Physician Dispensing

Understanding the Complexities and Challenges of Physician Dispensing

Dispensing Physician Practices and the physicians working within those practices are referred to by many names or phrases including “in-office dispensing,”  “medically integrated dispensaries” “point-of-care dispensing” and “physician dispensing.” This practice is especially pronounced in the oncology setting. Oncologists, specifically those in independent oncology practices (as opposed to hospitals), dispense cancer drugs directly to patients under one of two primary practice models based on applicable state board of pharmacy regulations and practices.

• One type of practice, commonly referred to as a “Medically Integrated Dispensary,” is a physician practice that dispenses medications to patients pursuant to the physician’s plenary medical license as permitted by state and federal law. These types of practices do not hold a pharmacy license. Occasionally, dispensing physicians must register as such with state boards of medicine or pharmacy prior to engaging in this activity, while others do not require any additional criteria for physician licensees in good standing.
• The second practice is operationalized through physician-owned pharmacies, whereby a practice dispenses drugs through a licensed retail pharmacy owned by the practice. In this instance, and where permitted by applicable law, the licensed retail pharmacy may be the same entity as the medical practice. This model differs from the a dispensing physician practice, as the entity holds a pharmacy license subject to all board of pharmacy rules and regulations regarding the operation of a pharmacy.

These two practices are distinct from traditional pharmacy practice wherein a physician writes a prescription in the office, gives it to the patient, and the patient takes the prescription to the pharmacy to obtain the prescribed medication.

Overall, the practice of physician dispensing comes with numerous benefits for both the patient and the physician and can help improve patient outcomes. For example, many of the medications that are dispensed directly to patients in a physician’s office are among the most complex , new, and innovative medications in the country including oncology medications, HIV medications, and other rare diseases medications. In addition to being complex, these medications are often expensive, have serious (and in some cases potentially life-threatening) side effects, and have specialized handling and administration requirements. The ability of a patient to work directly with their physician in taking their prescribed medication is directly tied to increases in positive outcomes because it ensures proper administration of and adherence to these drugs and protocols to ensure optimal results. Further, in this setting, physicians can respond much faster when medications are not effective and engage in more proactive patient monitoring. Despite the potential benefits of this model, the legal framework that permits this practice to take place is exceedingly complex and requires advanced legal expertise to accurately and effectively navigate.