At the 2016 WCRI conference in Boston, physician dispensing was an important topic. This has become controversial, and in many ways, for good reason. The purpose of this article is to give my opinion on both the good and the bad things I see about physician dispensing.
Back in 2011 and 2012, the Workers’ Comp Research Institute (WCRI) published a report on physician dispensing in both Maryland and Pennsylvania. The report found that physicians routinely charged patients prices that were three times higher than retail pharmacy rates. Even if the price of a particular drug was dropping throughout the marketplace, the study found that some physicians were charging patents rates that remained the same. But is it really all bad? Here’s my take:
I know that when I see a patient I sometimes feel the need to dispense medications upon evaluation. The most obvious condition in which this applies is when I am concerned about a possible infection. Initiating antibiotics immediately can make a big difference in preventing infections. Dispensing, as opposed to writing a prescription, prevents a delay in the patient getting the antibiotics. And believe me, stopping an infection at the initial stages is much less painful and more cost effective than trying to fight it after it has flared up.
For acute conditions like fractures, contusions or crush injuries, immediately dispensing pain medications is advantageous to the patient. There are even topical creams that are not available at pharmacies that provide good pain control. Also, there are medications like omeprazole. These are non-steroidal anti-inflammatories and gastrointestinal protective medications that I believe, in certain situations, greatly benefit patients when the medication is dispensed directly to them.
I am aware that some physicians dispense medications that do not meet utilization review guidelines. This is especially true for compound creams. I also know that, as the WCRI report shows, the cost of physician dispensing medication is usually higher than if the patient had gone to a pharmacy. Often it’s much higher. In the case of compound creams, the prices can be astronomical. Just take a look at this article where the average cost of compounding creams paid by TRICARE has shot up from $192 to $2,595. And unfortunately, some physicians have tried to turn physician dispensing into a significant profit center for their practice.
I like having the flexibility to dispense medications when I believe it’s appropriate. However, I can see why stakeholders who get stuck with the generally higher cost of physician dispensing have called for physician dispensing to be banned. My hope is that through the physician dispensing debate common sense will prevail. This is especially true when we are talking about relatively low cost medications that do not pose a significant danger to patients.