Pharmacist-Prescriber spouse ethics?

[Jabberwocky12]

Okay so here is an ethical question I have for people (and possibly a legal response can help here as well?)

What are the implications of a husband pharmacist and a wife PA who own their own pharmacy and practice in the same building along with other prescribers? Is that considered a conflict of interest in any way since the pharmacy and practice are separate? I know a prescriber cannot *refuse* to write a med in a different pharmacy but what are the ethical concerns about this setup?

I figured there would be an issue with the prescriber possibly writing for more meds than normal (over medication) or writing for high margin drugs that are completely unnecessary at all. Then the prescriber would strongly recommend the other pharmacy but that would be more for a convenience thing more than anything else.

Going up a step, what about a collaborative agreement between the pharmacist and prescriber spouse and other physicians/optometrists in the building?

Any thoughts? It was an interesting conversation I had with my gf today since she joked about becoming a PA in her own practice (NC allows it) and having my own pharmacy in the same building would be great for the household. I started talking with other people and apparently there are some rather sticky ethics behind it. I just wanted other people's opinions and see what they had to say. It's not something I plan on doing but it does bring up an interesting scenario.

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[owlegrad]

No legal advice PLEASE!

Feel free to discuss ethics though. I may offer my two cents later.

 

[dingerx]

Okay so here is an ethical question I have for people (and possibly a legal response can help here as well?)

What are the implications of a husband pharmacist and a wife PA who own their own pharmacy and practice in the same building along with other prescribers? Is that considered a conflict of interest in any way since the pharmacy and practice are separate? I know a prescriber cannot *refuse* to write a med in a different pharmacy but what are the ethical concerns about this setup?

I figured there would be an issue with the prescriber possibly writing for more meds than normal (over medication) or writing for high margin drugs that are completely unnecessary at all. Then the prescriber would strongly recommend the other pharmacy but that would be more for a convenience thing more than anything else.

Going up a step, what about a collaborative agreement between the pharmacist and prescriber spouse and other physicians/optometrists in the building?

Any thoughts? It was an interesting conversation I had with my gf today since she joked about becoming a PA in her own practice (NC allows it) and having my own pharmacy in the same building would be great for the household. I started talking with other people and apparently there are some rather sticky ethics behind it. I just wanted other people's opinions and see what they had to say. It's not something I plan on doing but it does bring up an interesting scenario.

Legality is based on the state and if there are any laws on the books. Look up that state's laws and you will find the answer.

 

[DYSF777]

What are the implications of a husband pharmacist and a wife PA who own their own pharmacy and practice in the same building along with other prescribers? Is that considered a conflict of interest in any way since the pharmacy and practice are separate? I know a prescriber cannot *refuse* to write a med in a different pharmacy but what are the ethical concerns about this setup?

It's certainly a conflict of interest. This is exactly the same issue that most are having with the law allowing physicians to prescribe and dispense for profit in Texas. What prevents the physician from being influenced by the medication he/she has in stock? Will they be more inclined to prescribe high margin items, unnecessary prescriptions, or even meds that are near expiration?

 

[Jabberwocky12]

No legal advice PLEASE!

Feel free to discuss ethics though. I may offer my two cents later.

Legal advice was not the intent of the post but sorry if it sounded that way 😛.

I just figured maybe there were some obscure legalities that someone would cite that would immediately make people say "that's horrible warglblarghlblargl"

But yeah conflict of interests are the main thing I was thinking of. How much of the concern is reasonable vs professionally unlikely? That is the main question that I'm posing.

 

[owlegrad]

Legal advice was not the intent of the post but sorry if it sounded that way 😛.

I just figured maybe there were some obscure legalities that someone would cite that would immediately make people say "that's horrible warglblarghlblargl"

But yeah conflict of interests are the main thing I was thinking of. How much of the concern is reasonable vs professionally unlikely? That is the main question that I'm posing.

Nah, you're good friend. I just would have hated for the thread to take a turn for the worst with the first post.

Now for the meat and potatoes of your thread.

For fun, I am going to take the "It's Cool" stand point. Anyone who wants to argue with me is welcomed to do so, but please keep it civil.


I honestly think this could be done without an ethics violation - it's not sooo different from any hypothetical PA/RPh marriage or any PA/RPh joint-owned shop.

In the first example, there is always the potential that a spouse might fill a script from their, er, spouse. Nothing wrong with that in-and-of itself.

In the second example, the PA always has the incentive to over prescribe - the more s/he prescribes, the more the store profits. This profit motive exists with or without a marriage being added into the mix. I don't see how being married changes the dynamic of the business situation that much.

 

[dingerx]

Nah, you're good friend. I just would have hated for the thread to take a turn for the worst with the first post.

Now for the meat and potatoes of your thread.

For fun, I am going to take the "It's Cool" stand point. Anyone who wants to argue with me is welcomed to do so, but please keep it civil.


I honestly think this could be done without an ethics violation - it's not sooo different from any hypothetical PA/RPh marriage or any PA/RPh joint-owned shop.

In the first example, there is always the potential that a spouse might fill a script from their, er, spouse. Nothing wrong with that in-and-of itself.

In the second example, the PA always has the incentive to over prescribe - the more s/he prescribes, the more the store profits. This profit motive exists with or without a marriage being added into the mix. I don't see how being married changes the dynamic of the business situation that much.

Surprisingly, again depending on states' laws, it is illegal to have ownership in a pharmacy if you are a prescriber. You will also be under intense scrutiny from the DEA. I'm certain that some states allow this. But in this day, why would you open your own store unless you were trying to specialize?

 

[Ackj]

This could be awesome. Get a building downtown, live in a sweet loft apartment with your clinic and pharmacy downstairs.

 

[PharmD RPh]

The only legal aspect of this I know of is something called Stark's Law.... and this would loosely tie into that... maybe?

In my area, there is a pain management clinic with 1 physician. From what I've been hearing is that if you are treated by him, you must get your narcs (i.e. oxycontin, hydrocodone etc.) filled there in office. He has been doing this for about 2 years now and I'm not sure how this is exactly legal or ethical since he has monetary gain from prescribing people controlled substances?