Cutting the middlemen is safe, convenient, and cost effective
BOSTON – Massachusetts should join 45 other states and allow prescribers to dispense drugs, according to a new study published by Pioneer Institute.
“One reason why patients are paying more for prescription drugs out-of-pocket is that middlemen — commercial pharmacies and pharmacy benefit managers — add substantial costs over wholesale prices,” said Josh Archambault, who co-authored “Prescriber Dispense Makes Sense: Massachusetts Can Lower Prescription Drug Costs by Joining 45 States that Allow Direct Dispensing” with Josh Windham and Dr. Jeff Gold. “Allowing prescribers to dispense routine drugs — often at a fraction of the price — would give patients a more affordable option.”
From 2019 to 2020, per-member spending on drugs jumped 8.6 percent for the 71 percent of Massachusetts enrollees with commercial insurance, bringing the average annual cost to almost $1,000. For the nearly half of enrollees in the Commonwealth who are on high-deductible plans, that cost comes almost entirely out-of-pocket.
National survey data show that around 30 percent of adults aren’t taking their prescribed drugs because of price concerns, 18 percent aren’t filling their prescriptions due to price, and 15 percent are cutting pills in half or skipping a dose. Medication adherence increased by 29 percent for seniors on Medicare plans that allowed direct dispensing.
Ninety-two percent of prescribers who dispense report that they do so at prices that are the same or lower than what patients would pay in a pharmacy, and 81 percent of the patients who purchase drugs from them agree.
Research shows that patients who get drugs directly from prescribers experience negative reactions at identical rates as those who purchase from a pharmacy. A far lower percentage sought emergency room care from prescriber-dispensed drugs, perhaps because the patient can take the first dose with the provider and be monitored in the office for any immediate reaction.
Direct dispensing also saves consumers time and reduces the amount of time prescriber staff have to spend coordinating with pharmacies. It also evens the playing field with big pharmacy chains.
“As chains like CVS and Walgreens offer more primary care in their stores, they can effectively offer direct dispensing,” said Dr. Jeff Gold. “But in Massachusetts, all others are banned from doing so.”
A 2014 study found that five of the states that allowed prescribers to dispense drugs required the prescribers to comply with the same regulations as pharmacies, 26 states required complying with only some of the regulations, and 16 merely required dispensing prescribers to register with a state licensing board.
H 2140 (An Act to Improve Access to Prescription Medication), would allow providers to prescribe routine, non-addictive drugs as long as they informed patients of their right to choose where to fill prescriptions and complied with any labeling, storage or record keeping requirements the Department of Health chose to adopt.
In addition to the 45 states that allow physicians to dispense drugs, 38 also allow nurse practitioners to do so. Massachusetts, which recently allowed nurse practitioners to practice independently, should consider allowing direct dispensing for both.