Maisy was having a severe reaction to her allergies this season and was having difficulty breathing. We called her doctor and he recommended we bring her in to the office.
After the examination and a shot that gave her some relief, we went to the front desk, where the doctor wrote a prescription that was immediately filled by his staff at that moment. We paid for the prescription and went home to start her course of medication.
Maisy is a 5 year old boxer that lives in Texas, and her veterinarian is allowed by Texas law to dispense prescription drugs in office, which can be administered there or taken home by her humans.
But physicians who prescribe medications to humans in Texas are prohibited from selling those same medications in their office, a common practice in many other states known as “physician dispense.” As a result, patients must travel to a pharmacy to fill their prescriptions, which can be exceptionally inconvenient for people in rural and high-traffic areas.
The inconvenience doesn’t stop there. A national survey found that the majority of patients (57 percent) wait five minutes or less at the pharmacy, but 15 percent wait 6 to 10 minutes, 21 percent wait 11 to 30 minutes, and 7 percent wait more than 30 minutes. Pharmacists must verify that all state- and federal-required information is received with the prescription, check the patient’s history to ensure the medication is safe, and run claims through insurance. The result is lengthy wait times.
Texas is one of only 5 states that does not allow physician dispense (there is an exception for physicians in rural areas with no pharmacy within 15 miles). Physicians may also give out complementary drug samples and dispense a maximum 72-hour drug supply to patients with “immediate needs,” meaning they lack immediate access to a pharmacy. The majority of Texans, however, cannot acquire medications at their physician’s office.
Previous legislative efforts to allow physician dispense throughout the state have been met with opposition from pharmacy lobbies. They say they’re concerned for patient safety. Yet a 2014 study by University of Utah researchers found that the rate of adverse drug reactions (ADRs) from physician-dispensed drugs was the same as pharmacist-dispensed drugs.
The study also found that among patients who experienced ADRs from physician-dispensed drugs, only 6 percent went to an urgent care or emergency room, compared to 15 percent of patients who experienced ADRs from pharmacist-dispense drugs. In other words, patients receiving medications from their physicians are less likely to use emergency care once they’ve had a bad reaction. They are also significantly more likely to consult their physician.
Not only is physician dispense safe, it has also been shown to increase medication adherence rates. A 2016 study of physician dispense in the Medicare Advantage program found that medication adherence increased 17 percent for oral antidiabetic agents, 29 percent for cholesterol medications, and 21 for blood pressure medications. Seventy-six percent of Medicare Advantage members said the delivery system was more convenient than going to a pharmacy, and 87 percent said it improved their ability to take their medication.
Of course, pharmacists provide a valuable service—a second pair of eyes when it comes to prescribing medication. They have software that allows them to review patients’ prescription and medical history to check for potential ADRs. But the same software is available to physicians and the evidence shows no real difference in safety.
There are currently two physician dispense bills pending in the Texas House Public Health committee, HB 460 and HB 1622. Neither bill would require patients to get their medications at their physicians’ offices. They would simply grant patients more options when choosing where to get their medications.
More options could mean saving money on medications. If a physician sells a particular drug at a cost lower than their patient’s pharmacy co-pay, the patient saves money. A patient could also call their local pharmacy from their physician’s office and compare prices before deciding where to purchase their medications.
Physician dispense would increase competition and put downward pressure on drug prices by allowing patients to shop around for the best deal in a market with more suppliers than there are today.
Ultimately, the battle to legalize physician dispense in Texas is about increasing patient choice and access to medications. Anti-competitive pharmacy lobbies have staved off reform thus far, but it is time for Texas to join 45 other states in allowing patients the same medical privileges that their animal companions enjoy.