In-Office Dispensing: A Win-Win for Physicians and Patients
My in-laws used to own a pharmacy in an affluent suburb outside New York City. It was the kind of place where every customer received the same personal service with their prescriptions as the movie star clientele. They had a little perfume counter and a few rows of gifts and sundries too, but at some point in the ‘80s the balance tipped, and suddenly the pharmacy’s primary income was coming not from drugs, but from completely non-medical products. Ten years later, they were losing money on pharmaceuticals, unable to compete with national pharmacy chains and big box stores that made one-stop shopping possible and used bulk purchasing to reduce their wholesale drug costs. The family closed the pharmacy permanently in the early 2000s.
Barriers to Health
It’s tempting to think that maybe it was a good thing that customers were able to get their prescriptions filled for less at these chain pharmacies. Had their customer base been in, say, a poorer neighborhood in the Bronx, that might have been true; prescription costs are one of many barriers to good health care in some socioeconomic groups. However, cost was never an issue for my in-laws’ customers — convenience was. And what often goes missing in less personal chain store prescription consultations affects pharmacy customers across all classes: time and attention that contribute to patient understanding and adherence to their meds.
If you believe patient compliance with prescription medications is an overblown concern, think again. Several oft-cited surveys in the last decade have revealed just how widespread the problem is. A 2013 poll reported 64% of patients fail to adhere to their prescription regimens, resulting in an estimated $100-300 billion cost to the public in largely preventable hospitalizations, nursing home admissions, and fatalities. It is worth noting more than 50% of Americans said that were they better informed about the consequences of non-adherence, they would be more likely to take their prescriptions as directed.
A Viable Solution
Improving patient outcomes and offering better care are on the front burner for many medical practices today. It makes sense then that providing in-office dispensing of prescription products is becoming more popular, and it has the added benefit of increasing practice revenue as well. There are essentially three kinds of in-office pharmacies:
- pharmacies selling ready-to-dispense drugs
- pharmacies compounding drugs for immediate use during procedures in the office
- pharmacies compounding drugs for patient use at home
The advantages of in-office dispensing start with patient convenience, as it saves them a trip to another location to get a prescription filled. Nor do they have to wait for a mail-order company to send their medications. A 2007 survey by the Opinion Research Corporation showed that 75% of patients would prefer to obtain their prescriptions at their point of care. Point-of-care dispensing also positively affects compliance. A 2006 survey by the National Community Pharmacy Association indicated that 31% of patients had received prescriptions that they never filled. Having to go elsewhere after the doctor’s office provides an opportunity for patients to skip getting their prescriptions filled.
Benefits to In-office Dispensing
Dispensing at the point of care also means the physician can better monitor refills, integrate accurate prescription information in the EHR, test for tolerability before charging for a full prescription, and make adjustments or titrations as often as needed. Additional benefits include:
- not tying up the physician’s time with back-and-forth calls and faxes to an outside pharmacy
- no issues with having less-common drugs in stock
- more time to educate the patient about all aspects of the prescription
- no challenges from the pharmacy trying to get the prescriber to switch drugs
- less opportunity for error in the prescription
If medications are being compounded in-house, especially topicals, there are even more advantages for both the physician and patient:
- Physicians can control the quality of compounding ingredients and methods.
- Prescriptions can be adjusted for different routes of administration, palatability, and allergies to certain ingredients.
- Longer acting delivery systems can be employed, such as transdermal patches, to improve compliance.
- Drug shortages can be circumvented.
- Drug-drug interactions can be reduced with topical formulations, especially important for seniors and patients with chronic illnesses who take many medications.
Basic Requirements and Considerations
Setting up an in-office pharmacy is much easier than many practitioners might think. About 300 square feet of space with hot and cold running water, as well as security measures in accordance with state laws are the basic necessities. After that, it depends on the individual practice and what its needs are. Some practices may have such a high volume of prescriptions that hiring a part-time or full-time pharmacist makes sense. For others, having a pharmacy technician on hand helps with managing the the physician’s time.
All practices are advised to crunch the numbers to see if in-house dispensing is worth the associated cash outlay. For some, having as few as two dozen prescriptions per day that could be filled on-site make it worthwhile. There are pharmacy companies that will provide turnkey setup for physicians, including dealing with third-party insurers, implementing software and training, and filing the necessary paperwork. While this may be an attractive option for time-crunched doctors, be aware that these companies usually require that you purchase your drugs from them, and you will have to be extremely careful about not violating any state fee-splitting or anti-kickback laws. Good legal counsel is a must.
It’s also important to understand that state regulations for the physician dispensing of pharmaceuticals vary widely. While the FDA has stepped up its oversight of in-office pharmacies and compounding pharmacies, state laws govern things like requiring the physician to personally go over a prescription with a patient (versus having a staff member do it) and maintain the log of prescriptions.
Opening your pharmacy could be somewhat controversial in a small community with a limited number of local pharmacy options. However, while you don’t want to burn your bridges with local drugstores, your pharmacy could also be a real boon in areas that are lacking in options. Also your compounding options will be limited to non-sterile preparations; anything requiring sterile conditions will still have to be done elsewhere under a hood.
The benefits of in-office dispensing usually outweigh the detriments for most practices. If you do the math and decide it’s right for your office, solicit solid legal advice, be aware you will have to document everything, and plan on a short learning curve. Once you get up and running, there’s little doubt you and your patients will find your on-site pharmacy a worthwhile addition to your practice.
Pharmaceutica North America would like to be your resource for in-office compounding. By offering bulk materials, pre-measured kits, and responsive customer service, we make it easier than ever for physicians to add on-site prescriptions to their practices. Please contact us today to learn how we can help take your practice to the next level.