Pharmacies in physician offices

Retaliation to pharmacy-based retail clinics? Having a physician-based pharmacy would improve revenue and patient satisfaction. Makes sense to me:

Three out of four Americans would have their prescription filled in their doctor’s office instead of a pharmacy if given the choice, a new study finds, suggesting physicians are missing an opportunity to improve patient satisfaction and enhance revenue by not dispensing medicine in their office.

Comments

RJS
Good luck dispensing controlled substances without a pharmacist. (And pharmacists are very expensive, I can assure you.)
There’s a physician-owned dispensary in Salem, NH. It’s quite small, and I suspect we do more business than he does from his own patients, despite what this study would suggest.
He just can’t compete with the convenience of a big retail pharmacy chain. And he also can’t dispense controlled substances.
And there’s no one doing Quality Assurance. Just an office person counting pills and putting them in a bottle. I find that disconcerting, even if “it is all computerized.”
That said, I have no problem with the concept of doctor-owned dispensaries, but I know that his dispensary doesn’t generate enough yearly revenue to cover a pharmacist’s salary. Nevermind after-COGS leftovers.
Anonymous
“Three out of four Americans would have their prescription filled in their doctor’s office instead of a pharmacy if given the choice”
This presumes that the prescription’s were paid for by insurance or cost the same as at a pharmacy. Prescriptions filled at Costco, for instance, are dramatically cheaper than at almost all pharmacies.
There is a definite convenience factor, however in practice pharmacies would put an even higher pressure on doctor’s to prescribe high profit margin drugs. You’d also have to have a pretty high volume practice to justify a pharmacist in-house.
RJS
“This presumes that the prescription’s were paid for by insurance or cost the same as at a pharmacy.”
They are. At least in the dispensary’s case that I referred to.
“Prescriptions filled at Costco, for instance, are dramatically cheaper than at almost all pharmacies.”
They’re used as loss leaders to get people in the door. A retailer like CVS gets as much as 70% of its revenue from the pharmacy. A place like Wal-Mart, on the other hand… well let’s just say it’s probably in the low single-digits as a percentage of its revenue, so they can certainly afford to use Rxs as a loss-leader tactic.
I’ve found that Wal-Mart’s prices for name-brand drugs are as much as $100/month more for the same drug as a place like CVS. ($380 for #180 Pentasa 500mg vs ~$172) So they use it as a loss leader for their brand drugs.
It always amuses me to see a script for something like Avandia go to Wal-Mart because the person thinks they’re going to get it for $4. It either comes back to us the same day, or the next month. The general public is sooo ignorant.
“You’d also have to have a pretty high volume practice to justify a pharmacist in-house.”
Agreed. Very high volume.
Incidentally, high profit-margin drugs tend to be generics. Generics are where the money’s at for pharmacies.
Anonymous
““Prescriptions filled at Costco, for instance, are dramatically cheaper than at almost all pharmacies.”
They’re used as loss leaders to get people in the door.”
I believe that is false in the case of Costco. Costco sells with a consistent but low mark up and doesn’t do “loss leader” pricing. They also don’t play the generic “up sell” game. (Some retail pharmacies have a corporate policy of having the pharmacist fill the prescription as generic, even to the point of calling the physician. The point not being to save the customer money but to sell a product with a higher markup.)
KoKo
Most States of the US will permit physicians to own pharmacies but not work as a pharmacist in dispensing medications.
Pharamcists are expensive, as mentioned by others on this board. Pharmacists graduating from a 6 year PharmD program are now starting, in retail, at salaries of $100,000+/year
in the Northeast.
RJS
“(Some retail pharmacies have a corporate policy of having the pharmacist fill the prescription as generic, even to the point of calling the physician. The point not being to save the customer money but to sell a product with a higher markup.)”
Um yeah. Why wouldn’t they? In fact, it’s a LAW in some states that if a generic equivalent exists, it must be dispensed unless the doctor WRITES for the brand (“no sub”).
I’d prefer the generic equivalent 10 times out of 10. Unless the brand name is less expensive. (Which does happen sometimes.)
Why?
Because generics are just as good. And any doctor who says otherwise is just ignorant.*
But I do think patients should be able to choose one way or the other for themselves. If they think they feel better taking brand name Celexa, then that’s fine with me. It’s all about what makes them feel better, whether it’s real or perceived.
* Drugs with narrow therapeutic windows like Synthroid and Digoxin, do not apply.
Anonymous
“Because generics are just as good. And any doctor who says otherwise is just ignorant.*”
Theoretically this should always be the case. However, it isn’t always true and the patient doesn’t have the information to know when it is and isn’t the case. Hopefully, the doctor who prescribed the meds does, or should, and made the prescription accordingly.
Anonymous
In all but a few states, dispensing is a part of the practice of medicine that does not require a pharmacist. It has always been a central responsibility of physicians that we have gradually shedded over the years for conveinience and in response to cries of “conflict of interest” from the relatively new ancillary profession of pharmacy, which is now engaging in a much much greater conflict of interest in opening in-pharmacy clinics staffed by other ancillaries. Dispensing is as much a part of medicine as taking a blood pressure, and the efforts by pharmacists to keep physicians from doing so is illegal restraint of trade.
Anonymous
Except for a few meds known to have a narrow therapeutic index and occasional bioavailability problems, I have never known a none Medicaid patient to have a prohibitive problem with generics. Medicaid patients, who have no financial incentive to use generics often need Valium or Xanax, while the corresponding generic products “just don’t work in my system doc”. I refuse to go along with that crap, which is quite transparently either for diversion or simple entitlement to “the best” at taxpayor expense.
Anonymous
In some states (NJ in particular) it is illegal for a physician to dispense, unless it is free samples.
Anonymous
NJ is an ass which allows upstart pharmacists to control the profession that brought them into being–in violation of the FTC’s rulings regarding restraint of trade. I believe that if someone wanted to take the time and money to take the matter to the feds, it would be overturned at that level-as it would in Texas, Utah, and the other 2 or 3 states that effetively prevent it. There is no practical reason for it–restraint of trade pure and simple and the FTC has said so.
Anonymous
Good luck dispensing controlled substances without a pharmacist? I don’t think you understand the rules that govern physician dispensing. In almost all states, physicians are permitted to dispense controlled substances (including class II controlled substances) to their patients, provided they maintain records of the transaction and follow state rules. You do not need to be a pharmacist to dispense a controlled substance to your patients.
The Washington Post published a feature story about physician dispensing in today’s newspaper. See http://www.washingtonpost.com/wp-dyn/content/article/2007/10/26/AR2007102602484.html?sub=AR
It’s unfortunate that so many pharmaceutical companies and retail pharmacies oppose all forms of in office medication dispensing. Clearly, this is something patients want from their physicians, and it can be done in a safe and ethical fashion. Perhaps sentiment will change when pharmacists realize doctors aren’t looking to steal their entire business. The same goes for physicians who are paranoid that pharmacy clinics will kill the old fashioned primary care physician relationship.
I happen to think pharmacy clinics are a nice option when you have a cold (and want to make sure it’s just a cold), or when you need a vaccine. I would never replace my family doctor with a retail clinic, though. The same goes for patients who receive a prescription from their physician. They won’t stop going to the pharmacy!

Pharmacies in physician offices

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