Physician dispensing in Texas

[BenJammin]

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Have you heard of this? Apparently there is a bill in the state legislature that would allow physicians to dispense non controlled drugs from their office. Just read an email saying that we're 1 of 3 states that prohibit it. What's the groups opinion on this?

 

[owlegrad]

Have you heard of this? Apparently there is a bill in the state legislature that would allow physicians to dispense non controlled drugs from their office. Just read an email saying that we're 1 of 3 states that prohibit it. What's the groups opinion on this?

It’s a nonissue. Practically no physician offices ever do a significant amount of dispensing or at least I have never seen one that does. The impact on pharmacy is negligible.

If you mean does anyone think it is a good idea, might as well ask “do pharmacists serve a purpose” lol. Of course it is a bad idea to not have a pharmacist check prescriptions/perform DUR.

 

[CardinalGirl210]

It’s a nonissue. Practically no physician offices ever do a significant amount of dispensing or at least I have never seen one that does. The impact on pharmacy is negligible.

If you mean does anyone think it is a good idea, might as well ask “do pharmacists serve a purpose” lol. Of course it is a bad idea to not have a pharmacist check prescriptions/perform DUR.

Right now it's negligible but the whole point is they want legislation to pass so they can take a bigger piece of the pie in the future. I say no! Before you know it patients will skip the pharmacy and mail order because they can just get it from the nurses at their doctor's offices.

 

[owlegrad]

Right now it's negligible but the whole point is they want legislation to pass so they can take a bigger piece of the pie in the future. I say no! Before you know it patients will skip the pharmacy and mail order because they can just get it from the nurses at their doctor's offices.

That doesn’t seem to happen in the 47 states where it is already legal so I think it will be fine in TX as well.

 

[CardinalGirl210]

That doesn’t seem to happen in the 47 states where it is already legal so I think it will be fine in TX as well.

Not right now, but there is a push in every sector of healthcare to expand their wings and get more money. You see it with NP and PAs. MDs are no different. Reimbursement is low and expectations are high for everyone. They are just building the roadwork to be able to expand later.

 

[Seriously Serious]

I do not think it's a big deal. No way physicians want the extra baggage of insurance issues, paperwork, and regulation. It makes sense that a physician could start the patient off on their regimen immediately from the office.

 

[VA Hopeful Dr]

That doesn’t seem to happen in the 47 states where it is already legal so I think it will be fine in TX as well.

Yep. Its legal in my state. Its almost entirely DPC doctors doing it with a few urgent cares that keep a handful of antibiotic courses on hand for patient convenience.

I would wager its the former group pushing for this in Texas.

 

[Jamie2013]

Do they have to follow pharmacy laws?

 

[CynicalIntern]

Pretty much the only people you're going to be seeing this from are the DPC legion. Even the most bare-bones family practitioner prescribes too varied of a selection to cut out the pharmacy - and most of the providers that I deal with like their shiny new drugs too much and certainly aren't going to open themselves up to more insurance bureaucracy.

What you might see, though, is specialists getting fed up with CVSGreens keeping the cash price of a cheap drug artificially high based on AWP and saying "screw it, I can sell you a few tablets out of the office" for something like Zofran, which every chain in the world seems to think costs $88 even though it costs closer to 8.8 cents.

Also, albuterol inhalers. That price is going to drop like a rock soon, and when it does (and Walgreens still charges $65 for the inhaler) I wont hear any arguments that it's a bad thing that the ER is selling albuterol inhalers for $15 because they're sick of their patient not getting their rescue inhaler because it costs too much.

 

[alpha12]

Dont many insurances make you go to a pharmacy anyway?

 

[lord999]

You mean it’s illegal in TX? Huh, it’s a nonissue and for physicians not to have discretionary dispense is honestly stupid and anti-patient. If this is a non J code dispense, more power to the physician. However, if it’s not a sample, the provider has to personally dispense it (we are the sole profession that can delegate under supervision). And the record keeping standards are very strict even for legends in Texas, so I kind of wonder if any of them would make the effort. They surely are not going to do this for major profit, it's easier to just outright own a pharmacy subject to Stark.

Now, for J-code administrations, they better keep that separate from their dispensing as I can see double bill and arbitrage fraud situations to CMS. I hope TX is not dumb enough to miss the "administer or dispense, choose one" part of the dispensing clause.

 

[BenJammin]

Found the law online. It looks like the goal is to bypass insurance and have the physician sell the medicine to the patient. Since running a pharmacy would require the state board to intervene, I guess they could only dispense to their own patients. Here's the text

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 157.002(f), Occupations Code, is amended
to read as follows:
(f) Subsections (b) and (c) do not authorize a physician or
a person acting under the supervision of a physician to keep a
pharmacy, advertised or otherwise, for the retail sale of dangerous
drugs, other than as authorized under Section 158.001(b),
without complying with the applicable laws relating to the
dangerous drugs.
SECTION 2. Section 158.001, Occupations Code, is amended by
amending Subsections (a) and (b) and adding Subsection (a-1) to
read as follows:
(a) In this section, "dangerous drug" has the meaning
assigned by Section 483.001, Health and Safety Code.
(a-1) A physician licensed under this subtitle may supply a
patient with any drug, remedy, or clinical supply necessary to meet
the patient's immediate needs.
(b) A physician may dispense dangerous drugs to the
physician's patients and charge the patients for the drugs
without complying with Chapter 558.
SECTION 3. Section 551.004(b), Occupations Code, is amended
to read as follows:
(b) This subtitle does not prevent a practitioner from:
(1) administering a drug to a patient of the
practitioner; or
(2) supplying dangerous drugs to a patient as provided
by Section 158.001(b).
SECTION 4. Section 563.051(d), Occupations Code, is amended
to read as follows:
(d) This section does not authorize a physician or a person
acting under the supervision of a physician to keep a pharmacy,
advertised or otherwise, for the retail sale of dangerous drugs,
other than as authorized under Section 158.001(b),
without complying with the applicable laws relating to the
dangerous drugs.
SECTION 5. Section 158.003, Occupations Code, is repealed.
SECTION 6. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2019.

 

[BidingMyTime]

It's legal in my state, I only know of 1 doctor in my vicinity that does so, and I think it is a very small part of their business (mostly antibiotics or other limited use RX's, they don't really do maintenance meds.) Most doctors don't want to deal with the record keeping. This is probably more common in rural areas, where a doctor has a clinic once or twice a week, and where a pharmacy can be a distance away. In other words, I wouldn't worry about this taking business away from pharmacies.

 

[PA_dud3]

I think it's only really common with dermatologists around here. And even then it's only the starting doses and a script is sent to the pt's pharmacy.