Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions expressed here are that of the authors and not Medical Economics.
Ever-rising drug costs are a huge problem for many Americans and a major reason for patient nonadherence to treatment recommendations.
In-house medication dispensing often can save patients money and improve medication adherence. Patients also report that they appreciate the convenience of in-house dispensing.
Forty-four states allow physicians to dispense medications directly to patients. While each state has its own rules regarding physician registration and compliance, in general, the requirements are not excessively burdensome.
Where I practice in Florida, dispensing physicians must register with the Florida Board of Medicine and pay a $100 fee. Physicians must also follow basic safety methods to ensure proper storage of medication, accurate labeling, and patient counseling.
A systematic approach
The first question I ask when deciding whether to dispense medication in the office is: Does the patient need the medication now? For example, does the patient have an acute infection like pyelonephritis or otitis media? In this case, I don’t want to delay the patient’s treatment by a trip to the pharmacy, so I offer the medication immediately from my office.
Or perhaps I think that giving the medication directly from the office at the visit will increase the likelihood of the patient starting treatment. A patient with clinical depression may delay picking up medication from a pharmacy due to apathy or concern for stigma. Also, patients with difficulty adhering to a hypertension or diabetes regimen may be more likely to get on-board with treatment if I hand them the medication bottle at the office because it eliminates barriers to pharmacy visits, such as transportation issues, long waits, and concerns over cost.
For these situations, I stock the most commonly-prescribed drugs—like antibiotics, SSRIs, and anti-hypertensives.
If the situation is less urgent, I ask myself three questions:
1. Can I get this patient’s medication for free?
Believe it or not, there are stores that offer certain medications for free. The grocery store chain Publix will give free 90-day supplies of lisinopril, amlodipine, and metformin. Meijer offers free metformin and atorvastatin. PriceChopper gives free metformin and sulfonylureas, as well as free lancets, insulin syringes, and pen needles. No matter what, I just can’t beat free.
2. How much is this medication at a low-cost pharmacy?
My next step is to enter the patient’s medication into GoodRx.com, where I can determine the cost at a discount pharmacy chain like Costco, Sam’s Club, or Walmart. These stores provide particularly good pricing for thyroid medication and contraception/hormone replacement. Sometimes the cash price for generic medication is even less than the patient’s co-pay using insurance.
3. How much is this medication from my wholesaler?
Once I know the lowest drug price at local pharmacies, I compare this price to what I can get from my wholesalers. If my price is much better (and it often is), I let the patient decide if they would like me to fill it for them directly. My discounted rates especially benefit patients without insurance and those with Medicare Part D, especially when patients are in the “donut hole,” but often are less expensive than the co-pay with traditional insurance plans.
The downside of in-house dispensing
Doctors who wish to dispense medication need one important thing: time. Printing a prescription and handing it to the patient is quick and easy. Checking prices, discussing medication alternatives, and preparing medication takes a bit longer. As a direct primary care (DPC) doctor, I have the luxury of extra time to provide this level of care. Doctors in traditional practice may need a designee to help with price checking and processing medication to be dispensed.
To optimize dispensing and ensure patient safety, doctors need an automated system. I utilize AtlasMD, an EHR that also tracks my medication inventory including expiration dates, prints accurate labels, and allows me to email or text patients their drug information with a click of a button.
While the risk of medication errors is always a concern, patient self-reported adverse drug reactions (ADRs) are equivalent between physician dispensaries and pharmacy dispensing. Of note, when patients do experience an ADR, those who receive the medication from a physician are more likely to contact the doctor for advice rather than utilizing the emergency department—resulting in additional cost savings.
In-house dispensing doesn’t work for every medication. There are few great deals to be found from wholesalers on non-generic drugs, insulin, or most inhaler medications. But have no fear. There is a way to help patients with these medications too, which I will explain in my next blog.