Doctor? Or Druggist?
Tuesday, October 30, 2007
When Anne Johnson recently visited the Nighttime Pediatrics and Adult Care Too! clinic near her home in Millersville with a case of hives, the doctor told her she needed steroids and several days' worth of antihistamines. But he didn't hand her a prescription. Instead, Johnson, 46, got a dose of each drug on the spot, and the chance to buy the rest on her way out the clinic door. Given the late hour -- 11 p.m. -- Johnson gladly accepted.
Some area residents are taking advantage of similar services to buy their drugs at their doctors' offices. Such "point of care" dispensing is outlawed in some states but not in Maryland, Virginia and the District, where dispensing physicians need only authorization from pharmacy boards to assume a role once held almost exclusively by pharmacists.
Less than 10 percent of U.S. physicians sell prescription medications to their patients, according to the journal Physicians Practice. But Mark Bard, president of Manhattan Research, a health-care market research firm in New York, says that figure could reach 25 percent in the next five to 10 years.
Commonly prescribed medications such as antibiotics, pain drugs and allergy pills make up the bulk of the drugs doctors sell, Bard says. But specialists have also expressed interest in dispensing more-targeted prescriptions, such as cancer drugs.
One incentive for doctors to move into the drug-selling business is that any profits fall outside the control of managed care, which has been putting the squeeze on reimbursement rates. Doctors generally charge more for drugs than a pharmacy does.
For patients, doctors' move to drug dispensing could be a timesaver. In a recent national survey of more than 900 adults, conducted for a company that sells drug-dispensing software and medicines to physicians, three out of four respondents said they'd prefer to buy their drugs from their doctors and skip a trip to the pharmacy.
But convenience could come at a high price, experts say, if patients are overcharged or not properly counseled about potential drug interactions. "It's important for patients to utilize the knowledge of their pharmacists as medication experts," says Mitchel Rothholtz, chief of staff of the American Pharmacists Association.
Although physicians' groups such as the American Medical Association and the American Academy of Pediatrics generally support a physician's right to sell medications in the office, patient advocates have qualms. "It's a system that's ripe for abuse," says Michael Cohen, president of the Institute for Safe Medication Practice, an advocacy group that aims to prevent medication errors and promote safe drug use.
The two largest firms selling drug-dispensing packages to doctors are Allscripts, a Chicago company that earned about $50 million from its dispensing business last year, and St. Louis-based Purkinje, which does not disclose its sales. Allscripts sells generic and brand-name drugs, while Purkinje sells only generics.
Doctors who sign up with QuiqMeds, a Philadelphia drug-dispensing firm, get vending machines stocked primarily with generic drugs as well as some nonprescription drugs such as cough medicines. Physicians sell them to patients, profiting about $5 per prescription and $3 per nonprescription product, according to the company. Chief executive Mel Stein says the company is in discussion with doctors in the Washington area.
Purkinje serves 71 physician practices in the District, Maryland, Northern Virginia and Delaware, says company spokesman Andrew Shea; about 180 physicians dispense from those offices.
Although some drug-dispensing firms promise doctors annual profits of $50,000 or more, such figures are not realistic, says Purkinje medical director Thomas Doerr. He says doctors who buy drugs from his company are more likely to average $15,000 profit per year.
In the District, Maryland and Virginia, doctors who sell drugs from their offices decide what prices to charge and whether they will accept a patient's drug co-pay fee as payment.
Who gets to seek the balance from the insurer -- the patient or the physician -- is also up to doctors.
"I see it as more of a patient convenience that saves a trip to the pharmacy and adds another reason why patients want to keep me as their doctor," says Tareq Abedin, a pediatrician and internist who started dispensing drugs in his Sterling office several months ago.
At the urgent care center run by internist Maurice Reid in Cockeysville, north of Baltimore, about 70 percent of patients accept his higher drug prices to avoid a separate pharmacy trip, he says. The rest of his patients -- including many of those who don't have drug insurance -- take the prescription to a pharmacy.
Saul Newman, a Silver Spring father of three who often visits Nighttime Pediatrics in Rockville when his kids spike a fever late in the day, says he usually chose to forgo the clinic's drug-dispensing option years ago when the policy was cash only.
"It was very inconvenient to get prescriptions filled at the nighttime clinic because they didn't file the insurance claim for me," said Newman, who preferred to go to the 24-hour CVS just down the road on Rockville Pike. "If you got them at the clinic, you had to pay the full price out-of-pocket and then submit the paperwork to insurance."
A recent change in clinic policy has made him rethink that decision. "Now that they're accepting insurance and only charging a co-pay," Newman says, "it might be worth my while to see the doctor and get the medicine all in one stop." ¿
Francesca Lunzer Kritz is a Washington area freelance writer. Comments:email@example.com.