In most states, a patient can take a strep test, see the results, and receive the appropriate antibiotics without ever leaving the doctor’s office. Although prohibitive overhead costs and dispensing laws render the practice an inefficient business model for many doctors, those who consider the price and effort worthwhile can lawfully run such a one-stop shop in most of the country. But in five states, the physician who just verified your illness and wrote the script for the medication cannot legally dispense it to you.
Why does this protocol exist, and whom does it protect? Predictably, the rule’s supporters (typically pharmacy lobbyists) insist it exists to ensure patient “safety.” Also predictably, the people it really protects are the pharmacy middlemen, who see less business when doctors can give prescriptions directly to patients.
Let’s examine some defenses of these laws and see how convincingly they justify them.
Do Pharmacists Make Fewer Harmful Medication Errors Than Physicians Do?
According to “Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy,” the answer is no. A comparison of outcomes from doctor dispensing and pharmacist dispensing found no significant difference in the number of adverse drug reactions in treated patients. Exact figures are hard to find, because pharmacies go to some trouble to obscure their statistics, with 62% of employees in California pharmacies admitting they neglect proper reporting procedures. The estimated 5 million pharmacy errors every year in California alone, however, indicate a serious problem.
Do Pharmacies Provide Checks And Balances Against Errors?
A pharmacist’s oversight can certainly catch a physician’s error. But although checks and balances offer multiple chances to catch dangerous mistakes, it’s worth noting the principle is complicated in this circumstance. Each interaction requires managing two separate organizations—a clinic and a pharmacy—collaboratively.
Within each, employees are tasked with providing specific services, which they learn to carry out in their own organization. Because the in-office routine is disrupted somewhat by the temporary link between the pharmacy and the clinic, that link creates a point of vulnerability.
Each time a patient is “handed off” between any two healthcare offices, the risk of miscommunication increases the risk of medication error.
Does Involving A Pharmacist Lead To Better Adherence To Medication Schedule?
Unsurprisingly, ill and frazzled patients often skip the pharmacy entirely after being released from the clinic. Around 30% of patients fail to even fill their prescriptions, with cost and inconvenience listed as reasons. But when patients can leave the clinic with medication in hand, sometimes given to them at cost by the doctor, these two obstacles can be virtually eliminated.
Furthermore, similar instructions given by a doctor and then a pharmacist can lead to confusion instead of clarity. One set of verbal instructions and one information packet, immediately followed by the opportunity to act on them, results in better follow-through than multiple directives from multiple sources.
Do Pharmacists Prevent Pharmaceutical Corruption?
The opioid crisis brought illicit pharmaceutical sales into the light, with the role of rogue doctors given prominent positions in news stories and research papers. But although doctors became famous for skirting the law to get kickbacks from pharmaceutical companies, pharmacists who engaged in the same corruption received less blowback until recently.
Doctors and pharmacists both have a mandate to prioritize patient safety, but both professions inevitably employ honest and dishonest individuals. Physicians and pharmacists are already governed by similar codes of ethics regarding medication dispensing, and they both have a duty to avoid conflicts of interest. But as the American Society of Health-System Pharmacists (ASHP) bluntly stated, “Pharmacists, like other healthcare providers, have a paradoxical relationship with drug and device manufacturers.”
If anything, laws in the five restrictive states favor pharmaceutical companies far more than those in the other 45 states. They typically allow doctors to dispense one limited prescription—often an unnecessarily large brand-name box covered in advertisements—instead of a generic version in a small and discreet package.
Both physicians and pharmacists can, if they so choose, abuse their positions for personal gain. Ironically, allowing pharmacists to insert themselves where they are not needed, ostensibly to avoid corruption, is a perfect example of such corruption. The protectionist laws in these remaining states protect pharmacists, not patients, who have the right to get their medication without jumping through virtual hoops and literal pharmacy lines.