the doctors will talk to them about their medications when they are dispensed in office even though the doc will charge them out the a** for a consult that would be free at a pharmacy.

 

[confettiflyer]

Doesn't seem like an efficient use of a physician's/PA's time...the time commitment it takes to prepare the medicine, manage stock, consult the pt, etc... could be spent seeing other patients, which are probably more lucrative for that physician. Plus, lots of patients are used to getting a script at the end of a visit.

I can see this work for one-time dispensation cases like urgent care, ER, etc... but that's about all I can see this working at.

Plus, you can use AMA's own argument of conflict of interest to argue against this practice.

 

[azPharmD2B]

I can see this work for one-time dispensation cases like urgent care, ER, etc... but that's about all I can see this working at.

Actually I can see it working great for specialists. Asthma specialists could carry all the common inhalers. Ophthalmologists would carry the common glaucoma eye drops. Dermatologists with a stock of creams, lotions, and ointments. A decent sized stock of the most common pre-packaged things you prescribe, no worries about things expiring because product turnover would be pretty quick, and even a small closet would have more than enough room to hold supplies to keep deliveries to once a week. MA prints off a label, MD signs it and slaps it on the box, hands it to the patient, and pockets a nice profit. The big pharma reps would be drooling at the prospect.

Of course then you have the issue of an unscrupulous doctor prescribing something for their patient which has the largest profit margin (plus kickbacks from the friendly pharma rep) of the drugs they have in stock and pushing their patient to purchase before walking out the door. But doctors would never do that . . .

 

[confettiflyer]

Yeah the above makes sense...but I could see insurance companies and their infinitely powerful lobby powers actually do something positive for patients. Since it's in their best interest to keep costs down, they could probably act as a check against rampant prescribing and look into physicians who have a higher than normal prescription writing rate.

Also, since insurance typically only covers 1 month...you're just more likely to see a one time dispensation + pt takes home a script for subsequent fills. Unless....ya know, the physician can convince your pt to come to you once a month.

I just think if it were that much more profitable for a physician and economical, we'd see more instances of it.

I don't know how the laws work in other states though.

 

[Pharmpills]

whats the big deal if doctors dispense meds? i mean they are the ones who write it lol the only problem is them having too much on there plate and taking away pharmacist jobs so they should stick to what they do and stick their nose somewhere else.

 

[Fatpharm]

If this situation was reversed, let say pharmacists started treating patients, the medical lobby would try to destroy it. The pharmacy lobby is not as strong. I don't know how it is at your schools, but we are trained to do patient exams. From what I understand, my school has been teaching this way for the last couple of decades, but the only pharmacists I know that practice "medicine" are in the Indian Health Service or VA. I believe there are several MD/DO jobs that a pharmacist could do just as well (general medicine or psychiatry). I think there are a lot of opportunities that pharmacists are left out of because MD/DO's have no clue what we do and usually they are not trained to use us as a resource. There is a catch 22 with more responsibility comes more legal liability and we as a profession will have to choose to accept or not.
I got really irked when I heard a story about the possibility of the FDA labeling certain perscription drugs as "Behind the Counter", the person they interviewed was an MD and he said it was a bad idea because pharmacists didn't have the training like MDs to dispense these drugs. I just thought to myself where why didn't they inteview a pharmacist?

 

[azPharmD2B]

whats the big deal if doctors dispense meds? i mean they are the ones who write it lol the only problem is them having too much on there plate and taking away pharmacist jobs so they should stick to what they do and stick their nose somewhere else.

Not sure if you work as a pharmacy tech, but I do, and I see about 1500 scripts in a 40 hour week. Of those, probably 10% contain errors and another 10% have drug interactions with something else the patient is taking. I say to myself "What kind of ******* MD prescribes 200mg of Provigil six times a day? Even a lowly tech like me knows that's just wrong!" Well, I know its wrong because I've read all about it on clinical pharmacology, along with a crapload of other drugs. MD's don't have that luxury. They spend their time learning what they need to know about their profession. Even then, they just don't have enough time to learn it all. There is a reason the two sides are broken into separate professions.

 

[genesis09]

In Illinois, the dispensing machines, the "vending machines," can only be used for refills.

 

[azPharmD2B]

Yeah the above makes sense...but I could see insurance companies and their infinitely powerful lobby powers actually do something positive for patients. Since it's in their best interest to keep costs down, they could probably act as a check against rampant prescribing and look into physicians who have a higher than normal prescription writing rate.

See, I don't think the physicians would charge more than a drug store. They could charge the same, or slightly less and still make a huge profit. Remember that the medical practice already covers facilities, payroll, insurance, etc. Selling meds would be almost pure gravy. Now their Rx write rate could change if this were allowed. I'm not sure what the insurance company could do other than to drop the doctor.

Also, since insurance typically only covers 1 month...you're just more likely to see a one time dispensation + pt takes home a script for subsequent fills. Unless....ya know, the physician can convince your pt to come to you once a month.

Its been my experience that a lot of insurance companies will allow for a 90 day supply for maintence medications. So getting back to my example, it would work great for glaucoma eye drops or inhalers. MD writes for a 90 day supply, 3 refills, and then notes on the Rx that the first 90 days were filled in office and first refill is <date> plus 60 days away. Patient comes back every year for a check up, rinse, repeat. After the first year the MD would have some numbers to help with inventory.

edit: AZ also passed laws about the vending machines. No controls, and only refills that don't require a consultation.

 

[confettiflyer]

wow my experience has been 30 day supply as the majority...your patients must have good insurance.

 

[Taurus]

I don't know how it is at your schools, but we are trained to do patient exams. From what I understand, my school has been teaching this way for the last couple of decades, but the only pharmacists I know that practice "medicine" are in the Indian Health Service or VA. I believe there are several MD/DO jobs that a pharmacist could do just as well (general medicine or psychiatry). I think there are a lot of opportunities that pharmacists are left out of because MD/DO's have no clue what we do and usually they are not trained to use us as a resource. There is a catch 22 with more responsibility comes more legal liability and we as a profession will have to choose to accept or not.

That was some funny stuff.

I wouldn't worry about physicians dispensing drugs. It won't become the norm because they're waaaay too busy. If they had time on their hands and there were huge profit margins in dispensing drugs, then maybe they would try to knock down existing barriers. However, if physicians continue to schedule 4 patients an hour, I don't see it happening.

What people should be more worried about is mail-order. I often see patients coming in and telling the doc that their insurance forces them to use mail-order companies and that they need 90 day supplies.

 

[Old Timer]

Before you all get your panties in a bunch, this is legal just about everywhere. There is no way this works except for cheap generics. Do your think your average allergist office wants to carry the amount of inventory required to dispense Nasacort, Nasonex, Rhinocort & Pumicort Ampules? Have any of you been involved when your store is inventoried? Do you have any idea of what it costs? A standard pharmacy doing 2500 scripts per week has an inventory of over $1,000,000.00. Lets say allergy products are 5%. Do you think they want to tie up $50,000.00 and bill people's insurance and wait for the money.

These doctor dispensers are usually Unit of use packages of inexpensive generic antibiotics and other acute meds that cost nothing and they can sell cash for a quick profit with low inventory.

Is there movement towards more MD dispensing? Yes. Once they get a taste of what a pharmacist does through, it won't go far....

 

[firefighter9015]

If this situation was reversed, let say pharmacists started treating patients, the medical lobby would try to destroy it. The pharmacy lobby is not as strong. I don't know how it is at your schools, but we are trained to do patient exams. From what I understand, my school has been teaching this way for the last couple of decades, but the only pharmacists I know that practice "medicine" are in the Indian Health Service or VA. I believe there are several MD/DO jobs that a pharmacist could do just as well (general medicine or psychiatry). I think there are a lot of opportunities that pharmacists are left out of because MD/DO's have no clue what we do and usually they are not trained to use us as a resource. There is a catch 22 with more responsibility comes more legal liability and we as a profession will have to choose to accept or not.
I got really irked when I heard a story about the possibility of the FDA labeling certain perscription drugs as "Behind the Counter", the person they interviewed was an MD and he said it was a bad idea because pharmacists didn't have the training like MDs to dispense these drugs. I just thought to myself where why didn't they inteview a pharmacist?

The pharmacy lobby isn't as strong becuase the profession doesn't band together. We have the great divide in the fact that we have 3 major powerhouse organizations that are working hard on their own agendas. While we have APhA which should be the voice of all pharmacists, it doesn't always work that way. There has been some push in recent years to condense APhA, ASHP and NCPA into one national organization. It is also important that we show legislators how important pharmacist and our skills are. My school has a health fair during our state legislative session each year in order to show our legislators how important we are and what we offer to the public.

 

[LizUMD]

If this situation was reversed, let say pharmacists started treating patients, the medical lobby would try to destroy it. The pharmacy lobby is not as strong. I don't know how it is at your schools, but we are trained to do patient exams. From what I understand, my school has been teaching this way for the last couple of decades, but the only pharmacists I know that practice "medicine" are in the Indian Health Service or VA. I believe there are several MD/DO jobs that a pharmacist could do just as well (general medicine or psychiatry). I think there are a lot of opportunities that pharmacists are left out of because MD/DO's have no clue what we do and usually they are not trained to use us as a resource. There is a catch 22 with more responsibility comes more legal liability and we as a profession will have to choose to accept or not.
I got really irked when I heard a story about the possibility of the FDA labeling certain perscription drugs as "Behind the Counter", the person they interviewed was an MD and he said it was a bad idea because pharmacists didn't have the training like MDs to dispense these drugs. I just thought to myself where why didn't they inteview a pharmacist?

Wow. Are you really saying that? You think after pharmacy school you are adequately educated and trained to be a family practitioner and psychiatrist? No wonder you seem to be getting the impression from physician colleagues that they don't respect you... I wouldn't blame them.