CHICAGO—At ACR Convergence 2025, experts discussed two approaches to dispensing medication from a practice: creating an in-office dispensary and hiring an integrated clinical pharmacist. Both approaches shorten communication lines, save money and improve patient care.
Option 1: A Medically Integrated Dispensary
“Medically integrated dispensaries are when specialty medications are dispensed from the physician’s office,” said Waleed Bolad, MD, who is in private practice at Bolad Arthritis and Rheumatology Clinic, Odessa, Fla. “It is a [method] used by oncologists for a long time, with a lot success.”
In-office dispensing is not new, but practices typically contract with third-party vendors to provide the service. With medically integrated dispensaries, the medical practice itself owns the dispensary. By implementing this service Dr. Bolad has seen improvements in quality of care, along with financial advantages for the practice.
Dr. Bolad is affiliated with American Arthritis & Rheumatology Associates operated by BendCare, a large group of medical practices across the U.S., which launched a series of pilot programs to assess the pros and cons of integrating a dispensary into a practice as a model of care. It took almost a year to complete the initial work of establishing an in-office dispensary, which included contract negotiations with patient benefit managers and pharmaceutical companies, staffing the pharmacy technicians and other support staff, and licensing considerations, which vary by state.
“The rheumatologist acts as a pharmacist, double checking the medications, dosing, etc., to make sure everything is accurate,” Dr. Bolad said. “[The medication] is then dispensed by the pharmacy technician.”
Positive Patient Outcomes
The pilot program began in January 2024 and has already shown positive outcomes. The pharmacy technician contacts the patient every month to see if they are taking their medication—and if not, they ask why. They ask about side effects and illnesses, and can bring patients’ concerns directly to the physician’s attention.
Having a medically integrated dispensary can the shorten lines of communication. If there are concerns about side effects or other considerations, the pharmacy technician is trained to address them. And when the need for physician involvement arises, the doctor is literally next door.
Efficiencies have been seen in prior authorization and co-pay assistance, too. In both cases, the need was identified when the prescription was entered and applications were made.
When using a specialty pharmacy, another layer is involved that can cause delays. Medically integrated dispensaries eliminate this delay, communicating directly with the payer or the insurance company.
Additionally, having a medically integrated dispensary helps track patient adherence to treatment. If the medication is being dispensed in house and the patient is not picking it up, then less confusion arises around why a medication is not working. This situation also highlights the need to follow up and address issues or concerns.
When the patient walks out the door after an appointment with their medication, there are few concerns about delivery. Specialty pharmacies send the medications to the patients. Thus, when the patient is not home to accept the delivery, a dose may be missed.
Medically integrated dispensaries impact patient outcomes. Abandonment of medications has been shown to be around 18% for patients taking biologic disease-modifying anti-rheumatic drugs nationwide.1 In Dr. Bolad’s practice, it is less than 2%. Adherence has been estimated to be around 45%.2 In Dr. Bolad’s practice when the in-office dispensary was started, medication adherence increased to 90% for patients.
The Financial Benefit
A medically integrated dispensaries does have financial benefits for the practice. Dr. Bolad pointed to a gap in Medicare reimbursements, which increase the costs of running a medical practice. He said that savings and income from medically integrated dispensaries closed that gap.
“Where we are today, an office-owned dispensary—operated like an infusion center—is within reach,” Dr. Bolad said. “It is a vital part of the rheumatology service, and I can’t imagine ever going back to practicing without one.”
Option 2: Integrating a Clinical Pharmacist
Some state laws make the model of a medically integrated dispensary impossible, or a medical practice may prefer a different option. So a clinical pharmacist integrated directly into the practice may be the best option.
Co-located integration of pharmacists has been shown to deliver a range of non-dispensing interventions that help the patient and the practice. They are involved in patient management, coordination of care and address cost problems.
Depending on the needs of the practice, pharmacists can be used in infusions centers, coordinating home infusion or home administration. Although the duties of a clinical pharmacist may differ in each domain, most of the main responsibilities remain the same.
Integrating a pharmacist into a practice means making them a full member of the care team, giving them the same access to medical records as other members of the team. This aspect helps the clinical pharmacist obtain the information needed to provide efficient care and facilitates communication with the doctor and nursing staff.
“In our practice, after the initiation of the treatment plans are initiated and our dedicated prior authorization team obtains approval, the pharmacist help coordinates care,” said Katharine McCarthy, PharmD, University of Rochester Medical Center, Rochester, New York. “After that, we ensure medicine access and care management, including financial assistance, medication education, side-effect management and tracking prior authorizations to avoid gaps in therapy.”
External Clarifications
Many red flags exist due to safety issues with medications. Although some system-generated flags aren’t clinically appropriate, they will still delay medication approval for the patient. Example: Dr. McCarthy had a patient flagged because of a breast cancer diagnosis. Further investigation found the patient had been treated 10 years earlier and was in remission, removing the concern.
“The practice works hard to get the patient their medication, but external clarifications can still delay care,” Dr. McCarthy said. “It can be subtle things, [for example, if] the prior authorization approves syringes, but pens are prescribed and preferred by the patient. They may be looking for a loading dose when one isn’t indicated. The integrated pharmacist finds these roadblocks and addresses them quickly.”
Monitoring Patients & Education
The pharmacist is responsible for monitoring healthcare concerns with patients, including keeping an eye on their weight fluctuations, which may require changes to their dose. They track patient health issues, such as hospitalizations or recent appointments with their primary care providers for infections. Clinical pharmacists ensure that needed lab tests are completed and send reminders to the patient.
Additionally, patient education is a responsibility of the pharmacist. From initial instruction on the medication itself to the ongoing discussion about side effects and how to respond, the clinical pharmacist not only helps the patient, but also takes some of the burden off the physician.
The Savings & Efficiencies
Having a clinical pharmacist on site also has a positive financial benefit for a medical practice. The integrated pharmacist manages the formulary, looking for savings that increase income as reimbursement remains the same.
“We can also decrease medicine waste,” Dr. McCarthy said. “Every practice has patients who they know are not going to show up consistently. We’ve developed workflow processes so that we prepare and deliver the medicines needed after they have arrived.”
The clinical pharmacists in a practice are involved in formulary management, helping the practice prioritize medications with greater reimbursement. Many medications have similar costs, with savings changing based on where they are delivered. There are significant differences in overhead and facility fees such as infusion centers compared with home infusion.
“The involvement of an integrated pharmacist is new to many rheumatology practices,” Dr. McCarthy said. “There is a gap in the knowledge of how to best implement them in the practice. We can fill that gap by improving efficiency in the clinic and patient care.”
Kurt Ullman is a freelance writer based in Indiana.
References
- Hopson S, Saverno K, Liu LZ, et al. Impact of out-of-pocket costs on prescription fills among new initiators of biologic therapies for rheumatoid arthritis. J Manag Care Spec Pharm. 2016 Feb;22(2):10.18553/jmcp.2016.14261.
- Aksoy N, Ozturk N, Agh T, et al. Adherence to the antirheumatic drugs: A systematic review and meta-analysis. Front Med (Lausanne). 2024 Sep 12;11:1456251.
