Home Forums Discussions General Discussion Dispensing medications

I am curious to learn if anyone out there is dispensing their own meds such as antibiotics, common generics, etc. to patients. I have been researching the addition of ancillary services and think this is an interesting concept. I have always pooh poohed the idea previously but, seriously, wouldn't it be a real convenience for patients to leave your office with their meds already in hand? And, now that pharmacies are giving vaccinations, why shouldn't I dispense meds?

Leslie

What's the extra amount of red tape and costs associated with it? Is all that combined with extra yours and staff time worth it? I'm curious too because we are investigating all sorts of things to try and bump the bottom line. Keep us in the loop and I'd love to hear your answers...

I used to work in an Interfaith clinic about 10 years ago that had a formulary. A pharmacist from the community maintained it, and it was very convenient. This was a community-supported health facility. I think the medications were provided at cost or a little higher -- probably about the same price as the Wal-Mart $4 list now!

Well, as I give out a lot of samples anyway, my staff's work would really not be that great. I am talking of only about 20 or so different meds all of which could be sold for around $4 and still turn a small profit. For instance, 100 tabs of Ciprofloxin 500 mg go for $6.81 on Esurge which would cost me less than $1 for a 14 day supply. If I charged what Wal-Mart charges ($4) the math tells the story. In my state, the only requirements are that the package has to have directions, patient's name, date and my name and address on it. But, this might be significanlty different elsewhere. Pill envelopes are also pretty cheap. The convenience factor would be tremendous for the patient. Come in with a UTI and leave with treament in hand and not have to make another stop or wait at Wal-Mart for 20-30 minutes while the script is filled.
I may give it a try. If it becomes too cumbersome, I can stop.
I can even track it in AC meds by using something like
"Cipro 500 mg DO" for Dipsensed in Office.

Leslie

Leslie, check out these articles from Medical Economics.
There seems to be a critical mass upon which the concept appears profitable. The second article is the newer one. As I recall (I have not read it for awhile), it would take about 200 Rx's per month in order to turn profit. A multi-doctor office could make this happen easily. A solo office would be more difficult. However if you train your patients to buy from you, maybe you could swing it and turn a small profit. You will not make hundreds of thousands of dollars howevever. A few hundreds of dollars is likely, maybe a few thousand. Is this worth the aggravation and hassle of maintaining the inventory, expiration dates, ect.?

Medical Economics Journal #1

Medical Economics Journal #2

Adam,

Medical Economics is where I got the idea. But a lot of those practices are using medicine dispensing companies which set the drugs up and refill the stock, etc. I thought they were exceedingly costly. I am not looking to make thousands of dollars but even a few hundred here or there would be nice. Also, I am not opposed to filling pill envelopes while I sit in front of the TV. And, as patients are now accoustomed to buying 3 months at a time, a bottle of 100 would be easy to dispense.
Anyway, I just ordered about $300 worth of meds. I'll let you know how it turns out.

Leslie

Please let me know Leslie.
I'm really curious how patients find your service.
I suppose it would make sense to offer those very common meds.

Question: Do you bill the patient's insurance company for the meds? Or do you just eaccept cash payments and keep only those meds in stock which are pennies per pill?

I plan to take cash only. A lot of my patients don't use their drug insurance anyway for those $4 generics...they find it easier and just as cheap (or cheaper) to buy locally than through their prescription mail order. Those and the patients without prescription insurance would be my target. I would stock only those meds that I can sell for $4/month's supply and make a few dollars. At least not lose money. Here's another example...Metformin ER 500 mg cost $4.65/100 tabs. Resell the bottle for $12 (which is actually less than what the patient would pay at Wal-Mart).


Leslie

I use this system.
http://www.dispensequick.com/accessories.html

I pay an average of 3-4 dollars for prepackaged antibiotics and/or maintenance meds, and sell the for 10 across the board. (Zpacks cost 11, and I sell them for 20) Most people prefer to buy from me to save the time and effort waiting at Wal-Mart.

I could bulk buy and repackage myself, but in my opinion.. this is tedious, would increase labor cost, and make inventory tracking a headache.

I do offer my employees some fun incentives to make the program flow better, as it does require some extra effort. This makes it a Win-Win for everyone.

While I am not going to get rich off of dispensing, patients truly do appreciate this value added service.

ADILJAFFER, (would love to call you by name)
Thanks for the input. I have looked at that program previously. Should my patients take to this new service I might bite the bullet and go that route. I think I will simply test the waters first doing it myself. The only things really needing repackaging are the antibiotics. The other routine maintenance meds I would sell in bottles of 100 (how they come to me). As far as inventory tracking goes, the shipments are so fast now days that, if I am out I surely can get them in in a day or so. Not really any different than when a patient has to mail in scripts and then hope they get their meds in 10-14 days.

I have also considered asking patients what they want me to order and, if more than $4, are they willing to pay my cost plus a modest profit. I can then special order these for them.

I'll see how it goes. It may end up too cumbersome.

Leslie

Leslie, nice points.
I believe Ohio requires my and the patients name on the bottle as well as the date, so that was a hurdle in selling the 100 stock bottles.
And it does seem that many people do not mind mailing or waiting for 3 month supplies of maintenance meds.
The ones that sell the quickest are for acute care (probably 90% of total)and would need re-packaged if bought in bulk. The most popular movers are amoxicillin, cipro, bactrim ds, cephelaxin, zithromax, naprosyn, and ibuprofen in counts ranging from 4 to 60. When I factored labor, bottles, labels, and time, I figured I would just buy from a re-packager.
Let me know how it goes though, maybe I will need to reconsider.

I just completed my first day of dispensing a few generic medications. SO FAR, THE PATIENTS LOVE IT!!! I had numerous requests for me to see if I can get their routine generics more cheaply than they can. They loved getting their antibiotics at the time of their visit and gladly paid the small charge for them. I will update more as I get more experience with it but, this may be my schtick (sad but true).

Leslie

Congrats Leslie!
You are indeed adventurous. Please keep us posted on this endeavor. I am interested in how well it works out.

I have been dispensing medicatons for 8 years out of my clinic. It is a hundred mile round trip to the nearest pharmacy for my patients. If I didn't dispense, many of my patients would just make a trip to town, do their shopping, go to an urgent care center, and go to a pharmacy. I keep a cabinet of my most commonly used meds. I have prepinted labels with blanks that I fill out and tape onto the bottles. It takes only a minute or two and my patients are very appreciative. I do not make much money but it is worth it to me. I add a 14$ dispensing fee to the cost of medication. With the current fuel costs it is a huge bargain and convenience for my patients.

My problem is that I would very much like to use the Superbill feature in the accounts section, but I haven't figured how to put in NDC numbers and HCPC codes for medications and supplies dispensed from my clinic. Can anyone advise me how I can do this?

Kerrius,

So far my patients love it too. In two days I have already taken enough orders for "stock bottles" to order without a shipping fee. I too made labels (using Avery software) and simply write their name and date on the label (which already had the directions and drug name on it) and stick it to the bottle. I would guestimate I make $5-10 per script. I can track these meds in AC in the Meds section by simply putting a "DO" before the drug name, e.g DO Amoxicillin 500 mg.
I actually had a patient give me a hug and a kiss today because I saved her over $60 by dispensing 100 Lisinopril 20 mg which she
can cut in half. She got 200 doses for $12, I made $6. It took all of about 60 seconds to process. I have never seen patients whip out their cash or their checkbooks so quickly as I have the last 2 days. I track the manufacturer, lot number and expiration dates in my PM program using the packing slip which came with the drugs when shipped. When the front office ladies enter the charge/payment for the drug, they can quickly enter this info also. I am trying to figure a way to do that in AC but have not yet come up with a better solution. Right now, I can do a search for the drug in AC then cross-reference in the PM program should I need that info.

Leslie

Leslie,
One, can what you want to write fit in the little yellow comments line? Would that work for you and your lot numbers?

Second, as a PAR provider are there any laws about requiring us to have to bill thru and go by the rates that the cartel idiots force upon us? Or as providers are we not governed by the pharmacy sides rules? Always the paranoid practice manager...

Lastly, more sincere concern as well as paranoia, did you say you are using little pill envelopes? Or are you using proper Rx bottles. I'm just thinking there is a real reason for tamper, child resistant bottles. I hate to think of some kid getting hurt and you getting in trouble because of it... I kept meaning to run this one by you and then would always forget when I get on here.... Well, I did remember finally....

Thanks for sharing and yes please keep us all imformed as to your adventures in micro pharmacy,
Paul

What about self-pay patients, who have no money at the time of visit? Would you dispense them your medication and bill them later?

Keep us posted Leslie.
I am curious about the prior cash pay question. Do you trust they'll pay you back? Or do you simply not dispense unless they can pay at time of service?

Paul,
First, I think I have discovered a place in AC to chart the drug specifics....in the Alert section which I use for little if anything.
Secondly, the patients who are taking advantage of this are those who either have no drug insurance, or find it cheaper and easier just to get this or that script locally (rather than through their insurance plan). I do not know of any contractual requirements forcing a patient to go one place or another. I think it has all been monetarily driven.
Third, child-proof containers are not mandatory in my state (don't know about NY) and my patients are generally much older. Like everything though, cautious warnings to the patient about the handling of drugs is given. I know of numerous patients who, because they themselves cannot get into the CRCs, simply leave the caps off...not really any different. The only meds going into pill envelopes are "single event meds
like antibiotics. All others are dispensed via stock bottles.
Apricot, I have not crossed the hurdle of "I can't afford it today, will you bill me" yet. But, I certainly have thought about it. In general, I think it would be safe to assume that, should a patient come into see you, say for a UTI, they would be prepared to go to the pharmacy and pay for a script. I know of none that would bill them. For those wanting their chronic meds I expect I will simply make it a policy of, no cash, no meds (although knowing me I will probably give away meds to some). It is bad enough not to get paid for the office call but then to get snookered also on their meds would be stupid.
Remember, I have not even been at this for a week yet. I have a lot to learn.

Leslie

You're a trail blazer (I'm a Jeep???) Leslie, you go girl!

I would extend credit. You will get burned on a certain percent, think of it as the cost of doing business. You will also be able to get some to make regular payments of 5-10 dollars per month. Some will settle up the bill when they can, (no really, some will do that,.. well at least one or two might or would if they didn't need the money for that new digital TV) You will be your own little miniature HMO but without the monthly CAP check.
But overall I think it would be a positive. Emotionally, not financially. (I am thinking of Ampicillin and Atenolol not Januvia or Actos). It would not be possible to extend credit if you are thinking of brand name patent meds.

It would not be a great business decision, but I would extend the credit.