Let physicians dispense some medications

Big pharmacies are in trouble. In March, Walgreens announced that it had reached a $10 billion buyout deal with private-equity firm Sycamore — a price that was just a tenth of its $100 billion value a decade ago. In recent years, the big three — Walgreens, CVS, and Rite Aid — have closed thousands of stores nationwide.

Smaller, independent pharmacies are struggling, too. A 2024 National Community Pharmacists Association survey found that nearly a third of these owners and managers were considering closure in the next year.

The issues plaguing pharmacies are many, including high employee turnover, unfavorable reimbursements, and changing consumer habits. Adding to the trouble, applications to pharmacy schools are dropping, as are graduation rates.

These challenges put the health and safety of Americans at risk. The best health care in the world does not matter if patients cannot follow the doctor’s orders. Who hasn’t experienced the frustration of not being able to get a prescription filled because of limited pharmacy hours, supply chain issues, or long waits?

The hope in any private equity deal is that the new firm will be able to look with fresh eyes at the business model and the opportunities that exist to address challenges. The strategies taken by Walgreens during this transitional period are likely to have wide-ranging consequences for how we access health care and health care products. If the strategies they pursue are successful, their competitors will likely follow suit.

But even in the best-case scenario, we’re several years from seeing meaningful changes in pharmacy access. And that’s assuming the company and broader industry are successful in driving new strategy that matches the shifts in how people order and access care. What can we do in the meantime?

There is one relatively simple solution could ease pressures on pharmacists while improving patient medication access: point-of-care medication dispensing.

Point-of-care dispensing allows a licensed and authorized provider to give prepackaged doses of common, often generic, medication to a patient at the end of a clinic visit. Importantly, providers can dispense medications to treat acute conditions or help to manage chronic ones. The provider also can answer questions directly while enabling the patient to avoid a separate trip to the pharmacy — both of which improve patient adherence. (One of us, Patrick, has served as chief medical officer for an organization that used point-of-care services, while Matt is CEO of a company offering these services.)

Subsequent prescriptions can be filled in office, at a pharmacy, or by mail order. To ensure patient safety, point-of-care dispensing systems have the same checks and balances built in as pharmacies, including barcode scanning, integration with electronic medical records, and patient counseling. Significantly, point of care systems also include distribution of pre-packaged medications, reducing the likelihood of a dispensation error.

The idea here is not to replace pharmacists altogether. They play a vital role in the American health care system. Pharmacists have extensive training in therapeutics and offer unique skills to patients with complex needs. They offer counsel and protect against medical errors and unintended interactions. Their expertise is vital to patient health and safety and cannot be replaced with this system alone. Point-of-care dispensing is limited to the authorized prescribers within the practice where the medication is being dispensed (depending on state law). This means that point-of-care dispensing cannot be a “one-stop shop” for patients who see multiple specialists. Inventories are also limited, so less common medications and treatments outside of the recommended best practice, like Schedule II narcotics, will still require a pharmacist.  

But as we face a growing shortage of pharmacists and a backlog of unfilled prescriptions, we need to develop new strategies for decongesting overburdened pharmacies. We also need to better match the skills of caregivers to the needs of patients. Point-of-care dispensing provides a needed release valve for the constrained pharmacy system.

Some may worry that moving the dispensation of these medications to primary care offices will exacerbate operational challenges for pharmacies. However, more and more prescriptions are already being handled through mail-order services. Point-of-care dispensing will not noticeably exacerbate this problem. Additionally, by transitioning some drugs to point-of-care dispensing, pharmacies can focus on more complex, need-intensive medications.

Other solutions are also gaining momentum. For example, several business-to-consumer mail-order pharmacies have entered the market (e.g., Hims, Cost Plus, and Amazon Pharmacy). At the same time, central pharmacies owned by payers have begun to provide mail-order services for chronic medications under many insurance plans. These programs offer improved efficiency, lower overhead, and more cost-effective staffing while appealing to a social context accustomed to instant delivery.

What gets lost in that mix are patient-provider interactions. And mail order pharmacies can struggle to provide quick service in the context of acute illness.

Point-of-care medication dispensing offers a return to a more straightforward approach, common to physician practices throughout much of American history. To encourage adoption of this approach, regulatory changes will be needed and patient/physician awareness must increase.  This solution is simpler than many other options but maintains the connection between health care professionals and patients obtaining prescriptions. Focusing on familiar, prepackaged medications allows physicians to keep a stock of frequently used drugs for which they offer expert guidance. At the same time, pharmacists remain available and pharmacies become a place for more complex services.

As the lack of pharmacy access becomes an increasing problem, point-of-care dispensing is a lever for convenience, adherence and connection.

Patrick Aguilar, M.D., MBA, is the managing director of health at Olin Business School at Washington University in St. Louis and a practicing pulmonologist and faculty member in the WashU School of Public Health. Matt Hoff, MBA, is the CEO of A-S Medication Solutions.