First, I’d be remiss if I didn’t note that advocates for physician dispensing cite a couple of advantages. It is certainly easier for the patient to pick up their drugs on the way out of the doctor’s office than to make another stop at the pharmacy.
Some also contend that handing the patient their medication on the way out of the doctor’s office increases “compliance” – the chance that the patient will actually take the medication. This may well be true, but I haven’t found any solid research that proves this to be the case.
However, the cost per script is usually much higher than the same prescription dispensed by a retail pharmacy; details on that are provided below.
There is another potentially significant issue with physician-dispensed medications: patient safety. The dispensing physician may not always have access to, or check the retail pharmacy prescription database which includes information about the patient’s other medications. Some drugs can cause problems when they are combined with others, so a lack of information can be a problem.
When physicians dispense repackaged drugs, costs are often much higher than the same script purchased at a retail pharmacy.
A July 26, 2010 Business Insurance article written by Roberto Ceniceros, summarized the cost problem rather succinctly:
“An increase in pharmaceuticals dispensing by doctors in several states is likely driving up workers compensation costs, [emphasis added] experts say. As more doctors link with companies that provide repackaged drugs with irregular identity codes to physician offices, the arrangements add extra costs and bypass established means of capping drug costs, they say…” According to Boca Raton, Fla.-based NCCI Holdings Inc., physician-dispensed pharmaceuticals accounted for 17% of workers comp drug costs in 2008, the latest year for which data is available, up from 8% the prior year…”We think it may be increasing costs,” said John Robertson, an NCCI director and senior actuary… the nonstandard NDCs used on repackaged drugs often facilitate charging prices above those allowed by state fee schedules, several sources agreed…
A report by the Workers Compensation Research Institute (WCRI) found that the average payment per claim for prescription drugs in the Massachusetts workers’ compensation system was $289–30 percent lower than the median of the study states. The main reasons for the lower prescription costs in Massachusetts include lower prices paid to pharmacies due to a lower pharmacy fee schedule, more frequent use of less expensive generic drugs, and a ban on physicians dispensing medications directly to their patients.
WCRI also found the average payment per work comp claim for prescription drugs in Florida was $565–38 percent higher than the median of the 16 states in the study. The main reason for Florida’s higher than average prescription costs was that some physicians wrote prescriptions and dispensed them directly to the patient at their offices. When physicians dispensed, they often were paid much more than pharmacies for the same prescription. [emphasis added.]”
In a Research Update published by the California Workers Compensation Institute in September of 2009, authors Alex Swedlow and John Ireland reported repackaged drugs had grown to account for 54.7% of prescriptions, and 59.2% of dollars spent on drugs by 2006. The problem has shrunk dramatically since the passage of legislation n California addressing the issue, but alas, it has moved on to other states.
According to the Workers’ Compensation Research Institute’s March 2010 Prescription Analysis, “the prices paid to physicians [in Florida] were often much higher for common drugs. The most striking examples are Ranitidine HCL (more than double what pharmacies were paid), Carisoprodol (five times higher), Hydrocodone-Acetaminophen (one and a half times higher).”
But this isn’t just a Florida problem. In fact, most other states allow physician dispensing.
WCRI also reported that 22% of prescriptions in Illinois were physician-dispensed, and that prices per pill were “often 25-50 percent higher than the price paid to pharmacies for the same prescription.”
WCRI’s analysis of Pennsylvania data showed “when physicians dispensed commonly used drugs, the average price paid was often 20-80 percent higher than what pharmacies would be paid for the same prescription.”
What does this mean for you?
Higher costs. Potentially problematic drug interactions.
