In the past, I've argued that there are legitimate reasons a doctor might dispense medications to a patient and that legislative and regulatory efforts to curb abuses of physician dispensing should be focused on the elimination of the financial incentive to do so while preserving the practice for the limited circumstances in which it might be necessary.
I've changed my mind.
The WCRI report published this week makes it crystal clear that the creativity of physician dispensers will always lead to maximization of revenue (and clearly inappropriate utilization of medications) unless the practice itself is eliminated. Essentially, drug re-packagers in California created novel dosages of certain medications in order to evade the constraints of the physician dispensing regulations. This allowed them to return to the typical physician dispensing practice of creating new NDC codes and charging exorbitant amounts of money for drugs that would be have been substantially cheaper had they been secured through a retail pharmacy. Worse, utilization of these medications sky rocketed as a result of the physician revenue incentive (my conclusion, not WCRI's).
Physician dispensing doesn't make sense. Not in any circumstances. I could see a potential allowance for a one-time, short-term fill, but the routine dispensing of medications by physicians to patients should be banned. Immediately.
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(Disclosure: PRIUM, and our parent company Ameritox, provide financial support to WCRI).