Why doctors should profit from dispensing medications

Hold onto your hats. I am about to enter dangerous territory. I am about to suggest maybe doctors should profit from dispensing medications from their office to offset declining reimbursements and rising expenses by using prescriptions as a source of ancillary revenues.

Why dangerous?  For a number of reasons.

One, physicians still grapple with the perception that it is improper for a physician to make money from the delivery of care from business ventures. Two, profit-making from prescription writing might induce physicians to write unnecessary prescriptions. Three, prescriptions for profit might lead to conflict with pharmacists. Four, Some states prohibit physician office dispensing, and more dispensing might lead to other states prohibiting the practice. Five, there is also a fear that such a physician business venture carry significant risk relative to government regulation.

Then, there’s the other side of the issue. Writing prescriptions and ordering their refills takes a lot of physicians’ time. It also takes knowledge. It carries some malpractice risk, should the patient suffer an adverse reaction. Dispensing from the office would be convenient for patients. Since 30% of patients never fill their prescriptions, office dispensing is more likely to assure compliance. And prescriptions dispensed at the office are generally significantly less expensive than those filled at the local pharmacy.

Besides, physician can work only a finite number of hours and see a finite number of patients. The rational way to increase revenues is to identify revenue streams that do not involve an inordinate amount of incremental time on the part of the physician. Ancillary services can assist the physician in his ultimate goal of providing quality medical care (often in his own office setting) while producing a profit for his efforts.

Add to this fact the reality that physicians across the country are already performing an increasing number of ancillary revenue-producing services – lab tests, x-rays, imaging services, osteoporosis screening, electrocardiograms, physical therapy units, alternative medicine and herbal drug sales, diabetes management programs, and weight management programs.

Are there other ways physicians can increase their compensation without sacrificing lifestyle or running afoul of government regulation?

Yes there are, and profits from prescribing is one of them. But again, consider the negative factors before setting up an office dispensing system.

• Hesitancy to change existing practice patterns
• Fear of being labeled sat “commercial”
• Lack of office space to store drug inventories
• Reluctance to buy inventories.
• Reservations about upsetting local pharmacists

Still, why shouldn’t a physician with an entrepreneurial orientation is allowed to design a plan for ancillary service delivery, execute it and make a profit?

Why not office dispensing? After all, a typical doctor sees 20 patients a day, writes one and half prescriptions and one a half refills per patient, or three for each patient. That amounts to 60 prescriptions per day. And that doesn’t count all those phone calls asking for refills. If these doctors were to have an average profit of $5 per prescription, that would be an extra $300 a day.

The linkage of e-prescribing with EHR systems, the ability of mobile iPads to send e-prescriptions, and concerns about the hazards of illegible doctor handwriting, and the push for more practice efficiencies, electronic prescribing is very much the rage these days.

So why not have the ability to e-prescribe inside the office using targeted software to write and refill prescriptions and to issue a bill?

Richard Reece is the author of Obama, Doctors, and Health Reform and blogs at medinnovationblog.

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  • http://Www.twitter.com/alicearobertson Alice

    The stigma still persists that your predecessors created. If the aging population is where the money is (the double edged sword….costly to the taxpayers and insurers…..but painfully profitable to others), this population remembers the days you were specifically prescribed certain drugs so the doctor could take a free vacation. The incentives were wonderful…seemed harmless…but it placed the doctor in a type of lobbyist position.

    Why not just place a tip jar on the counter…..ugh!:). Or buy stock based on pharmaceuticals?

  • http://www.LVMedIT.com Leo Bletnitsky

    I have been working with doctors to setup in-Office dispensing system in their offices for over 3 years. Not only is it an ancillary revenue stream of $24k-$200k+ per year, but it is a benefit to their patients from the standpoint of time savings and compliance.

    I’ve been amazed at how resistant some physicians are to this concept.

  • http://www.Qliance.com Norm Wu

    Docs should not do things that could be perceived as creating a financial incentive to push things on patients they don’t really need. At Qliance, we used to sell generics from our dispensary at our cost. Now we just give first fills away, up to 30 days of chronic and acute meds. That helps ensure patient compliance and convenience. And there’s no real or perceived conflict. If you feel you need income from ancillaries to make a living, consider changing to a direct primary care practice model. DPCare.org tells you why.

    • http://warmsocks.wordpress.com/ WarmSocks

      As a patient, I don’t see this a pushing things that patients don’t need. Maybe it depends on how it’s presented, but there are times it would be extremely convenient to avoid going to the pharmacy. A simple sign might work: “For your convenience, this office can dispense prescriptions. Of course, you are still free to use any pharmacy of your choosing.”

  • Dan R.

    It can be beneficial, but… as someone who investigated this at a rural practice:

    Its not going to make sense for physicians to stock every medication they write, in every dosage — depending on the specialty this could significantly reduce the usefulness of the model.

    In many states, even if the physician is allowed to dispense, the physician must actually count/touch the script — thus taking the place of the pharmacist. I think its unwise to have a non-pharmacist/non-physician dispense, and this drives up costs significantly.

    Safety issues — if the physician is known as dispensing, it can cause problems with controlled substances. Many physicians only keep a relatively few number around (say in their desk), but dispensing creates additional problems.

    Malpractice — its not just adverse reactions. All the malpractice issues facing the pharmacist, are now put on the physician.

    • Dan Kaufman Pharm D

      As a pharmacist my biggest objection is that patients go to more than one doctor. Most patients keep lousy records of what they take both in strength and just what drugs they are on. Unles the doctor giving out drugs is the only prescriber the potential for both drug abuse and interactions is amzing. I had a patient seeing 2 doctors- one put her on Brand Cardizem CD and the other had her on diltiazem Sr for a total of 720mg because she didn’t know they were the same med. I don;t own my own pharmacy and I don’t get paid by the prescription I am only concerned with the patient. Also it is amzing how many patients ask me what the prescription they have is for?. I doubt that doctors are going to take the time to explain as much as I do.
      While it smacks of socialism the answer is that patients get charged the same amount no matter what pharmacy they go and patients are either assigned or chose a pharmacy that they HAVE to go for a year. Each year they can pick a different pharmacy if they like . This eliminates doctor shopping for abusive drugs. Or have some computer whiz figure out how to unite all prescription records (maybe without prices). We had 1 patient going to several doctors and several pharmacies getting 1000 Norco’s per month. In California you can ask for a report on scheduled med use but that takes time.

  • http://www.TheHealthCulture.com Jan Henderson

    This fits right in with a post I just did on the decline of the physical exam and the social standing of physicians (http://bit.ly/fxfj2a) (not the recent decline, but the disappearance of the exam for 300 years prior to the 18th century). The public perception of medicine these days is that it’s a business and the physician is just another businessperson. That’s why patients feel free to initiate malpractice suits and why they turn to alternative therapies in increasing numbers. (Not that alternative therapies aren’t a business, but they offer what is now an old-fashioned model of the doctor-patient relationship.)

    Medicine underwent significant change in the second half of the last century. Not only were there dramatic scientific and technological developments, but medicine became a business. Just look at the vocabulary. The “doctor” became a “provider,” the “patient” became a “client” or “consumer,” and a “visit” with the doctor – a term that suggests conversation – became a “medical encounter.”

    Medicine has come too far to go back to the old days when doctors ameliorated the somaticized complaints of patients simply by listening in a way that made patients feel understood and cared for. Expressing concern for the patient – taking time to know the whole person – is no longer therapeutically essential and time is of the essence. (Or, as Aldous Huxley said, time is money.)

    We may have lost the soul of medicine, but perhaps this is a change we shouldn’t resist. As time moves on, there will no longer be doctors or patients who have experienced the type of medicine that was practiced in the days of Marcus Welby. No one will lament its passing because they have never known it.

    I hope someone will tell me I’m wrong. I’m sure there are doctors who prefer not to go the business route. But will they survive?

  • Finn

    As a patient, I certainly wouldn’t object to this, but I wonder if that damned intrusive third party–health insurers–would cover it, and whether they would pay enough to make it worth a doctor’s while. I’d be willing to pay a few extra bucks out of pocket just for the convenience, particularly for quick access to post-procedure pain meds and antibiotics.

  • Webhill

    Talk to a few veterinarians. I find dispensing far more trouble than it is worth & would love to stop, but clients demand it. Most of my colleagues seem to agree, at least the under 50 crowd.

  • Anonymous

    Two, profit-making from prescription writing might induce physicians to write unnecessary prescriptions.

    Those who already do write unnecessary prescriptions will just be earing extra money from their questionable habits.

  • http://www.pharmacy.vcu.edu/sub/faculty/facdetail.aspx?id=82 David Holdford

    Two words. Moral hazard.
    When physicians profit from dispensing medications, there is real risk of moral hazard leading to prescribing that may not be in the best interests of their patients. If physicians dispense from their offices, they need to decouple the link between what is prescribed and how much is prescribed from any financial gains they may get.
    If one were to agree with the argument made in the post above, it would make similar sense for community pharmacists to be allowed to prescribe for their patients because that would be even more convenient (more pharmacies) and inexpensive for patients (no office charge). I would never trust a physician who profits from the drugs he or she dispensed. I do not think it is a very patient-centric practice.

    • http://myheartsisters.org Carolyn Thomas

      Well put, Dr. Holdford. Here in Canada (commie-pinko land of socialized medicine), our own provincial College of Physicians and Surgeons – the profession’s licensing and regulatory body – has this to say about doctors who’d like to profit from personal retail sales:

      “Promoting and selling medical or non‐medical products to patients for a profit is not only unethical, it constitutes a direct conflict of interest. Such transactions might reasonably be perceived as self‐serving. Even if there is no direct financial gain for the physician, the selling of products might be considered ethically questionable since patients often believe that a physician’s recommendation naturally implies an endorsement of the product’s value and/or efficacy.”

  • http://healthtrain.blogspot.com Gary Levin

    We will find that with increasing regulatory pressure, decllning reimbursements, and threats about ACOs and more centralized control true entrepeneurs (which is what doctors used to be ) will adapt and survive. (or go out of business). Otherwise who would go through 12 or more years of education, unable to pay back loans of 150,000 unless their income is sufficient to do so. Bottom line…diversity !! That is what other businesses do, or disappear like a dinosaur. Ethic? Morality? Patients do have choices…they do not have to buy from physicians, if they think we are gouging them .(they already think that).
    We have to pay bills just like everyone else. We should stop self-flagellating ourselves….(attorneys do not).

    • http://Www.twitter.com/alicearobertson Alice

      Teachers do it for a lot less money, and we do not have a teacher shortage. We have a good teacher shortage. PhD’ers do it……etc.

  • http://www.myheartsisters.org Carolyn Thomas

    For valid reasons to dismiss this goofball idea, please re-read the five points listed in your third paragraph.

    This is clearly a cash grab, pure and simple. Please don’t try to embroider the concept as some sort of patronizing worry about the convenience of your non-compliant patients. Consider last February’s Harvard study published in the Journal of General Internal Medicine, for example, in which both affordability and the quality of patient-physician communication were cited as equally important reasons that patients don’t fill those prescriptions.

    I have a swell idea for doctors who simply want to make more money, since that seems to be the thinly-veiled real focus here.

    Why not just sign on as a “sales affiliate” of one of those online celebrity docs who have discovered that selling retail is where it’s at when it comes to making real money, compared to the drudgery of day-to-day managed care?

    You too can make 15% cash commissions, for example, flogging miracle products for Dr. Stephen Sinatra, or even a whopping 60% commission flogging for Dr. Joseph Mercola!

    As Sinatra promises: “You’re making money and being rewarded for your promotional efforts!” Go for it, Dr. Reece!

    And just think – no pesky patients to have to deal with!

    As Jan Henderson writes, above: “The public perception of medicine these days is that it’s a business and the physician is just another businessperson. That’s why patients feel free to initiate malpractice suits and why they turn to alternative therapies in increasing numbers.”

    Posts like this merely reinforce the reality of that statement.

  • skeptikus

    Why don’t we just get rid of all prescription medicine? Let anyone buy any drug any where. (That’s the way it is in most parts of the world, and it’s no big deal). Let freedom ring–and if docs want to be Walgreens . . . . they’re welcome to it.

  • soloFP

    Under the current system, if a patient wants a brand name drug or a chronic med that may be generic but is a higher tier drug, docs and their staff have to prior authorize the drugs for the patients. The office visits do not cover all the extra trime prior authorzing meds or dealing with mail order pharmacies.

  • Outrider

    I second Webhill: talk to a few veterinarians. I carry as little inventory as possible and script out to human pharmacies as often as is practical. Dispensing medications is an enormous PITA for me, not a profit center.

    • Fam Med Doc

      Dear Outrider,

      Thank you much for your comment. Could you elaborate further as I am considering physician based dispensing for my office?

      Specifically, why is it such a PITA? Also, the companies that will set up a doc with physician based dispensing claim a $4-$5 per bottle profit. Is that inaccurate? Any & all info would be much appreciated.

      • Outrider

        >>Could you elaborate further as I am considering physician based dispensing for my office?>>

        I’d like to preface this by saying most veterinarians do a terrible job of managing inventory. We’re busy, distracted, sometimes exhausted and much more interested in treating patients than monitoring expiration dates or product turnover.

        That said, inventory is the least profitable and most criticized (by clients) aspect of my practice. Inventory money is basically tied up awaiting a patient and a diagnosis. After ten years, I’ve all but stopped stocking meds also used in humans because my clients are going to shop the prices to WalMart, CVS, etc. anyhow. I can’t (and don’t have any inclination) to price match $4-10 prescriptions. As for some of the expensive drugs not used in humans, my clients price shop those, too, so I’ve gone to drop shipping so I don’t lose money (if a true veterinary pharmacy existed, I’d use that instead). Inventory also expires, which is wasted money because not all companies will swap short dates on unopened bottles and of course none will swap opened bottles. I dispense no controlled substances at all, but one pet peeve: I still don’t know what to do with my expired ketamine – no one will give me a straight answer, in writing!

        >>Specifically, why is it such a PITA?

        Price shopping. Time spent on client education (pharmacists are extraordinarily helpful and knowledgeable, even when they’re not familiar with the species). Phone calls at 4:45PM on Friday before long weekend: “I only have enough for tonight.” “I mixed the pills with food but he didn’t eat it so I need more.” “You gave me pills but my friend got capsules for the same drug so can I exchange this prescription?” Back orders and recalls.

        >>Also, the companies that will set up a doc with physician based dispensing claim a $4-$5 per bottle profit. Is that inaccurate?>>

        $4-5/bottle doesn’t sound worthwhile for the headache, IMO, even though your volume is going to be greater than mine.

        Honestly, on the human side, I would be most reluctant to give up the professional knowledge of pharmacists (no, my SO is not a pharmacist!). The average aging human is much more pharmaceutically complicated than one of my patients. You’re going to have to provide client education if you assume the role of dispensing pharmacist, and your time is your most valuable and currently most overbooked commodity. This being human medicine, I also see potential liability here.

        I know you guys in family medicine are having a tough time right now, but I’d be looking at other solutions, like micropractice (which is similar to my practice model, actually). Staff is even more expensive than inventory, but that’s a whole other discussion.

      • http://www.BocaConciergeDoc.com Steven Reznick MD

        Have gone the route of trying prescribing years ago. As soon as we brought in a common sense formulary of generic drugs that our patients use, the local pharmacy chains deeply discounted their products. We were left with inventory in large quantities. The administrative cost of compliance and courses required to office dispense made the experience non profitable and unpleasant. We tried this back in the 1980′s when the original Stark laws eliminated our fifty doctor shared laboratory as a conflict of interest. For the family practitioners and general internists, this loss of ” passive ” income hampered our ability to meet the high overhead costs of a general medical practice and make a living that supported a family.
        There is no question that when a physician or representative of a physician offers a service such as dispensing medicines, doing blood lab tests, doing imaging studies, providing durable medical products , providing physical therapy etc there is always room for unscrupulous individuals to over utilize for personal gain. At the same time most do not do this. The result of the lack of ” passive income” generation in these practices is that they generate far less income than other specialties because they have no highly reimbursed procedures to perform. The result of that is that todays future physicians and extenders ( nurse practitioners, physician assistants) shy away from entering these areas of medicine because they can not afford to practice ethically providing evaluation and management ( cognitive) services only and earn enough to pay off their school loans, practice start up loans and raise a family. Looking around the nation generalists are now turning to weight loss gimmicks, sales of unproven vitamins , minerals and supplements and providing in house imaging procedures read by individuals not quite as qualified and experienced as the board certified radiologist, all in hopes of generating enough income to pay the bills. If this is what Pete Stark and the moralists on this board want then good luck in finding a qualified primary care physician in a decade.

        In rural areas with few pharmacies, office prescribing makes sense. In pediatric offices where parents bring in sick kids and find it inconvenient to run to the pharmacy with their sick infant, it may make sense.

  • http://www.movetoemr.com Leo Bletnitsky

    I’m disturbed that the idea of doctors making money offends some people. Why is that?

    Lawyers spend far fewer years in school and quite often make far more for the destruction they cause than doctors who because of their studies and training don’t even get to begin their professional life until their 30′s and who’s job it is to help us stay healthy or treat us in sickness. People make lawyer jokes but still think its OK for them to make millions, and then even elect them to public office.

    A medical office is a business and if costs exceed revenues the office closes and the staff becomes unemployed. My main job is to help ambulatory practices move to an EMR system and the biggest hurdle I come across in small practices that don’t have the ability to pay for or even finance the technology they need.

    I wonder how good the health care for patients is when their physician can barely afford to stay open and must see more patients for less money every year. I guarantee that the doctor is human and his preoccupations with survival will effect care far more that entrepreneurship that works.

    • http://www.pharmacy.vcu.edu/sub/faculty/facdetail.aspx?id=82 David Holdford

      I am NOT against physicians making money. I just believe that this idea has unintended consquences that will likely hurt the physician/patient relationship and public trust in doctors. There are better ways of making money.

      • Fam Med Doc

        Dear Mr Holdford,

        I clicked on your name and found your website. Much thanks. You have an advanced pharmacy degree. You have written two books, Marketing For Pharmacists and Leadership and Advocacy for Pharmacy. Good for you. And you certainly do your job well. But I question your ability to be objective given your very obvious professional mission. You also don’t seem to trust doctors very much. But I will give you a chance. Please elaborate more on why this is so bad.

  • anonymousdoc

    “Why not just sign on as a “sales affiliate” of one of those online celebrity docs who have discovered that selling retail is where it’s at when it comes to making real money, compared to the drudgery of day-to-day managed care?”

    I’d love to, but I am not good looking enough

  • Fam Med Doc

    Two years ago I researched in-depth physician based dispensing & found both pros & cons to the idea. Overall, it seemed like a good idea. But I was reluctant & ultimately did not add this ancillary service as I couldn’t find any primary care docs who did it so I could have a final hopeful expectation. I just couldn’t risk it. So I REALLY would appreciate any docs out there who could give me your FIRST hand experience on this service. I’m already convinced most patients would appreciate it & am not influenced by the idea that some patients would see this as a money grab. Most reasonable people (unlike Carolyn Thomas above) understand that doctors need to make money or they cant survive. The reality is my primary care practice is going under due to low the reinbursement in primary care & I truly need more revenue or I will be forced to close my practice in 2011. So please, if you do physician based dispensing please tell me your experience- positive or negative, cuz the water is about up to my neck, & if it rises anymore I’m gonna gurgle. And if physician based dispensing could bring down the water level, even just a bit, I just might finally take the plunge.

    • http://www.BocaConciergeDoc.com Steven Reznick MD

      If you practice in an area with many large chain pharmacies they will undercut your generic prices to destroy your dispensing business. One large chain associated with a grocery chain just gave away the medicines free of charge as a loss leader to knock out physician dispensing and get clients into their store.

      • Fam Med Doc

        Dear Esteemed collegue Dr Reznick,

        Thank-you so much for your reply. It helps.

        Can I give you more specifics on what the current physician based dispensing companies (pbdc) are offering so you might better understand what is before me. Then please comment back if it alters your opinion.

        1) I live in a huge metropolitan area. I am a tiny fam med practice sourounded by large national pharmacy chains. They aren’t even aware of, nor care about me. But your comment on large pharmacies undercutting prices could be true. Yet current technology offered by the pbdc are a computer program that in real time gives you the insurance approval, or denial of the Rx. So, you wouldn’t lose money. The patient must pay for the Rx before he picks up the medication if he chooses the doctor instead of the pharmacy as the location where s/he picks up the Rxs.

        2) I agree some patients might shop around for cheaper pharmacies, but pbdc set up the doc to MAIL the patient his/her prescriptions on a monthly basis. The pt no longer has to go to the pharmacy monthly. Quite convenient for the patient. This is what is the advantage, I believe, to the pt & what will keep the pt getting his Rxs from the doc and not the pharmacy. I suspect 75% of the patients would select the doc as the pharmacy due to convenience. 25% might go to the large retail chain. In addition, at the very beginning when the Rx is generated at the physician-patient encounter, the pt wouldn’t have to next go to the pharmacy but just pick it up right in the docs office. Many patients would love that.

        3) the pbdc does all the counting & packaging of every specific bottle of meeds you will hand out or mail. Specifically if you prescribe metformin 1000 mg bid, they would send you a bottle of metformin already packaged with the safety seal of 120 tabs (assuming a 500 mg tab) The doctors office only has to put the pt label on it. So the NEITHER the office staff nor the doctor has to COUNT individual tablets & put them in bottles. The doctor when s/he first signs up with the pbdc gives a list of his typical meds AND the typical prescription sig & the pbdc sends pre packaged bottles.
        4) in regard to having large inventories of medications: it not supposed to happen or be necessary. The computer program that the pbdc sells to the doctor communicates via internet with their company & sends you a replacement bottle JUST as you send out the first bottle. Meaning, if you are monthly filling lisinopril for a patient from the office, just as you send him his next months lisinopril you get another bottle for your cabinet. One comes in; one comes out.
        5) office space required- if the doc is dispensing 100 different medications, only space for 100 bottles are necessary. That is a small overhead cabinet.

        Well, Dr Reznick (and others), does that change your opinion? Why or why not? All coments welcome cuz I’m considering doing this but still uncertain.

        A solo fam med doc

        • http://www.physiciandispensingsolutions.com My2Cents

          Solo Fam

          I would agree with everything you said, but would like to offer an alternative solution. You might want to consider a cash & carry dispensing program before you jump into real-time claim adjudication. Unless, you have a large Medicare patient base.

          Cash & Carry programs cost less and are less complicated.

          If you’re doing real-time claim adjudication, then price shouldn’t be an issue. You’ll be basically selling the medication for the same price the pharmacy will charginge the patient.

          Patients will much rather get their meds directly from you, since the price will be the same.

          The insurance companies will let you know what to collect & what they’ll pay in real-time via the software. I would recommend not paying over $750 for this type of solution.

          Hope that helps.

        • http://www.BocaConciergeDoc.com Steven Reznick MD FACP

          If the vendor selling you the dispensing service has data on a practice in an area like yours, with multiple pharmaceutical chain stores nearby and similar patient makeup , that is doing well then you need to consider the proposal. The operation of the service you are describing is not very different from what our group practice without walls tried at multiple sites years ago. It didnt work . Staff didnt enjoy the service because it added another task prior to patient checkout.

        • http://warmsocks.wordpress.com/ WarmSocks

          Not a doctor here, but I can give you a few thoughts from a patient’s perspective.

          I would love the convenience of picking up a two-week antibiotic immediately when it is prescribed. That would be great.

          Routine meds, I’m not so sure about. How would having the doctor’s office mail prescriptions be different (from the patient’s standpoint) than using a mail-order pharmacy? As a patient, I would be pretty leery of this because there seems to be a problem with the postal service between my PO box and my doctor’s office, and I rarely get things that they say they’re mailing to me. If I really need something from my doctor’s office, I either make a special trip to pick it up, or have them hold it for me until the next time I’m in town. No buy-in here for having my doctor’s office mail me my meds, because I’m not sure they’d ever arrive. Are you going to make enough profit off these to offset the shipping costs? How would you handle shipping refrigerated meds?

          Another thing to consider: Would you carry medicines prescribed for your patients by other doctors? If patients get your prescriptions from you, but still have to go to the pharmacy for meds prescribed by other doctors, the convenience is lost.

          I like having the pharmacist look at all my meds and double-check that there won’t be any harmful interactions. If you both prescribe and dispense, who serves as the second set of eyes?

          You might ask patients which pharmacy they currently use and how they selected that one. For a long time I chose my pharmacy based on their flat bottles with labels that are very easy to read. I wouldn’t have switched to my doctor’s office unless he offered those same awesome labels.

          How inconvenient is it going to be for your staff to deal with vacation overrides on prescriptions?

          As for cost vs. convenience, patients with Rx insurance will pay the same co-pay no matter where they get their meds, so it might be more convenient to fill prescriptions at the doctor’s office instead of making an extra trip to the pharmacy; that’s your market. Patients who pay for prescriptions out of a health savings account are going to shop around for the best price and compare cost vs hassle of going elsewhere. Patients really watching their pennies can usually get three-months-for-the-price-of-two by using a mail-order pharmacy. It boils down to this service probably being used most by patients with good prescription insurance.

          • Fam Med Doc

            Dear WS,

            Thanks for the patient perspective- it helps.
            In response:
            1) it is not much different than a mail-order pharmacy. But believe it or not, that service is not used much by my particular patient population. I don’t know why.
            2) the physician based dispensing companies claim $3-$4 profit AFTER all costs which includes shipping costs. As I don’t do dispensing now, I can’t vouch for the claimed profits.
            3) in regard to refrigeration, I rarely prescribe these, but good point. But I DO receive refrigerated vaccines via the mail so I know it’s safe & it just needs special packing.
            4) in regard to OTHER doctors prescriptions: YES I would fill their Rxs. One reason is profit and (yes, the doubters & accusers who have commented on this blog will NOT believe me) the other reason is by filling other MD’s Rx’s I will know what my pts are taking & keep their medication list in the chart up to date. I am their primary care physician after all. By knowing what is being prescribed it will help me keep informed of what other docs are diagnosing my pts with.
            5) GREAT point on labels. If I do this, I will make sure I get BIG print on the labels.
            6) vacation overrides- don’t know. Good question.
            7) most of my pts pick up their meds every month from the pharmacy, not a mail order pharmacy, so I think I do have a large pt population who might be interested. And most of my pts have good Rx coverage & don’t use health savings accounts, so really are good potential candidates for his service.
            8) drug to to drug interactions & a second set of eyes- maybe a good point. Maybe not. You would think that after being a physician x 7 yrs I wudda made SOME error in drug to drug interaction, but I have never received a call about such an issue from a pharmacist. With the medical pharmacy books I have in my office and the pharmacy computer programs available with these services, I think that risk can be mitigated. But it’s a good point.

            Overall, I’m still on the fence on physician based dispensing. It has it’s pros & cons. Anyone else with comments is still much appreciated.

          • Outrider

            >>4) in regard to OTHER doctors prescriptions: YES I would fill their Rxs.>>

            Just a question, not an accusation: Is that legal?

            As a veterinarian, I am under the impression that I cannot fill a prescription written by another veterinarian, at least not in the state in which I practice. I’m not sure the rules would be any different for physicians or if so, why.

  • ManAlive

    For years, pharmacists objected to doctors dispensing meds, citing “conflict of interest”.
    Now those very pharmacists employ NPs in their drug stores — even as they still admonish our “conflict of interest”.

  • chain RPh

    I would advise any MD to check out the insurance re-imbursement for the drugs in their specialty. Our computer prints out a list of drugs dispensed at a loss each day. My company draws the line at a $50.00 loss on a single RX; we ask the customer to pay cash instead and submit the receipt themselves to their insurance co. Insurance cos. pay a dispensing fee of 1 to 3 dollars. This doesn’t come close to the actual cost of approx. $10.00 per RX.

  • http://www.physiciandispensingsolutions.com My2Cents

    I have helped doctors dispense medication for years and I can tell you that the doctors that come to me aren’t money hungry doctors looking to squeeze their patients for every dollar they can.

    They’re at the point where they need to add on these services in order to help keep their doors open.
    I understand there is a fine line between patient trust & doctor care, but if patients understood the position doctors are in these days, they wouldn’t mind paying the physician for the medication rather than the pharmacy.

    I mean there is a reason why there is a shortage of PCP docs in this country, so if they have to adjust their model in order to stay in business & provide ancillary services, l say go for it!
    Wanted to clarify some myths:

    1. The opportunity for doctors to prescribe unnecessary medication is always there, but pharmacy boards will take note if a doctors prescribing habits change and will question that provider. As long as the provider continues to prescribe the medication the same, there shouldn’t be an issue for doctors to dispense medication & collect the reimbursement.

    2. Risk from dispensing – A lot of these dispensing programs offer drug-to-drug contraindicators programs that check for drug issues.

    3. Typically dispensing shouldn’t increase malpractice insurance, because they view it pretty much the same as passing out samples.

  • http://paynehertz.blogspot.com Payne Hertz

    Two, profit-making from prescription writing might induce physicians to write unnecessary prescriptions.

    Stop right there. There is no “might.” This is guaranteed to make at least *some* doctors write more scripts, just as owning shares in imaging labs leads some doctors to order more MRIs and such. That alone is reason to prohibit it.

    Secondly, it is doubtful a private doctor could sell drugs as cheaply as the drugstore chains, as they do not have the same purchasing power nor do they enjoy economies of scale, and they are not really in competition with other doctors on the basis of the prices of the drugs they sell, so there’s no downward pressure on drug prices as with the chains.

    • http://www.BocaConciergeDoc.com Steven Reznick MD

      Once again are the rules and regulations going to be designed to treat every physician and health care practitioner as a criminal? Its easier to get a gun in Wal Mart with your Minute clinic checkup than it is for physician to add an additional service without being accused of being a money grubbing selfish individual.

      • http://paynehertz.blogspot.com Payne Hertz

        So long as so many doctors are incapable of recognizing the right of the public to be protected from conflicts of interest that can jeopardize human life and health exceeds that of doctors to generate extra revenue, then we are wise to prohibit this practice.

        Physician prescribing has no tangible benefit to the public that isn’t massively offset by its risks, and I see no reason to risk human life and health for the benefit of profit. The medical system in this country generates billions of dollars a year in fraud. This is not an industry we can write a blank check to.

  • joe

    This is not new. Community medical oncolgists have been doing this for decades with their IV chemotherapy. Granted this is slightly different with oral meds but the idea is the same. I suggest anybody thinking about this have a long talk with one the medoncs because it is NOT a happy story. In 2005 medicare (and insurances have followed) stopped allowing beyond a minimal markup on chemotherapy purchased by the oncologist from the wholesale price. Though I agree with the moral hazard argument above to some extent esepcially with chemotherapy, the reality of IV chemotherapy is that it is exeedingly expensive to stock these meds. Also, medicare DID NOT take into account the cost of adminstering the chemotherapy (onc nursing done well is very expensive) and has ignored arguments from oncology they were now losing money by giving chemotherapy, which many are. The result is the days of the independant medical oncology practice are coming to an end. Practices are being purchased by hospitals, academic practices (which negotiate sweethearts deals from the feds), US oncology or simply closing. Now if you are the healthbeat reporter in which Manhattan medicine is the gold standard that may be fine. However, the reality is that rural americans are suffering of this issue. I would think long and hard on this issue, because if CMS thinks you are making money off this issue, they will address it.

  • jake

    Can anyone give me a list of options available to doctors who wish to implement a physician-dispensing solution?

  • Ashish

    As someone who has Listened and read comments by non physicians on kevinmd.com for nearly 4 years, doctors need to realize patients as a group reject the notion that private practice physicians run a small business. Given that premise., the only way doctors can survive is by radically changing their practice. The 20 year old solutions of to counter declining reimbursements and increasing expenses 1) see more patients 2) add ancillaries is no longer a solution.

    Doctors need to redefine the patient doctor relationship. We need to set limits. Limits in patient panels, limits in crapy insurance we are willing to accept, limits on tolerating patients who don’t value our profession by not paying balances and whining about copays. Limits on adminsteative paperwork my staff is responsible for when the PATIENT’s INSURANCE request my time. Limits limits. Thats what I did when I hung my shingle 4 years ago. And in doing so, I spend more time per patient providing a higher level of care with much greater professional and personal satisfaction.

    I agree with not dispensing meds or other gimics. . Just cut your overhead, cut your panel, control insurances you’re willing to accept and set patient limits. The numbers work.

  • soloFP

    It would end up insurance copays and deductibles to collect, which would add hassles to the already convoluted system. In addition, my area has suits against major pharmacy chains for dispensing Vioxx and Yaz but no current suits against individual physicians. I think dispensing meds would increase out liability exposure.

  • http://www.movetoemr.com Leo Bletnitsky

    I think that the definition of in-Office dispensing varies too much in people’s minds to be on the same page when discussing this issue.

    Let me define how the solution works for most practices doing it successfully:

    Dispensing is legal in all states except Utah, Texas and New Jersey as of the lat time I checked. It is not legal where there is a very strong pharmacy lobby.Some states require a dispensing license, many only require a DEA License.

    Our solutions only provide pre-packaged, safety sealed medications where the practice never touches individual pills. All inventory and dispensing is handled by a web based system that tracks what patient received what script, lot number, expiration, label printing and reorders. We recommend that a practice never order more medications than what they feel they will need in a 2 week period, as reorders only take a few days to be receive and there is no need to carry a big inventory. Additionally, unless your contract requires it, we recommend against insurance adjudication and for the practice to only carry medications that cost under $10 unless they are doing a lot of workers comp and PI work.

    Also, we recommend that the doctor stay out of the conversation with the patient as to where to fill the script. Let the MA’s do that part to keep the doctor from being perceived as selling to the patient.

    There are three types of dispensing that we run across regularly,/b>
    1) Acute care at time of service:
    Patient sees the doctor and needs a prescription. Practice carries the med and dispenses it to the patient for $15 or $20. Patient goes home. (There is no insurance adjudication needed) The patient has to be given the option of going to the pharmacy to prevent Stark issues. Many patients co pays are higher than this, they will save money and gain convenience. Those that have lower co-pays, have a choice depending upon how valuable their time is. (This will not work for practices with very high medicaid or medicare patient populations)

    2) Workers Comp Medicine
    Comp patient needs a script and is given one by the practice. There is no charge to the patient. Either the practice or the billing company that works with the dispensing solution bills workers comp for the medication and there is a revenue split. (ex: For a $2 Lortab script workers comp pays $35 (depending upon the state) The one thing to be careful about is to not dispense to a comp patient after the carrier tells you to stop or they will not pay.

    3) Personal Injury Patient
    This is the same as above. Patient receives medication without paying like they normally would, the biggest benefits to them is that they save the time of going to a pharmacy that takes attorney leans (there are not that many that do in may areas). The practice then adds the medications to the lean at a multiple of AWP (Average Wholesale Price) just like the pharmacy does. When it comes time to settle the case, the practice has a lot more to negotiate with. Often the pharmacy will only reduce their portion by a small amount and the practice has to negotiate the bill for medical services down considerably. This way the practice does not loose as much during the negotiations.

    In summary, if done right this can add additional income to the practice, save the patients time, and is considered by many to be safer for the patient as there are no counting error or cross contamination that can happen at the pharmacy with loose pills. The physician does not have any involvement with the solutions on a day to day basis after they have made their formulary choice and occasionally reviews it to decide changes.

    If anyone has any more specific questions please feel free to email me directly at leo.disp@LVMedIT.com

  • ninguem

    Pharmacies have medical clinics run by NP’s with the plain objective of sending them to that pharmacy to dispense medication for their profit. They do vaccines…..well, the easy ones…….then send the records to us, expecting we will do their recordkeeping, and deal with complications, and yes I have seen them from pharmacy vaccinations. They run CLIA waived lab tests, and we field calls from patients expecting us to deal with the results of tests we didn’t order…..for free over the phone.

    And that’s OK. That’s ethical.

    How about a regulation that pharmacy NP clinic prescriptions can be filled anywhere but the pharmacy that hosted the clinic? How about you stop doing vaccines? How about you stop running CLIA-waived lab tests? How about you stick to counting pills before you lecture physicians about “ethics”. Actually, from the last few patient complaints this past week, where I have told patients to use another pharmacy, I will some pharmacists would start counting the pills for a change.

  • ninguem

    Go to the OIG exclusions database


    See the pharmacies excluded for fraud.

    For that matter, just google “pharmacy” and “fraud”. See the prosecutions. Lots of them. I do not need to be lectured to by such types.

    If pharmacies vertically integrate by running clinics in their premises, run lab tests, add any number of services not central to their mission……that’s OK. If hospitals take over practices, labs, merge every hospital in a county into one monopoly, and bully doctors who try to run surgicenters, taking away hospital privileges….that’s OK.

    But heaven forbid a doctor sell some generic blood pressure medicine from his office.

    I don’t sell medicines from my office. It just doesn’t work for me….yet. I retain the right to do so if I wish. But I have nothing but contempt for pharmacy “leaders” who preach to physicians about ethics when their field is doing precisely the same thing.

  • Fam Med Doc

    Dear outrider,

    In regard to your question:
    “Just a question, not an accusation: Is that legal?”

    Yes, but the Rx would now be under my name.

    • Outrider

      Sure, I do that sometimes, after my patients see a specialist (ophthalmologist, surgeon, cardiologist, etc.) and are prescribed a medication for chronic use.

      What do you do when you don’t agree with the other physician’s prescription? Or when you aren’t familiar with a medication prescribed by the other physician? Or when you have a pill bottle but no records from the other physician? I’ve encountered all of these issues, and as I mentioned earlier, my patients are far less complicated, pharmaceutically, than the average aging human.

      Honestly, I don’t understand why anyone who didn’t have to deal with being a dispensing pharmacy on top of practicing medicine would even consider this option. To each his own, though.

      • Fam Med Doc

        Dear outrider,

        1) I’ve never, YET, come across a Rx I disagreed with. And if it’s from a specialist, as a primary care physician I would be reluctant to disagree w a specialists field of expertise. But in the final end, I could refuse to dispense the medication if I really felt it was harmful. But before I went there I would call the specialist first & gather his opinion on why.
        2) if I’m not familiar w a drug I need to look it up & learn about it. It’s not that hard.
        3) pill bottles are fine in my opinion if the patients name are on them. And new pts bring in bags of meds all the time. I go through each on & put it on their medication record.

        Their are several reasons to dispense Rxs from the office one is profit. Yes, I’m aware some people commenting on this blog are anti-profit for docs, but I disagree & have long disregarded such nonsense. Docs should be making a healthy income. But the reality is not only am I not making a healthy income, but my practice is struggling to survive, so if this helps maybe I should do it. There is real risk I may need to close it. And finally, I really do believe that this would be a welcome conveniece for some, ONLY SOME OK, of my pts.

        If wasn’t an MD & I had diagnoses that needed daily meeds, I would LOVE my doctor to mail me my meds every month. For real.

        • http://warmsocks.wordpress.com/ WarmSocks

          If wasn’t an MD & I had diagnoses that needed daily meeds, I would LOVE my doctor to mail me my meds every month.

          The main reason I prefer going to the pharmacy is that I can control when I refill my prescriptions. If you’ve ever assembled an emergency kit (for earthquakes, floods, etc.), one thing that people are supposed to include is one month’s supply of their medications. It would be cost prohibitive to pay cash for an extra month of all my meds, so I’ve managed to find a less expensive way to work toward this goal. Every time I go to the pharmacy, I go a couple days early; this gets me an extra few days’ worth of pills every month, and eventually it will add up to the one-month stash that is recommended for an emergency kit. If meds arrive in the mail on someone else’s timetable, that might not be possible.

          If you decide to mail rx to your patients, this is one more factor to consider.

        • Outrider

          >>1) I’ve never, YET, come across a Rx I disagreed with.>>

          Really? Well, I guess you wouldn’t see as much off-label use as I do. I also see a lot of problems with compliance once the patient leaves the specialist’s office, generally because the dosing regimen is impractical (e.g. 4x/day = usually not gonna happen).

          >>I could refuse to dispense the medication if I really felt it was harmful. But before I went there I would call the specialist first & gather his opinion on why.>>

          Sounds like a lot of time spent playing telephone tag since I’m guessing you, unlike me, don’t have the personal cell phone numbers of the specialists your patients see (nothing special about me; my little corner of the veterinary world is tiny and communicates well).

          >>2) if I’m not familiar w a drug I need to look it up & learn about it. It’s not that hard.>>

          More of your time spent, and drug guides are far from complete re: the bad and ugly, IME.

          >>3) pill bottles are fine in my opinion if the patients name are on them. And new pts bring in bags of meds all the time. I go through each on & put it on their medication record.>>

          The patient may not know the overall treatment plan, even if the prescription bottle still has refills.

          >>my practice is struggling to survive, so if this helps maybe I should do it. There is real risk I may need to close it.>>

          That’s really too bad, but I hope you’re looking at other potential solutions.

          >>I would LOVE my doctor to mail me my meds every month.>>

          I simply don’t want to be the doctor responsible for mailing those meds every month. Do what you like, though.

          • ninguem

            For Pity’s sake, where is it written that the physician has to be responsible for dispensing all the patient’s medicines? Where is it written that if a physician does some drug dispensing, the doc then has to be a mail-order pharmacy?

            The doctor is free to dispense whatever medicines that work out, are practical to store and dispense, are profitable, and help out the patient.

            It might be short courses of antibiotics for the basic infections seen in primary care. Maybe a fixed course of analgesics for acute pain. Maybe you induce treatment with certain meds, and you want to have a supply available to get a patient started. Dispense a fixed supply, the patient has the drug in hand, has no excuse for not filling the prescription. Antidepressants come to mind, maybe for a patient who is having a hard time facing the psychiatric diagnosis. Maybe that patient would fail to go to the pharmacy, but it’s in the patient’s hands, maybe even took the first pill in the office. You bill accordingly.

            You have a patient with depression. Maybe you want to start a SSRI. The offices that stock manufacturer samples, they might start the patient on Lexapro, because that’s on the shelf. The patient gets locked into the expensive branded drug. Then you have a fight later on, when the patient tries to get the drug covered.

            In the SSRI scenario, keep a supply of the generic SSRI you prefer. Start the patient that way. The patient benefits. No insurance hassles. You avoid the fight. The patient gets the reassurance of the doctor handing the medication. You don’t have the problem of doctor handing the expensive branded drug, then the patient being told the insurance is trying to push the patient to something now perceived as second-best. And though it may offend many on this site………the doctor actually adds a few dollars more to the profit margin.

            Having established the treatment works, the patient can turn over to a pharmacy or a mail-order if desired.

            You’re making it sound like the doc has to either be a full-service pharmacy, or nothing. If the doctor stocks a course of antibiotics for UTI’s, adds value to the visit, makes a few dollars, by this line of thinking, the doc has to stock disease-modifying antirheumatics in case a doctor across town recommends it.

            Stock the medicines that work from a business and patient care standpoint. It doesn’t have to be the entire United States Pharmacopoeia.

  • ninguem

    The rules over physician dispensing vary state-to-state, depending on how powerful the self-serving pharmacy lobby is in that particular state.

    I think the outside doctor thing is the difference between a pharmacy and a dispensary, at least in my state. Hardly expert on the technicalities. In training, I did a little elective time with an alternative medicine practitioner, The practitioner was a fully-licensed MD, with a controversial (but quite popular and well-known) alternative medicine practice. I wanted to see what was done, the rationale, how it was done, what I could incorporate into a more traditional practice, etc.

    The clinic had a facility that looked like any pharmacy counter. They were not happy when I casually used the word “pharmacy” to describe it.

    “We’re a DISPENSARY.”

    I **think** the difference is, when you are creating some sort of non-FDA-approved herbal potion for your own patients, that’s OK and under the purview of the Medical Board. If you dispense that same potion for a doctor not in that clinic, then you are a pharmacy and under the purview of the FDA, Pharmacy Boards, subject to a bunch of laws that might get you in trouble because of the controversial nature of the treatments.

    At least that was my understanding, based on what they explained to me.

    I don’t dispense in my own office; however, I would insist on retaining my legal right to do so in my state. As pharmacists and other mid-level types pressure government to expand their scope of practice to physicians, they also try to limit the ability of physicians to practice in the mid-level’s field.

  • imdoc

    So, if a doctor is employed by a large hospital or health system, is there inherent conflict of interest to use that system for referral and facilities? Certainly there is covert pressure to do so.

    • http://warmsocks.wordpress.com/ WarmSocks

      Covert pressure? I suspect it’s stronger than that. I see a specialist who is employed by a hospital, and was explicitly told that she’s not allowed to refer outside the system. This doctor orders labwork, x-rays, and MRIs that all generate quite a bit of revenue for that hospital system. That’s way more conflict of interest than a family physician dispensing antibiotics to save patients a trip to the pharmacy!

      • ninguem

        I was thinkin’ the same thing.

        “Covert”? heh More like a billboard.

  • James G, MD, PharmD

    As both a licensed physician and pharmacist, I would not recommend in-office dispensing for a number of reasons not already mentioned in the above discussion. First, in most states, if you dispense drugs from your office, you are responsible for keeping all the same records that a pharmacy keeps. While phycians are very familar with record keeping, very few have any idea of rules governing pharmacy records. Doctors can educate themselves about these records, but why add that much more to already burdensome record keeping responsibilities. Second, while catastrophic errors rarely occur, they do happen. As a pharmacist, I caught 2 errors that could have resulted in serious harm to the patient (one due a dose miscalculation and one due to the patient giving an incomplete history). I like the idea that another professional is checking behind me to ensure that no harm comes to my patient. Third, you can’t possibly match the prices of the big retail pharmacies. Some patients are willing to pay for the convenience of in-office dispensing, but that only applies to low-cost generic drugs. Even some commonly used generic drugs are expensive (for instance, a generic Z-pak still runs ~$30-50) and patients will want to file these on insurance (generic Z-pak on insurance is $10-15). That leads to point 4: if you want bill the patient’s drug coverage, that will increase your startup and dispensing cost. Insurance payment for dispensing is often at or below your cost, especially with Medicare/Medicaid. Pharmacies can off set this loss by the volume of Rx’s they dispense paid for by non-Medicare plans and by selling other OTC products (the prescriptions gets them in the door, but the OTC’s they buy while there make up for the loss). It’s not feasible for a physician to make up the loss with volume or selling other products. Last, dispensing controlled substances is a really bad idea. Added rules govening these Rx’s, the increased risk of loss by theft, and the consequences of loss make this too much of a risk. If you have drugs in your office, you must open up your dispensing area to a state drug inspector should he come to your office. If he finds your inventory short due to poor record keeping or other loss, be prepared for consequences, especially if the loss in a controlled substance. All things considered, I would never dispense out of my office.

  • Outrider

    I agree with everything you said (especially about matching prices), and once again, I’m reminded how happy I am veterinarians don’t have to deal with insurance co-pays.

    >>Last, dispensing controlled substances is a really bad idea. Added rules govening these Rx’s, the increased risk of loss by theft, and the consequences of loss make this too much of a risk.>>

    This is exactly why I don’t dispense any controlled substances, even though I’m a veterinarian. Talk about asking for trouble.

  • imdoc

    So while the debate here is splitting hairs regarding some solo doc dispensing a few antibiotics, conflict of interest occurs in large institutions on large scale, including public ones like some medical schools. So that is acceptable? Perhaps the only solution is prohibiting doctors from being employed by non-physicians.

  • ninguem

    The economics of Depo-Provera is such that I can’t keep it in my office. So when I have a patient who needs it, I have them go to the pharmacy to pick it up, bring it to me, and I inject it, billing just the injection fee.

    Well, since there’s almost always a guaranteed “by the way” matter, it ends up getting turned into an office visit anyway.

    And the patients are almost invariably floored that I DON’T dispense the drugs from my office.

    When I biopsy a skin lesion, maybe I should have the patient pick up the local anesthetic from the pharmacy. How dare I bill the local anesthetic with a “J”-code added to the surgical fee.

    Of course, if I did the same thing in an Urgent Care clinic affiliated with a hospital, they find ways to add facility fees and the bill ends up some multiple of what I did, for the same procedure. But that’s OK, because it saves money to spend twice as much as the procedure done in the office. No I didn’t expect it to make sense.

    Protestations to the contrary, this is, precisely, 100%, about people having a problem with doctors making a dollar more than anyone else.

    Some here argue about the practicalities of doing it, and that’s fine. My dispensing is very limited, I guess not zero when I think about it.

    But spare me the “ethics” lecture. Pharmacies have their share of corruption, from Rite-Aid executives, down to individual pharmacists, and everything in between, as bad as any other human endeavor.

    • Fam Med Doc

      I agree w all your posts, especially the reality that pts are against doctors making a profit. Which is ridiculous. Primary Care is dying due to money loss. I’ve long since ignored these the ridiculous idea such as docs shouldnt make money. I’m an unusually honest doctor, I know I can dispense meds in my office safely & without exploiting my pts. You should ignore them, too. Keep your head above the drama clouds- ignore folks like Payne Hertz, David Holford, Carolyn Thomas. They aren’t helpful. Keep up the good work, & continue to give the the best care you can. That’s what I am doing. At least till I close my practice cuz due to non-payment of my office bills & salary to my staff. Which might be this year. But I will keep trying.

      • http://www.drdispense.com Keith Waldorf

        I stumbled across this thread doing searches on our business name, Doctor Dispense. Being a vendor in the physician dispense space, we have developed our business to address the unique needs of they physician market.

        We’ll leave our opinion out of this response but wanted to let the practitioners know that there are solutions available that reduce the complexity of managing an in-house dispense program.

        Our solution manages all logging and reporting, provides real-time claims adjudication including drug utilization review, as well as just in time inventory management. We also integrate with e-prescribing vendors as a pharmacy technology vendor. Allowing practitioners to reduce errors by transmitting patient and prescription data electronically to their own in-house dispensing queue.

        We of course believe this is a legitimate solution for medical practitioners but will concede it is not ideal for some specialties.

        The patients of our customers love the service. It is nice to see a healthy conversation on the topic.

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