Physician Dispensers

[gwarm01]

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I recently received an invitation to a CE at NSU that centers on the topic of physician dispensers. The program description makes a lot of claims that seem ridiculous, like in two years 60% of prescriptions will be filled by physician dispensers in their own offices rather than pharmacies. It also claims that physician dispensers have grown from 287 to over 9,000 since 2011, with a prediction of over 20,000 being registered within the next two years. They say a group of companies are recruiting physician's offices throughout the state to create these in-office pharmacies with a promise of increasing yearly revenue by over $50,000.

I assume these numbers are solely for the state of Florida, but I have no clue as to how valid they are. Has anyone else heard of this phenomenon? Is this a fear mongering invitation to a paid CE, or is there validity to these claims?

 

[Digsbe]

Yes, and it's legal in my state. Practicing medicine here is basically a license to do everything with few checks, and the medical board rarely goes after them. It wouldn't surprise me if this becomes a phenomenon in the southeast where prescription drug abuse is rampant.

I rotated at an independent that was next to a women's health/diet clinic. What that consisted of was doctors rubber stamping scripts for phentermine and also dispensing them out of the office. At one point I was told they handed out 50,000 phentermine pills in one month. They'd put them in Ziploc bags with inappropriate labeling. Whenever they ran out of the stuff the pharmacy would get those scripts. They were basically hooking people on amphetamines and making a killing selling the drug and seeing many patients a day where nurses checked them in and in 30 sec they got their meds. The pharmacy I was at went to the board of pharmacy saying they're violating laws due to improper labeling, unsafe dispensing practices (no counselling, DUR, etc) and basically being harmful to patients. The board of pharmacy said that they can't touch them and that it's a board of medicine issue and that because their license and practice laws are different they don't have to conform to laws that apply to pharmacist dispensing. I'd see it be a thing when it comes to controlled substances and shady clinics writing shady scripts and handing out the pills too. But if you live in states where having a medical license = do whatever you want legally and a board that barely inspect then you're screwed, plus you'll likely never pass laws aimed at improving patient safety by limiting physician scope of practice as it relates to dispensing, or anything really.

 

[Gosondth]

It's very much legal. Amerisource Bergen is trying to start one for specialty meds at our outpatient clinic. The requirement is that it cannot "appear like a pharmacy". The only competition to this dispensing practice are the specialty mail order pharmacies. (This is in California)

 

[awval999]

Seems like a lot of headaches for the doctors for a very marginal increase in revenue with substantial risk of lawsuits and overhead expenses.

 

[zelman]

.... They'd put them in Ziploc bags with inappropriate labeling. ...

From https://www.cpsc.gov//PageFiles/113945/384.pdf
Q. I know of several physicians who dispense prescription drugs for a fee. Are they subject to the provisions of the PPPA?A. Yes. Physicians who dispense drugs (including drug samples), are, and always have been, subject to the regulations under the PPPA. It is important to note, however, that for the purpose of accommodating elderly and disabled consumers who have difficulty using special packaging, Section 4(b) of the PPPA gives medical practitioners the authority to specify conventional packaging for drugs they prescribe.

 

[pillpharmer14]

Seems like a lot of headaches for the doctors for a very marginal increase in revenue with substantial risk of lawsuits and overhead expenses.

I agree. I mean who are they going to entrust with running these "pharmacies"? A pharmacy run by MA's or even nurses without the background in pharm would lead to huge med errors. Obviously this sounds like a pro-pharmacy slant from a pharmacist, but in retail you see ridiculous errors on the reg.

 

[BenJammin]

Not legal in Texas and for good reason: physician dispensing is not in the interest of public health.

 

[Old Timer]

This works for rural areas or for diet clinics. Is he going to accept their MED D plan? This is really nothing to worry about. It's been going on for years.....

 

[gwarm01]

This works for rural areas or for diet clinics. Is he going to accept their MED D plan? This is really nothing to worry about. It's been going on for years.....

The CE seems very alarmist, claiming that the number of registered dispensers has skyrocketed and in two years will overtake traditional pharmacy dispensing. Controversy sells tickets, I suppose. The only part that worries me is the claim that third party companies are actively soliciting doctors to allow them to set up these shops in their clinics.

 

[Gosondth]

Seems like a lot of headaches for the doctors for a very marginal increase in revenue with substantial risk of lawsuits and overhead expenses.

The revenue depends on what is being dispensed. Specialty seems to have a reasonable margin (about 20%) based on historical reimbursement data. That's probably the same reason why specialty pharmacies have blossomed so quickly. In our situation there will be no direct competition with retail since specialty is still relatively niche.

 

[BidingMyTime]

I agree. I mean who are they going to entrust with running these "pharmacies"? A pharmacy run by MA's or even nurses without the background in pharm would lead to huge med errors. Obviously this sounds like a pro-pharmacy slant from a pharmacist, but in retail you see ridiculous errors on the reg.

I've heard of a couple run by pharmacy technicians. Yes, the problem with errors is huge. The guy who said his state pharmacy board wouldn't intervene, that is crazy. Once a physician crosses over into the area of pharmacy, then use the Pharmacy Board can ask them to cease and desist for practicing pharmacy without a license and/or running a non-licensed pharmacy. Of course, its a grey area, at which point they are practicing pharmacy, and at which point they are a doctor providing drugs for their patients.

I had always heard, that doctors had to run their non-pharmacy "pharmacies" as non-profit, because to run them at a profit, would be a conflict of interest. This may be a state thing though.

In general, doctor-run "pharmacies" (they can't legally call them pharmacies in my state), have a very limited supply of drugs, because of expiration issues they certainly aren't carrying any slow-mover or high-priced item (unless its samples they've got from a rep.) They also don't touch control's, because they don't want to deal with the record keeping required for that. Antibiotics & NSAID's are probably the biggest thing they dispense. Some cheap generic maintenance meds.

As someone mentioned, dr dispensing has been around forever. In my experience, it was far more prevalent in the 80's and 90's with independent doctors. Now with most practices owned by hospitals, the hospitals have their own for-profit retail pharmacy, so there is no business reason for them to run a non-profit dispensary in a doctor's office. So, I don't see dr dispensing being anything more than a marginal role in the future.

 

[ChalupaBatman86]

The revenue depends on what is being dispensed. Specialty seems to have a reasonable margin (about 20%) based on historical reimbursement data. That's probably the same reason why specialty pharmacies have blossomed so quickly. In our situation there will be no direct competition with retail since specialty is still relatively niche.

Margin at specialty is nowhere near 20%. Look at the filings from the Diplomat IPO.

 

[genesis09]

Most physicians don't want the headache of dealing with dispensing.