Should You Sell Drugs to Patients?

Debra Hughes, MS


May 09, 2013

In This Article

A Win for Patients and Doctors Alike

Patients with cancer who are prescribed oral oncolytic medications can fill their prescriptions in several ways: at hospital, retail, and specialty pharmacies; via mail order; or in an oncology practice. Although in-office dispensing -- defined as drug dispensing by a physician to patients -- is controversial in oncology (and other specialties), there are sound reasons to consider offering it in your practice. Patients appreciate the convenience; physicians and staff derive satisfaction from seeing patients adhere to their medication regimens; and it could -- some experts would say should -- be profitable for your clinic.

Then why the controversy? Detractors point to the potential for a financial conflict of interest when physicians dispense medications in their own practices. However, although offering in-office dispensing can add to a practice's viability, it's not the potential for revenue that should guide the decision. Rather, the key question is, "What is the adherence rate of my patients receiving chemotherapeutic agents?"

So says Steven L. D'Amato, RPh, a board-certified oncology pharmacist and executive director of the Maine Center for Cancer Medicine and Blood Disorders, a 14-physician community oncology group with 4 sites. After a year of planning, the center initiated in-office dispensing in April 2011.

Since then, patient adherence rates have climbed to 90%, compared with national adherence rates for many long-term drug therapies of approximately 40%-50%.[1] Lower adherence rates are associated with an increase in physician visits, higher hospitalization rates, and longer hospital stays.[1]

In addition, unmeasurable rewards have resulted from the satisfaction derived when physicians and clinic staff work closely together "to ensure patients are educated on the benefit of adherence, toxicities are identified early, modifications are made rapidly, and symptoms are managed," says D'Amato.

His group represents nearly 35% of the cancer specialists in Maine and serves approximately 42,000 patients annually, with 2400 new patients per year. The in-office dispensing program is run through the largest site, in Scarborough, and is open from 8 AM to 5 PM Monday through Friday -- the same hours as the practice. Patients may choose to use the in-office dispensing program after being informed of all available options, as is required by law. Courier services are used to distribute medications to the other sites.