“Doctor dispensing” is the term for when doctors hand their patients a drug prescription on site in their office instead of sending the order through pharmacy middlemen. Texas is currently one of five states that do not allow doctors located within 15 miles of a pharmacy to bypass pharmacies and dispense the drugs themselves.
In fact, there are only eight doctors in all of Texas that are legally permitted to dispense drugs themselves.
The two doctors behind the lawsuit are Dr. Kristin Held of San Antonio and Dr. Michael Garrett of Austin. The pair are joined in the lawsuit by the Texas office of the Institute for Justice (IJ), an organization which aims to “protect Texans’ private property rights, economic liberty and freedom of speech.”
The suit was filed on June 27 in the Travis County District Court against the Texas State Board of Pharmacy and the Texas Medical Board.
First, they argue that the law doesn’t accomplish anything for the general public, just industry insiders such as pharmacy benefit management organizations. And second, they argue that the law is “unduly burdensome compared to their public objectives.”
IJ Attorney Wesley Hottot said of the legal challenge, “The Texas Constitution forbids laws that do nothing more than protect the financial interests of established businesses.”
Should the lawsuit be victorious it wouldn’t require patients to get their prescriptions filled directly from the doctor, but would rather simply expand patients’ options, thereby forcing pharmacies to compete with doctors in the drug dispensing market.
Proponents say this would help drive down rising drug costs.
A 2017 survey conducted by Truven Health Analytics and NPR found that over two-thirds of patients who do not fill their prescriptions do so because of cost. With nearly a third of total prescriptions going unfilled, a lot of patients go without their prescribed medicine.
Held said in a video on IJ’s website, “The ban on doctor dispensing raises drugs costs, endangers my patients and hinders my ability to practice medicine. The only ones who benefit are the pharmacies.”
There is also a belief that in light of the cost-barrier to filling prescriptions, dispensing directly from the doctor will better ensure the patient actually receives their medicine.
The Texas Public Policy Foundation’s analysis of the issue found inconclusive results as to the cost-effectiveness of doctor dispensing, but argue that such an approach makes sense for providing patients with more options, improving the ability of physicians to provide care, and potentially decreasing the overall number of patients who choose not to fill their prescriptions.
Of course, a number of studies have come to differing conclusions.
One study published by the American Journal of Managed Care found costs of prescriptions were reduced due to doctor dispensing. Another published in 2012 by the Workers Compensation Research Institute out of Massachusetts, a state that also bans direct dispensing, found costs associated with direct dispensing were higher.
Among the proponents is the Texas Medical Association (TMA).
TMA told The Texan they support “allowing physicians to dispense medications out of their offices to patients, at cost. Doing so can reduce patients’ costs and improve their care, by increasing the likelihood they will take their necessary medicine.”
TMA added, “While [we] are supportive of the aims of the lawsuit, we are not a party to it.”
Critics say the law change would threaten the safety of patients.
The Texas Pharmacy Association (TPA) opposed a similar bill during the 86th Legislature which would have accomplished the same goal as the lawsuit. TPA called it at the time, “detrimental to patients [and] the profession.”
That bill, sponsored by Rep. Tom Oliverson (R-Cypress), died in committee.
During the bill’s hearing, TPA CEO Debbie Garza testified, saying, “This bill threatens patients’ health and safety by not requiring the same high standards to which pharmacists are held to promote safe medication use and patient safety.”
But a 2014 study conducted by the University of Utah found that the rate of urgent care and emergency room visits from prescription drug problems is the same whether the patient buys their drugs from a pharmacy or directly from the physician.
During her testimony, Garza also cited an Express Scripts study which found that over 66 percent of “medication non-adherence” is done out of inattention and procrastination as opposed to high prescription drug costs. This stands in contradiction to the Truven Health Analytics survey.
About the Express Scripts study’s conclusion, Garza said, “It’s not about not being able to get to the pharmacy. It’s about human behavior. And you can’t legislate that.”
Express Scripts is a Fortune 100 company that was bought out by Cigna last year in a $67 billion merger. Prior to the merger, Express Scripts has been the largest pharmacy benefit management firm in the United States.
Pharmacy benefit managers serve as third-party middlemen that manage the prescription drug supply chain and its interaction with various health insurance plans.
Besides Texas, the other states who continue to prohibit direct dispensing are Massachusetts, New Hampshire, New Jersey, and New York.
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Brad Johnson is an Ohio native who graduated from the University of Cincinnati in 2017. He is an avid sports fan who most enjoys watching his favorite teams continue their title drought throughout his cognizant lifetime. In his free time, you may find Brad quoting Monty Python productions and trying to calculate the airspeed velocity of an unladen swallow.