[Pharmwaste] Medication dispensers in doctors' offices

Thu Mar 29 08:17:46 EDT 2007

An interesting article was in the Business section of yesterday's
Philadelphia Inquirer about a medication dispenser for generic
prescription drugs that allows physicians to distribute prescriptions to
patients right in their offices.  Advantages are cited:  patients not
having to make separate trips to pharmacies; cost to patient generally
competitive with patients' insurance co-pays; physician is more certain
patient is receiving the correct medication; physicians' time is freed
from calling pharmacies; and physicians are more certain patients are
taking their proper medications.

>From the pharm waste issue, it raises new concerns and possible
solutions:  more places dispensing prescription drugs but perhaps more
institutional control; more places disposing of prescription drugs but
perhaps more easily identifiable "point sources" for easier collection.
The article raises some interesting possibilities.

 http://www.philly.com/philly/business/20070328_MEDS_DISPENSER.html      

 Machines offer drugs in physicians' offices                             
 An area company distributes a device that parcels prescriptions in      
 doctors' offices.                                                       
 By Stacey Burling                                                       
 Inquirer Staff Writer                                                   

 When his doctor prescribed a medicine for his heart failure earlier     
 this month, Kenneth Howley didn't have to go to the pharmacy to get it. 

 He picked it up at the front desk.                                      

 His medication - a hundred-day supply of a generic diuretic - came from 
 a bright-blue device much like a vending machine that towered among     
 Hatboro Medical Associates' file drawers. Howley paid $15 in cash for   
 it and was on his way.                                                  

 The 600-pound machine grew out of an idea that Howley's doctor, Jim     
 Judd, had about six years ago when some of his elderly patients lost    
 insurance coverage for prescription drugs. He started buying some       
 common generic medicines, selling them to patients for less than they'd 
 pay at the pharmacy and making a little profit for his practice as      
 well.                                                                   

 That evolved into QuiqMeds, a Plymouth Meeting company that provides    
 high-tech machines that dispense medicines - most of them generics - in 
 doctors' offices. Doctors order the medicines using a simple touch      
 screen. The patient pays, and the machine spits out the drug. A nearby  
 printer prints an instruction sheet complete with warnings in red and   
 color pictures of what the pills look like.                             

 The QuiqMeds approach, company officials say, is more convenient for    
 patients and often cheaper than the alternatives. At a time when their  
 margins are dwindling, doctors make about $5 a bottle on the drugs - if 
 their prescription volume is high enough to cover a $240-a-month        
 service fee for monitoring and restocking the machine.                  

 The machine increases the odds a patient will get the medicines the     
 doctor orders and keep taking them, doctors said. Plus, it saves        
 doctors phone time with pharmacists who cannot read their writing or    
 need approval for a refill.                                             

 "QuiqMeds gives them an opportunity to provide an ethical, quality      
 service to their patients, and earn some incremental income," said Mel  
 Stein, a pharmacist and former Aetna Inc. executive who joined the      
 company as chief executive officer last year.                           

 The company, which launched in 2005, now has eight doctors' offices on  
 board. It expects to add two more by the end of April and is in talks   
 with potential franchisers in Connecticut and Florida, Stein said.      

 While QuiqMeds can offer some popular name-brand drugs that insurance   
 plans do not cover - think Viagra and its ilk - its business model      
 rests on drugs that have been generic long enough to allow for          
 competition and rock-bottom prices, Stein said. The markup on those     
 drugs is high enough to allow QuiqMeds and the doctors to make some     
 money and sell the drugs at a price - usually $12 to $22 - that's       
 competitive with most people's insurance co-payments, he said.          

 The machines can hold 30 to 50 items. Doctors choose among 100 drugs.   
 The most popular so far treat high blood pressure and cholesterol,      
 inflammation and infection.                                             

 QuiqMeds is profitable only for large practices. Ideally, a practice    
 needs to be writing 325 to 375 prescriptions through the system each    
 month, Stein said.                                                      

 The company is entering the marketplace at a time when many insurers    
 are strongly encouraging subscribers to use generics, usually by        
 widening the gap between co-payments for generic and name-brand drugs.  
 The average insurance co-pay for generics is now $11, according to the  
 Kaiser Family Foundation. Co-payments rise if patients buy more than a  
 30-day supply of drugs.                                                 

 Independence Blue Cross, this region's largest insurer, is waiving      
 co-pays for generics for 1.2 million of its members for the rest of the 
 year, a move that makes QuiqMeds less appealing to some patients. Judd, 
 who is an investor and chief medical officer for QuiqMeds, said some    
 people got the drugs at his office even when their co-pays are $2 or    
 $3.                                                                     

 "The patient is more than willing to pay a couple dollars extra for     
 convenience," Judd said. "People see going to the pharmacy as a         
 burden."                                                                

 Aetna has partnered with MedVantx Inc., a California company that also  
 puts generic-dispensing machines in doctors' offices, but has a         
 different approach. The company has about 20 machines in the            
 Philadelphia area, said Jeff Taylor, an Aetna pharmacy director.        
 Patients receive the first month of drugs free from the MedVantx        
 machine. Insurance companies pay MedVantx for the drugs as a way of     
 encouraging their subscribers to try the cheaper medicines. The doctors 
 get nothing.                                                            

 "That's why we really like this program," Taylor said. "The reason the  
 physicians would do this is to help their patient."                     

 Doctors who use the QuiqMeds machines say they are not tempted to write 
 more prescriptions for the drugs they sell just because they make a     
 little more money.                                                      

 Stein said that the machines were good for the insurance companies -    
 they are the biggest winners in this model, since they pay nothing -    
 and that financial incentives are appropriate. "We believe that         
 ethically reimbursing a physician for medication therapy right there in 
 his office is a proper way of rewarding doctors," he said.              

 Glenn Hyatt, an Ambler doctor whose three-doctor group got a QuiqMeds   
 machine last June, said he believed the machine increased the odds that 
 patients would get and take the medicines he prescribed. His practice   
 is breaking even. "What I appreciate about this system is that it's     
 fully automated, and it's very secure," he said.                        

 Marc Kress, a Jenkintown doctor, said Blue Cross' free co-pays had hurt 
 his group, which also started using QuiqMeds last June. His             
 four-physician practice had hoped to make a little extra money in what  
 he said were tight times for doctors. "Unfortunately, I'm not seeing    
 the kind of volume that makes this a profitable enterprise," he said.   
 The group plans to try the machine for at least a year.                 

 Morris Kliger, a Lansdale physician who recently ordered the machine,   
 said his primary worry was patients' not taking their medications       
 because they could not afford them. "I can't imagine this could be a    
 huge moneymaker for us," he said. "It's just something that will keep   
 the patients compliant with their medications and, hopefully, satisfied 
 with the service they receive from us."                                 

Virginia Thompson
Sustainable Healthcare Sector Coordinator
Office of Environmental Innovation (3EA40)
US Environmental Protection Agency Region 3
1650 Arch Street, Philadelphia, PA  19103
Voice:  (215) 814-5755; Fax (215) 814-2783
thompson.virginia at epa.gov