While many arguments are made for and against physician dispensing, the fundamental trade-off is largely between patient outcomes and satisfaction on one side vs. the potential for distorted outcomes related to financial incentives on the other.
We’ve provided a complete list of Provider Benefits and Patient Benefits on the linked pages, but here are the most-cited benefits of physician dispensing:
- Patient compliance and improved outcomes: Studies have shown that between 20 and 30% of prescriptions are never filled by patients. By dispensing at the point of care, patients save the trip to the pharmacy and are far more likely to begin treatments, resulting in better outcomes.
- Confidentiality: Dispensing can be particularly useful in specialties that might be a bit more sensitive to patients, such as weight loss, men’s health and women’s health. Patients often prefer getting these medications from their trusted medical professional rather than a pharmacist.
- Patient satisfaction: Patients love saving time and money by getting their low-cost generics directly from their provider. Providers who dispense often report improved patient satisfaction scores.
- Cost savings: By eliminating the pharmacy, providers are often able to offer patients lower prices while still generating additional revenue for the practice. This can be especially beneficial in situations where companies or entities are self-insured, for example at Student Health Centers or Employer Worksite Clinics. By sourcing medications directly, you can save significant money for the practice.
- Increased practice income: Create a new revenue stream for your practice.
- Improve service offering: Dispensing is highly popular among patients and allows you to compete with other practices in your area. This is particularly beneficial if you treat acute conditions (e.g. urgent care) or where patient confidentiality is paramount (e.g. weight loss, men’s health and women’s health).
Very few things in life are without drawbacks, and physician dispensing is no different. The most common downsides cited include:
- Increased patient cost: Ultimately the price set for the patient is up to the dispensing provider. In some cases, providers will include large markups on the items and the ultimate price to the patient may be higher than at the pharmacy. However, the prices our suppliers provide are very competitive so in many cases providers can generate income while still charging well under what the pharmacy charges for medications.
- Difficulty billing insurance: It can be a challenge to bill insurance for dispensed medications and be profitable, so most providers opt for cash & carry dispensing only. This can mean that patients who want to use their insurance must still go to the pharmacy. That being said, the beauty of physician dispensing is that you can and in fact must provide the patients with the option to go to the pharmacy to get their medication. In that sense, physician dispensing can only give patients more options, not less.
- Conflict of interest: Opponents of dispensing often cite the financial incentives for doctors and the concern that dispensing will result in changes in the way doctors prescribe, either encouraging them to prescribe more or to prescribe the items they have in stock. In practice, most of our providers are carrying their most common generic medications and are only generating a few dollars in profit from each dispense. The financial incentives are not such that they are likely to cause any changes in the way the provider treats his or her patient.
- Patient safety: One downside of physician dispensing is that there is only one set of eyes on a prescription and the provider may not always know a patient’s complete medication history. That being said, pharmacists also often don’t have the full picture, but having a second set of eyes on the prescriptions may result in catching some prescribing errors. On the other hand, dispensing reduces the chances that the wrong medication is dispensed and allows the doctor to counsel the patient and ask questions about their other medications.
If you’d like to read more, the National Center for Biotechnology Information (part of the NIH) has a good article titled Good Intentions, Uncertain Outcomes: Physician Dispensing in Offices and Clinics that discusses many of these points.