The Case Against Physician Dispensing

This website aims to be neutral and discuss both the pros and the cons of physician dispensing.  This article discusses the cons.

Physician Dispensing Can Encourage Over-Prescription

One source of concern about in-office dispensing is that if a doctor has an economic incentive to prescribe prescription medication, he or she will be more likely to do so.  At best, this creates waste and unnecessary costs in the health care system, and at worst, patient health and care could be negatively impacted by unneessary or excessive introduction of prescription drugs.

While it can hopefully be assumed that most physicians and medical practitioners are ethical and put patient care above their own financial incentives, there is significant evidence that incentives do influence some doctors' decisions.  For example, the opioid crisis has been at least partly fuelled by bribes and kickbacks to doctors to prescribe these drugs.  Unfortunately, there has not been significant research or studies about whether the incentives in current physician dispensing regimes are driving over-prescription.

Physician Dispensing Can Encourage Doctors to Change Prescriptions

Related to the above, even in cases where prescription medications are warranted, a physician may have an incentive to substitute one drug for another, if he or she stands to earn an increased profit for the substitute and/or only has the substitute "in stock" at his or her clinic.

Physician Dispensing Can Increase Costs to Patients

Many studies have shown that drugs dispensed at the point of care are generally priced significantly higher than at a pharmacy.  Some states restrict or limit what doctors can charge and/or mandate that medical practitioners who dispense in office notify their patients that they have the option of having their prescription filled at a pharmacy, although it is unclear whether these regulations are strictly enforced.

Physician Dispensing Risks Patient Safety

In the traditional pharmacist dispensing model, among the pharmacist's set of duties is to provide a second set of eyes on the patient's prescripton in case of errors.  It is not clear that this function is being duplicated by clinic staff who are dispensing medication, who might not have the training or the time to recognize potential prescription errors and/or to discuss these with the physician, who may be their employer. 

Posted in Analysis on Jul 19, 2019