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History of Dispensing
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Physician Dispensing Then and Now… 1200's to 1980
Back in 1271 in France, doctors and pharmacists were reported to have feuded over dispensing. This discussion has continued to this day in many countries, developed as well as developing. In 1240 the German Emperor Frederick II initiated the separation of the occupations performed by doctors and pharmacists. Doctors became the diagnostic and prescribing experts and pharmacists experts in drug dispensing and drug management. This development became possible due to urbanization whereby markets had become large enough to allow for specialization. Doctors could generate an income from diagnosing and prescribing. Likewise, pharmacists were not prescribing but could sustain a living through the sale and dispensing of drugs. The fact that doctors could generate an income from diagnosing and prescribing, and pharmacists from dispensing alone, was fundamental to the separation of the two practices.
These principles were accepted by Parliament in the UK in 1912 and by the national health insurance in 1964. Paying for a consultation is, however, not accepted in all cultures. In India and Pakistan patients do not generally accept paying a consultation fee, and the common way doctors generate an income is by dispensing (selling) drugs. This is also the practice in Japan, Mexico and South Africa. In 1991, over 80 % of all doctors in these countries dispensed medicines.
In countries such as Scandinavia and Germany, the two professions continue to be separate. For example, in Denmark the law does not allow a person to practice medicine and pharmacy at the same time. Doctors dispense injections and drugs only in special circumstances, such as emergencies.
Most countries have regulated dispensing by doctors. In the USA all 50 states have regulations governing physician dispensing 46 of them allow physicians to generate a profit from their practice. A US survey in 1989 found that 20 states had strengthened their regulations in the last 2-3 years.
The number of dispensing doctors has recently increased in several countries. In the UK about 12.5% of general practitioners were found to dispense in 1966/67(56). This increased slightly to 14% in 1989-90 and to 15% in 1993: dispensing doctors account for about 7% of all primary care prescriptions. In the USA, about 40% of all physicians dispensed drugs in 1923; this decreased to 25% in 1947, 8.7-10% in 1967, and about 5%-8.5% in 1990-91. A survey in Louisiana in 1992 based on questionnaires found that only 4 % of physicians dispensed; but the same survey found that 10.5 % stated that they intended to dispense within the next 2 years.
The industry consensus is that the number of dispensing doctors will continue to increase. The reasons include; significant reductions in deaths and unnecessary healthcare costs related to pharmacy errors; increase patient therapy compliance and convenience; purer and safer products for the consumer; lower reimbursement costs to payers; increased efficiencies in the physician office and finally a new source of revenue for the physician. In office dispensing in its present form began in 1982 with the introduction of FDA approved repackaged drug. Allowing Physicians other licensed medical professionals in the U.S. to dispense drugs packaged and labeled by an FDA approved Drug Repackager. Drug Repackagers in the U.S. are required to adhere to stringent Current Good Manufacturing Practices (cGMP’s) regulated by the FDA and DEA. While Dispensing drugs in the office use to be a complicated and time consuming process, today's current systems allow a physician to complete the entire dispensing process in less than 30 sec.
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