Guest guest Posted November 7, 2008 Report Share Posted November 7, 2008 In Virginia, there is a pharmacy license per practionor which is a couple of hundred dollars/year. You would also need to set up your pharmacy area and store, label, and dispense the meds in accordance with state pharmacy regulations. Recently, pharmacies in virginia have been required by law to submit certain prescription info to the state. Mostly schedule 2 and 3 meds I believe, so may not be a problem in IMP practice. I believe there are services which will do the labeling and a lot of the paperwork for you, if they are your wholesaler. StrazDoes anyone have experience with keeping 4 or 5 stock bottles of a fewgeneric medicines? It seems like patients would appreciate not havingto go to pharmacy for a single script. Some straight forward 1prescription treatments that come to mind are: Doxy for tick bites,PNC for strep, prednisone for PI, cipro for UTIs.They are just pennies per pill, if you buy by a bottle of a hundred. Im not talking about a big in office pharmacy.Lots of issues come to mind and can be used as reasons not to do itand I would appreciate hearing some comments on these and if you canthink of others:state regsmalpractice coverageHMO policiesundermine relationship with the pharmacy? (Chains give flu shots andsome now hire NPs to run clinics. Also just a handful of locals are left)How to charge? Perhaps ask pt for equivalent to a "pharmacy copay" butdont submit bill to HMO since the $10 to $20 would be adequate.It seems that patient convenience should be the overwhelming factor.Would appreciate some discussionMike Safran Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2008 Report Share Posted November 7, 2008 In Virginia, there is a pharmacy license per practionor which is a couple of hundred dollars/year. You would also need to set up your pharmacy area and store, label, and dispense the meds in accordance with state pharmacy regulations. Recently, pharmacies in virginia have been required by law to submit certain prescription info to the state. Mostly schedule 2 and 3 meds I believe, so may not be a problem in IMP practice. I believe there are services which will do the labeling and a lot of the paperwork for you, if they are your wholesaler. StrazDoes anyone have experience with keeping 4 or 5 stock bottles of a fewgeneric medicines? It seems like patients would appreciate not havingto go to pharmacy for a single script. Some straight forward 1prescription treatments that come to mind are: Doxy for tick bites,PNC for strep, prednisone for PI, cipro for UTIs.They are just pennies per pill, if you buy by a bottle of a hundred. Im not talking about a big in office pharmacy.Lots of issues come to mind and can be used as reasons not to do itand I would appreciate hearing some comments on these and if you canthink of others:state regsmalpractice coverageHMO policiesundermine relationship with the pharmacy? (Chains give flu shots andsome now hire NPs to run clinics. Also just a handful of locals are left)How to charge? Perhaps ask pt for equivalent to a "pharmacy copay" butdont submit bill to HMO since the $10 to $20 would be adequate.It seems that patient convenience should be the overwhelming factor.Would appreciate some discussionMike Safran Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2008 Report Share Posted November 7, 2008 Two years ago there were companies who would provide the prescribing system (storage for pills, label printing, pill bottles for your top ten meds) at minimal cost to the doc. I forget the companies’ names but it seemed like a sweet system. (The company made some $ but sure handles the hassle factor for the prescriber/dispenser.) Unfortunately, Montana law does not allow physicians to dispense medications (except samples) except under very rare situations. The company referenced above lost interest in me when they found out I practiced in MT. So.....check you state law to make sure you can do dispense. Also, in a small town, you’re very likely to be stepping on the local pharmacies’ toes since the very Rx you are thinking about dispensing are the ones where they have the biggest profit margin. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2008 Report Share Posted November 7, 2008 Two years ago there were companies who would provide the prescribing system (storage for pills, label printing, pill bottles for your top ten meds) at minimal cost to the doc. I forget the companies’ names but it seemed like a sweet system. (The company made some $ but sure handles the hassle factor for the prescriber/dispenser.) Unfortunately, Montana law does not allow physicians to dispense medications (except samples) except under very rare situations. The company referenced above lost interest in me when they found out I practiced in MT. So.....check you state law to make sure you can do dispense. Also, in a small town, you’re very likely to be stepping on the local pharmacies’ toes since the very Rx you are thinking about dispensing are the ones where they have the biggest profit margin. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2008 Report Share Posted November 7, 2008 Mike, I dispense quite a few generics in my office, everything from antibiotics to statins to bp meds, phenergan, lomotil, baclofen, triamcinolone cream, diflucan...... The patients love it. I purchase stock bottles of 100 for drugs such as simvastatin, metoprolol, citalopram and sell them for $12.00. The antibiotics are counted out into appropriate "event" numbers and packaged in pill envelopes onto which instructions are written. I pre-make sheets of instruction labels for the stock bottles. It is a cash only proprosition. I bill no insurance companies. There are many, many patients that would go to places like Wal-Mart to get these outside of their prescription plans before as they were actually less expensive. Now many of them get them from me. They love the convenience and ease of getting in my office to get their meds and those who are ill and get an antibiotic really appreciate not having to make another stop at the pharmacy. As far as my concerns about "undermining" relationships with pharmacies....I have none. As you said, they have encroached into our territory also. I cannot say I have made a fortune dispensing but, for the little time it takes me to order, put the bottles on a shelf, count out pills (I may do this one afternoon for an hour or so and get several packages ready) and then write a patient's name on a pre-made label, it is a nice service. My patients joke that maybe the next time they come in I'll also have milk and bread! I also have many patients ask me to order meds for them which are more expensive because it is still less expensive for them than at other places. I would advise you to first check out your state laws and then check out www.mohawkmedical.com. No shipping fees on orders over $200. Solo Internal Medicine Southern Indiana Stock bottles Does anyone have experience with keeping 4 or 5 stock bottles of a fewgeneric medicines? It seems like patients would appreciate not havingto go to pharmacy for a single script. Some straight forward 1prescription treatments that come to mind are: Doxy for tick bites,PNC for strep, prednisone for PI, cipro for UTIs.They are just pennies per pill, if you buy by a bottle of a hundred. Im not talking about a big in office pharmacy.Lots of issues come to mind and can be used as reasons not to do itand I would appreciate hearing some comments on these and if you canthink of others:state regsmalpractice coverageHMO policiesundermine relationship with the pharmacy? (Chains give flu shots andsome now hire NPs to run clinics. Also just a handful of locals are left)How to charge? Perhaps ask pt for equivalent to a "pharmacy copay" butdont submit bill to HMO since the $10 to $20 would be adequate.It seems that patient convenience should be the overwhelming factor.Would appreciate some discussionMike Safran Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2008 Report Share Posted November 7, 2008 Mike, I forgot to add that I do also keep an Excel sheet containing all of the medication information...wholeseller, manufacturer, lot numbers and expiration dates and when a patient makes a purchase here, it is recorded, along with the Excel info(by number) in their chart. My EMR does have a searchable database so, if needed I can find who I gave what to and when. Stock bottles Does anyone have experience with keeping 4 or 5 stock bottles of a fewgeneric medicines? It seems like patients would appreciate not havingto go to pharmacy for a single script. Some straight forward 1prescription treatments that come to mind are: Doxy for tick bites,PNC for strep, prednisone for PI, cipro for UTIs.They are just pennies per pill, if you buy by a bottle of a hundred. Im not talking about a big in office pharmacy.Lots of issues come to mind and can be used as reasons not to do itand I would appreciate hearing some comments on these and if you canthink of others:state regsmalpractice coverageHMO policiesundermine relationship with the pharmacy? (Chains give flu shots andsome now hire NPs to run clinics. Also just a handful of locals are left)How to charge? Perhaps ask pt for equivalent to a "pharmacy copay" butdont submit bill to HMO since the $10 to $20 would be adequate.It seems that patient convenience should be the overwhelming factor.Would appreciate some discussionMike Safran Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2008 Report Share Posted November 7, 2008 Mike, I forgot to add that I do also keep an Excel sheet containing all of the medication information...wholeseller, manufacturer, lot numbers and expiration dates and when a patient makes a purchase here, it is recorded, along with the Excel info(by number) in their chart. My EMR does have a searchable database so, if needed I can find who I gave what to and when. Stock bottles Does anyone have experience with keeping 4 or 5 stock bottles of a fewgeneric medicines? It seems like patients would appreciate not havingto go to pharmacy for a single script. Some straight forward 1prescription treatments that come to mind are: Doxy for tick bites,PNC for strep, prednisone for PI, cipro for UTIs.They are just pennies per pill, if you buy by a bottle of a hundred. Im not talking about a big in office pharmacy.Lots of issues come to mind and can be used as reasons not to do itand I would appreciate hearing some comments on these and if you canthink of others:state regsmalpractice coverageHMO policiesundermine relationship with the pharmacy? (Chains give flu shots andsome now hire NPs to run clinics. Also just a handful of locals are left)How to charge? Perhaps ask pt for equivalent to a "pharmacy copay" butdont submit bill to HMO since the $10 to $20 would be adequate.It seems that patient convenience should be the overwhelming factor.Would appreciate some discussionMike Safran Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2008 Report Share Posted November 7, 2008 I work in free and university clinics that have done dispensing (with Allscripts and without), so I know that managing the pharmacy license and everything that goes along with that would be time-prohibitive for me in NC. Also, I have an independent pharmacist who gets me vaccines at cost (cheaper than I can get them anywhere else), and that relationship could be spoiled by taking some of the medication dispensing business. Haresch > > Does anyone have experience with keeping 4 or 5 stock bottles of a few > generic medicines? It seems like patients would appreciate not having > to go to pharmacy for a single script. Some straight forward 1 > prescription treatments that come to mind are: Doxy for tick bites, > PNC for strep, prednisone for PI, cipro for UTIs. > > They are just pennies per pill, if you buy by a bottle of a hundred. > Im not talking about a big in office pharmacy. > > Lots of issues come to mind and can be used as reasons not to do it > and I would appreciate hearing some comments on these and if you can > think of others: > state regs > malpractice coverage > HMO policies > undermine relationship with the pharmacy? (Chains give flu shots and > some now hire NPs to run clinics. Also just a handful of locals are left) > How to charge? Perhaps ask pt for equivalent to a " pharmacy copay " but > dont submit bill to HMO since the $10 to $20 would be adequate. > > It seems that patient convenience should be the overwhelming factor. > > Would appreciate some discussion > Mike Safran > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2008 Report Share Posted November 7, 2008 I work in free and university clinics that have done dispensing (with Allscripts and without), so I know that managing the pharmacy license and everything that goes along with that would be time-prohibitive for me in NC. Also, I have an independent pharmacist who gets me vaccines at cost (cheaper than I can get them anywhere else), and that relationship could be spoiled by taking some of the medication dispensing business. Haresch > > Does anyone have experience with keeping 4 or 5 stock bottles of a few > generic medicines? It seems like patients would appreciate not having > to go to pharmacy for a single script. Some straight forward 1 > prescription treatments that come to mind are: Doxy for tick bites, > PNC for strep, prednisone for PI, cipro for UTIs. > > They are just pennies per pill, if you buy by a bottle of a hundred. > Im not talking about a big in office pharmacy. > > Lots of issues come to mind and can be used as reasons not to do it > and I would appreciate hearing some comments on these and if you can > think of others: > state regs > malpractice coverage > HMO policies > undermine relationship with the pharmacy? (Chains give flu shots and > some now hire NPs to run clinics. Also just a handful of locals are left) > How to charge? Perhaps ask pt for equivalent to a " pharmacy copay " but > dont submit bill to HMO since the $10 to $20 would be adequate. > > It seems that patient convenience should be the overwhelming factor. > > Would appreciate some discussion > Mike Safran > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2008 Report Share Posted November 8, 2008 Thanks for comments. I too work PT in a university health center and we dispense there also. I will start with them to figure out state laws. I too thought about the last local pharmacy left in town. I refer all my patients to him as is. We also use him for our families prescriptions. ly, if he is depending on our small practice, he is dead in the water. 98% of our patients use the chains anyway. They are competing with me. Anyone else want to chime in? Mike Instant access to the latest most popular FREE games while you browse with the Games Toolbar - Download Now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2008 Report Share Posted November 8, 2008 Thanks for comments. I too work PT in a university health center and we dispense there also. I will start with them to figure out state laws. I too thought about the last local pharmacy left in town. I refer all my patients to him as is. We also use him for our families prescriptions. ly, if he is depending on our small practice, he is dead in the water. 98% of our patients use the chains anyway. They are competing with me. Anyone else want to chime in? Mike Instant access to the latest most popular FREE games while you browse with the Games Toolbar - Download Now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2008 Report Share Posted November 8, 2008 You are describing what I was thinking about. I cant believe how inexpensive these generics are. I dont want to get into filling long term rx's like statins. Patients can go to Walmart or Hannaford and get them for $3. The issue is really patient convenience. Many of our patients are driving 15 to 20 miles or more to see us. They dont want to make another stop and wait in line. Added benefit may also be reduction in expectation for unpaid phone work (I know this is a whole other story so please no comments about that). For example.......If Ms. calls and says I just found a tick can you call in Rx? Or " I have a UTI" Receptionist can now say "come in we have it here", Vital signs, tell what to look for, give two doxy or 6 cipro and bingo 99212 or 99213. NYS laws are definitely something I need to check. Anyone else trying to drive WalMart out of NYS by giving out 6 Cipro? Mike Mutt, I share your concern about local pharmacist but 98% of patients go to chains anyway and gosh, darn it, they are trying to take my bread and butter. We are not a small town. There must be at least 1 to 2 dozen chain and Walmart type pharmacies in region. I think I can continue to work on my relationship with last local guy in other ways. I send him all my patients to him for DME, splints, compounding, special orders, etc. Thank you both for your comments. Mike S. Instant access to the latest most popular FREE games while you browse with the Games Toolbar - Download Now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2008 Report Share Posted November 11, 2008 I found out in NYS you can only prescribe for 3 days unless you dont charge for medicines. I still might elect to do it. Patients will love it and 3 days will cover tick prophylaxis and short treatment for UTI. Again, will decrease phone management requests for those patients who are not prepared / dont want to pay for telephone management. Mike S.Instant access to the latest most popular FREE games while you browse with the Games Toolbar - Download Now! Quote Link to comment Share on other sites More sharing options...
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