Should physicians dispense drugs?

I have been seeing reports from the Workers Compensation Research Institute (WCRI) about physicians dispensing drugs. That this practice still exists surprises and dismays me.

I lived much of my life in New York State, where I had never encountered the practice. I became aware of it only when I was working for a publication that catered to primary care doctors, and of course I thought that it was a great idea because of the convenience.

I cannot deny the convenience, but just about everything else about it is so wrong. I haven’t been able to find statistics on the degree to which health plans pay for physician-prescribed drugs, but if any commercial, Medicaid or Medicare plans do, they should certainly reconsider.

One major aspect of managed care is controlling costs, and when a doctor dispenses, the costs are always higher than at the pharmacy. And then there is the problem of doctors complying with the dizzying number of laws and regulations relating to pharmacy. Can practices be up to date when dispensing is presumably a small part of their operation? What about waste that is due to product expirations at a small practice? At a time when pharmacy coverage is shifting greater percentages of costs onto patients, plans need to do whatever they can to keep these costs in check.

WCRI has a new report on what happened after Florida clamped down on physician dispensing of opiates in 2011: Physicians stopped dispensing, as required. You would expect them to write the same number of prescriptions (to be filled at the pharmacy) as before the ban, but in fact, the 14% fewer workers received strong opioids. There was greater prescribing of NSAIDS.

I don’t have to spell out the implications.

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