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Prescription for Disaster

Harold E. Cohen, RPh
Editor-in-Chief

10/19/2012

US Pharm. 2012;37(10):1.

Physician dispensing of medication directly to the patient was all the rage some 25 years ago. Pharmacists, and the associations that represent their professional interests, rightfully protested, and it appeared over the years that physician dispensing had waned. Aside from the obvious safety issue of not having pharmacists run a patient’s drug history through their computer systems to check for drug interactions, prescribing errors, medication therapy management, and a host of other professional services normally provided by the pharmacist, many dispensing physicians quickly came to realize the financial burden of having to stock hundreds of medications and also adhere to the restrictive rules and regulations of state boards of pharmacy.

While dispensing by physicians continues unabated in some specialty practices, at least one legislative bill has been presented that exempts oncologists and other medical personnel and allows them to dispense drugs used to support cancer treatment (excluding Schedule I, II, and III drugs). Though it can be argued that such a practice may improve patient adherence, it can just as easily be debated that it bypasses crucially important pharmacist safety checks. Laws of this nature have stirred up the issue of physician dispensing once again in this country. And while the safety considerations remain, what is not always addressed is the profit motive, an important issue given a changing health care system that might be conceived by some to negatively impact the financial stability of a typical medical practice.

According to a recent New York Times article, some physicians are charging patients as much as 10 times what a pharmacist would charge for the same medication. While the article does not allude to how widespread this practice is, it certainly highlights the issue of abuse and fraud in a health care system that is already fraught with waste. Some people may say that every group has a few bad apples, yet this begs the question of whether or not physician dispensing presents a conflict of interest not only in regard to which drugs are dispensed but also as to whether patients are receiving the best drug for their condition given the limited amount of inventory on hand.

When I looked for a more definitive answer to help solve the ongoing physician-dispensing debate, I came across a fairly undramatic official position statement from the American Academy of Family Physicians (AAFP). The organization believes that “physicians have the right under their medical license to diagnose, prescribe for, and dispense pharmacologic agents and other therapeutic products whenever and wherever it is appropriate.” The statement goes on to say that “no regulation or law should infringe on that right” but that physicians who dispense prescription medications “should be held to the same high standards as other professionals so privileged.” While I applaud the AAFP for taking a stance, I don’t believe this statement is strong enough because it makes no mention of the safety or profit motive issues involved. How about this for a more succinct statement: “Physicians should diagnose and prescribe, and pharmacists should dispense and counsel patients.”

Doctors should not be allowed to dispense medication with any motive for making a profit. The AAFP does suggest that doctors be subjected to the same rules as pharmacists, but state finances are in a very delicate condition today and board of pharmacy budgets are being slashed, which leaves inspections of physician-dispensing offices at the bottom of the pile. It is about time we had a federal law that prohibits doctors from making a profit on selling prescriptions in their practice. By removing the pharmacist safety net, physician dispensing for a profit is a prescription for disaster.

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