Allowing doctors to also dispense drugs, some say, is cheaper and more convenient for patients. Critics aren’t so sure.
SOMETIME AROUND 2007 or 2008, Samantha Jefferies came to her brother Trent with a request: Could he help figure out an easier way for doctors to sell prescription drugs to their patients? Typically, when doctors want their patients to take a drug, they write a prescription, and a pharmacist — generally at a local, unaffiliated pharmacy elsewhere in a patient’s community — dispenses the medication. But in the 1980s, a rising number of physicians in the United States began bypassing pharmacies and selling certain drugs directly to their patients. The practice, often called physician dispensing, is largely prohibited in many high-income countries, including Australia and Germany, but it’s currently legal in 45 U.S. states, and the practice appears to be growing.
Samantha Jefferies works in health care management in southern California. After reading an article about how this kind of in-office dispensing can generate new revenue for medical practices, she reached out to her brother for his thoughts.
Trent Jefferies had served in the U.S. Army Corps of Engineers, worked as an engineer for Black & Decker, and managed materials and logistics for a company that builds carbon fiber parts for airplanes. On the venture capital platform F6S, he describes himself as a “mech engineer, six-sigma black belt, lean expert, and supply chain guru.” After hearing from his sister, Jefferies looped in a couple other engineers and began sketching out plans. Their idea was straightforward: to build a pharmaceutical vending machine that would sit directly inside a doctor’s office or clinic.
In 2011, the group received a first round of investor funding and incorporated a company, VendRx. The next year, they filed the first of four patents on a device “for dispensing beneficial products.” To build it, Jefferies and his collaborators hired a firm that takes standard snack vending systems — “just normal candy machines, for lack of a better word,” Jefferies said — and soups them up for other applications. When the relationship with the firm soured, Jefferies says he took the not-yet-completed prototype and enlisted a new engineer, building the rest of the machine in the team’s own warehouse.
The VendRx system dispensed its first bottle of medicine to a patient at the offices of Ross Legacy Medical Group in Mission Viejo, California in 2017. (Samantha Jefferies, executive director of that group, is now on VendRx’s board.)
From the outside, the machine is a tall cabinet of off-white powder-coated steel, fitted with a large touchscreen. Inside, the system stocks up to 500 packages of medication, each nestled in a v-shaped notch. When a doctor prescribes a drug, VendRx software routes a record of the prescription to the machine. On the way out the door, the patient can stop and tap their name and date of birth onto the touchscreen. This sends a mechanical arm whirring to the correct slot, where it grasps a pre-packaged, pre-counted bottle of medicine and shuttles it to a small printer for labeling. The machine then ferries the drug to a delivery slot.
The whole process takes around 70 seconds — and the VendRx machine accepts credit cards. Even a small medical practice, the company says, can make five-figure profits through the machine each year.
Advocates for in-office dispensing argue that it is both more convenient and cheaper for patients, and some say it can also bring in extra revenue to doctors. The arrangement, supporters argue, can also bypass the elaborate and opaque vagaries of retail drug pricing that often leave patients paying far more for drugs at the pharmacy than is necessary. And given that a significant percentage of patients, even with a prescription from a doctor in hand, never end up going to a pharmacy and getting it filled, supporters also say the convenience of getting drugs directly from doctors can help close a crucial compliance gap and improve overall patient health.
“Physicians are human beings, and when you look around, people react on their financial incentives. They do.”
Not everybody buys these arguments — least of all pharmacists. They and other critics argue that pharmacists play an important role in patient education, and that they act as a crucial safety check on doctors’ orders, helping to head-off potentially dangerous drug interactions or other complications. Critics of physician dispensing also say that the arrangement involves an inherent conflict: Doctors who prescribe drugs ought not be in a position to profit off of them…
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undark.org/2021/10/11/dispensing-doctors-should-physicians-sell-drugs-to-patients/
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