The # 1 question asked by physicians concerning point of care medication dispensing: Is it legal?
YES! Every physician is allowed by law to dispense medications to his/her own patients, for a profit, within the practice environment. Under Stark regulations, physician dispensing is considered acceptable when the dispensing is limited to the physician’s own patients; and the medications and products dispensed meet FDA guidelines for pre-packaging and labeling. There are only two states which prohibit physician dispensing (MT, UT) and five which have limitations (AK, MA, NJ, NY, TX).
How much will “Point of Care” medication dispensing cost my practice?
The VantageRx dispensing system allows positive cash flow from day one. The cost of the medications ordered (we typically order a 2-week supply at a time) by the physician are charged on the practice’s credit card and does not need to be paid for 30 days later to the credit card processor. In other words, the physician collects the Rx Co-Pays from the patients from day one and doesn’t pay for the medications for 30 days later. The practice will need to supply its own computers, laser printers, and high speed internet access. VantageRx will facilitate the purchase of bar code scanners and medications and pharmacy labels.
Does “Point of Care” medication dispensing comply with state and federal drug dispensing regulations?
The VantageRx dispensing system complies with all DEA and FDA requirements. Repackaging companies are held to more stringent guidelines than pharmacies and all medications are repackaged in sterile environments to assure compliance. For example, the FDA has 7 steps to insure proper bottling, and our repackagers have up to 90 steps which far exceeds the requirements.
What is the profit potential to my practice?
The new revenue source can be very significant. As with any program, utilization is the key. Please have us prepare a personalized Proforma for your practice as the profits are based on your customized formulary, number of daily patients and number of prescriptions per patient. We have clients ranging from $1,000 to $50,000 profits per month. The “average” profit is around $7.50 per oral medication, whereas the profits from injectable kits are from $100 - $200 and collection kits and single NDC# compound creams are even higher. So… the monthly income depends upon the number of prescriptions written from your customized formulary.
Why have I not heard of this before? Is In-office dispensing a new concept?
The practice of in-office dispensing has been around since 1905, but a re-emergence as the industry began in the early 1980’s with repackaged medications being introduced into the market and recently and increased interest with the creation of various kits which can now be administered to patients. In 1983, a nationwide campaign lead by the retail pharmacy industry was begun with the intent to eliminate the physician’s rights to dispense. In 1985, legislation in Congress was passed in 46 states to secure the physician’s rights to dispense FDA approved medications to their own patients. The 1990’s dispensing systems were developing to make the process fast, easy and cost effective for the physician and now in the 2000’s with reimbursement cut backs to physicians and only a limited amount of time to see patients which decreases the chance of a physician increasing his patient load, physicians are turning to ancillary services such as in-office dispensing to help make-up loses from Medicare and managed care cutbacks.
Does the physician need a special license to dispense medications in the office?
There are 30 states that require either a Dispensing Practitioners license, or a controlled substance license, or both; in addition to your DEA license and medical license. These are very easy to obtain. The fees assessed by the states range from $50 to $245. VantageRx will assist you in obtaining these state licenses.
How will “Point of Care” medication dispensing benefit my patients?
Your patients benefit from the three “C’s”; Care, Compliance and Convenience. Your patients will no longer have to drive to the pharmacy and wait 60 minutes to fill prescriptions. Filling prescriptions in your office is an added service to your patients that saves them time and adds no additional cost to your patients. Additionally, by having the medications in your office, your patients will become more compliant. Statistically, between 35-40% of the scripts written don’t get filled for one reason or another, and then 6-8% of the time they are filled incorrectly, so dispensing directly to your patients is good medicine, and improves patient care.
What about security? Break-ins?
All doctors naturally have a concern regarding security. To date, none of our clients have experienced a break-in to steal medications. In theory, it could happen at any time. As a general rule, physicians have always maintained a supply of “samples” and have never had a thief break into the office to steal the “medications” (samples) in their office. After our clients dispense for 2-6 months, the concern regarding security subsides. There are motion detection digital cameras which can be installed to “film” a thief which breaks in at night. If this happens, we simply submit a report to the DEA to report the stolen items, overnight a replacement shipment, and you submit a claim to your insurance carrier for reimbursement.
What if patients ask about our pricing versus their regular pharmacy?
There are two types of patients, 1) Insured (with a drug card) and 2) Retail (no drug card – such as uninsured, auto claim, PI claim, high deductible, Medicare Part B). When we adjudicate online, your patients’ price will be exactly what it would be at the pharmacy (insured patients’ Rx Co-Pay). For “Retail” patients, you set your “cash” prices slightly below what pharmacies charge for retail prices (we update our system nightly with suggested prices set at $2.00 below the average pharmacy retail prices).
Who can dispense the medications in our office? Will I need additional staff to dispense?
In most states, a directive from the physician allows other staff members to dispense medications within the office. A few states do require that the physician actually do the dispensing or verify that the proper label is placed on the bottle. The volume dictates if it is necessary to hire a new full-time “dispensing technician”. The cost of this FTE comes from the new revenue of the program, and also frees up time for your current staff by no longer receiving most phone calls and faxes from pharmacies.
What liability does the physician practice assume by dispensing medications in the office?
The liability is the same for writing a prescription. The “risk” of the prescription being filled correctly is reduced by your staff dispensing the medication directly to your patient vs. hoping the pharmacy dispenses the correct medication. There are more stringent guidelines concerning packaging and labeling of pre-packaged medications than pharmacies filling the prescription. It is safer for a patient to receive a pre-packaged medication from you than it is to receive a filled prescription from a pharmacy. In-office dispensing does NOT affect your medical malpractice insurance.
What if we have multiple physicians in our practice?
Having multiple physicians in a practice is not a problem, as the system tracks the dispensing history separately by physician and patient. You can also have security access assigned at different levels to approved staff members who will be assisting in the dispensing process.
Will dispensing cause my malpractice premiums to increase?
NO, whether a physician prescribes medications that are filled at a pharmacy or dispensed in the practice, the physician’s responsibility is the same. Malpractice carriers do not charge higher rates for dispensing physicians.
Do we have to file insurance claims for medications dispensed in the practice?
No. By using our Adjudication system, we obtain verification in less than a second if the patient is eligible and the Rx co-pay amount (commercial, Medicare Part D, Workers’ Compensation, Tricare), and our system electronically bills the carrier for the difference (if any) between the Rx Co-Pay and the reimbursement amount. If there is a payment due beyond the Co-Pay, the payment will be sent to your practice by either VantageRx, or in some cases, directly from the carriers.
Is the VantageRx software program easy to use? Will VantageRx train my staff and how long will the training take
The VantageRx software has been designed specifically for use in an active physician’s practice. It requires minimal time, is easy to navigate and understand, and automatically tracks inventory, patient dispensing history, and other functions that are currently done manually in the practice. VantageRx will provide complete training and technical support. We suggest the staff to view our training videos and then our staff trains your staff. The training typically takes 45-60 minutes.
Is “Point of Care” dispensing efficient? How much time will it take my staff to dispense a medication?
The VantageRx dispensing program is easily integrated into your office procedures and is a streamlined process that can be completed in 30 seconds. Trained staff members can handle dispensing with minimal interruption to other office responsibilities. In fact, considering the amount of calls coming into each practice from pharmacies with questions about a script, we are confident that your staff will spend less time by using the VantageRx program.
Does the VantageRx program have a patient database with dispensing history?
Yes, patients are loaded in the database automatically when you dispense a medication and you can pull reports on dispensing history by patient, medication, date, physician, etc.
How much time will it take to enter a new patient into the database?
A new patient can be added within 30 seconds. The minimal required information would be the patient’s first name, last name, sex, and birth date. Insurance information (BIN#, PCN#, Group#, Member #) can be added at time of dispensing. We suggest to enter this information for a new patient while they are waiting in the waiting room to be seen by the physician.
Does the VantageRx program have an inventory tracking process?
Yes, the program will automatically re-order a particular medication which is below the pre-set levels that will be determined by each individual office at the time of installation and training. Medications are automatically drop shipped directly to your office from the repackager.
How secure is the VantageRx program?
A sophisticated password protected/encrypted system is built into the software. Each function performed by the software can be password protected to accommodate the needs and parameters of the individual physician practice. A double check system will not allow you to dispense a medication through the system that does not have a code matched to the item to be dispensed.
Will “Point of Care” dispensing upset local pharmacies?
If the local pharmacists are genuinely interested in good quality care, increased compliance on prescriptions actually filled; they should have no problems with point of care dispensing. The pharmacy’s industry statistics report that only about 60-65% of prescriptions are ever actually filled and with “Point of Care” dispensing, the physician knows that the patient received the medications thus increasing the chances of patient compliance. Having said this, with every medication dispensed in-office is one less medication filled at a pharmacy.
How much space is required? Is the cabinet a locked system?
The dispensing cabinet is a metal cabinet measuring approximately 30” wide, 72” high and 15” deep. It is a locking cabinet and conforms to DEA regulations concerning the storage of medications. An additional interior secured cabinet for controlled substances is placed within the exterior cabinet if you want to dispense Schedule II medications. The number of cabinets will be determined by the number of different items you want in your customized formulary (each cabinet can house up to 60 medications).
Are the pre-packaged medications supplied as starter doses or full course doses?
Almost all dispensing physicians prescribe a full course dose of medication therapy to their patients, but starter doses are available.
How do we determine which medications to include in our formulary and how do we order? Can VantageRx provide any medications I choose, including controlled substances?
VantageRx can provide any medication that is shown on our catalog and in most cases, ANY medication that you desire, including generics, name brands, controlled substances, schedule II medications (we have over 6,000 medications), collection kits, injectable kits, single NDC# compound creams. We suggest that you stock the medications that you most commonly prescribe. Your practice’s specific formulary will develop over time and will probably change with seasonal practice activity.
How do we re-order medications?
VantageRx’s dispensing program will automatically re-order the medications to be drop shipped to your location. Again, we order a 2-week supply at a time. Our goal that on any given day of the week that you have between a 1 - 2 week supply on hand (we do not want you to run out, but there is no need to have more than a two-week supply on hand).
How do I set pricing for the medications?
If the patient has insurance, the insurance company sets the Co-Pay amounts. For non drug card patients (auto, PI, uninsured, high deductible, Medicare Part B), you pre-select the “Cash” amount for each medication ($2.00 below the average pharmacy retail price). Your goal should be for your “cash” patients to pay slightly less than what they would pay at the pharmacy.
Which medications generate the most income for the practice?
Generally, generic medications offer the most profit potential for a physician’s practice and the greatest savings to the patients. We will compare like medications (pain meds, antiinflammatory, etc.) which you typically prescribe, so you can select the most profitable medication among your favorite most typically prescribed medications.
What about theft from Staff?
The VantageRx dispensing process is managed in such a way that theft is rarely a problem. Password protected automatic inventory system and dispensing records of who dispensed make it difficult to hide theft of medications. Every container is accounted for in the inventory system and the reports allow the staff to easily and quickly determine if there is a problem; unlike the basic “supply closet” concept.
Why purchase pre-packaged medications?
State and Federal regulations state that dispensing is allowed through the physician practice only if the medications are properly packaged and labeled. Products must comply to federally mandated current Good Manufacturing Practices (GMP’s) as noted in Title 21 of Code of Federal Regulations. Noncompliance with these laws could render the medication as “adulterated” and/or “misbranded”. It is a federal crime to dispense an adulterated or misbranded medication to a patient.
Why are pre-packaged medications repackaged in negative airflow sterile rooms?
FDA reports that 50% of all drug reactions in the United States are caused by penicillin and cephalosporin contamination. It is almost impossible to get medications from a pharmacy that does not have some contamination of dust spores from penicillin or cephalosporin based medications as all medications are sorted using the same trays as the penicillin/cephalosporin based medications and cross contamination is a constant problem. One unit of penicillin is invisible to the naked eye, and many patients are highly allergic to penicillin/cephalosporin which can lead to anaphylactic shock. Repackaging medications in sterile negative airflow environments greatly decreases the chance of cross contamination.
What happens if there is a product recall from a drug manufacturer?
VantageRx’s software program can help you quickly identify any patients who are currently using a medication that has been recalled. You will send these medications back to the repackager, at no cost to you.
Who do I call if I have problems with software, medication delivery, regulatory questions, etc?
We at VantageRx are very service oriented and have technical support available at any time to help with questions, concerns, software problems or problems with medication orders. You will have contact information for a technical support staff member upon installation and training.
Can we “see” online the payments received and the payments due?
Yes. We provide reports which give you details listed by PBM of the deposits made into your account. Also, we provide an AR report showing you the payments to be made, by PBM, patient, medication, etc.
What about Refills? What are my options?
There are three options you can easily handle refills for your patients (maintenance medications).
  1. Dispense the medication in your office. This may or may not be convenient for your patient, but it is an option.
  2. Dispense and mail. You dispense as if the patient was in your office, charge his/her credit card for their portion, and mail the medication (except Schedule II’s) to their home. You make the dispensing money and save your patients a trip to the pharmacy.
  3. Write a prescription for refills. You do not make any money with this option, but some health plans mandate the use of a certain mail-order pharmacy.

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