Montana should get with the times on doctor dispensing

Montana should get with the times on doctor dispensing

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In recent months, states across the country have rolled back scores of unnecessary regulations that were preventing patients from obtaining much-needed medical care. Montana’s law banning doctors from dispensing prescription medications should be next.

As family doctors, we see patients almost every day who have difficulty obtaining the medications we prescribe. Sometimes the problem is cost. Sometimes patients forget to fill their prescriptions. Sometimes the issue is the inconvenience of making extra trips to a pharmacy (especially now that people are being advised to avoid unnecessary public outings). But whatever the precise reason, prescription non-adherence is common and has major costs, both to patients’ health and to society at large.

One way to help solve this problem is to allow doctors to dispense common medications, such as antibiotics, at cost, directly to patients in their offices. Forty-four states and Washington, D.C., already allow doctors to provide this beneficial service. And as proponents of the direct-primary-care model — which extols the doctor-patient relationship and aims to streamline the provision of care for patients — we would like to do the same. But Montana effectively bans the service.

Montana’s law is backwards. Historically, doctor dispensing was the norm in this country. As one doctor noted in 1722, “all our Practitioners dispense their own medicines.” That norm remained largely unchanged until the late 20th century, when pharmacy groups lobbied in several states to ban the practice. While some states, like Montana, hewed to the lobbyists’ wishes, most states have embraced doctor dispensing and a majority of our peers across the country now report dispensing on a daily basis.

This makes sense. Doctor dispensing, by making treatment easier and more affordable to obtain, increases the chances patients will take the medications they are prescribed. The practice is also quite safe. A 2014 report from the University of Utah shows that patients experience adverse reactions to medications at the same rate whether purchasing them from doctors or pharmacies. That’s hardly surprising. If doctors are qualified to prescribe you the right medication — and we are — we’re certainly qualified to hand it to you on your way out the door.

In a way, Montana’s ban implicitly recognizes these benefits. The ban does not apply to doctors who work more than 10 miles from pharmacies. Nor does it prohibit doctors from dispensing free samples, dispensing “occasionally” or dispensing in an “emergency.” Unfortunately, all three of us work too close to pharmacies to qualify for the 10-mile exception, and the other exceptions are too narrow to allow us to dispense for most of our patients. But these exceptions beg the questions: If dispensing is good for rural patients, why not for urban ones? And if dispensing is good “occasionally” or in “emergencies,” why not regularly?

The obvious answer is that doctor dispensing is, broadly speaking, a good thing. Giving doctors the freedom to offer more convenient, more affordable care is good for patients. And giving patients the freedom to choose that care is good for their health outcomes and for the broader medical system. That is why we recently teamed up with the Institute for Justice to file a constitutional lawsuit to strike down Montana’s ban. Simply put, there’s no good reason for Montana to remain a national outlier on this issue.

Dr. Carol Bridges, Dr. Todd Bergland and Dr. Cara Harrop are licensed family doctors who work in Missoula, Whitefish and Polson, respectively.

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