BRP

PHARMACEUTICALS
Physician Dispensing at point-of-care
What is Physician Dispensing & Point of Care Dispensing?
Physician dispensing enables doctors and clinics to offer their patients timely, convenient, and hassle-free alternatives for
receiving their medication.
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Regulatory Compliance
Under current medical licenses, physicians are permitted to dispense medications at the office directly to patients
with no restrictions in 44 states.
BRP is licensed by the FDA and DEA.
Physician dispensing is supported by the American Medical Association.

Physician dispensing is regulated at the state level by the state board of pharmacy.
!
Medication Adherence & Procedure Concerns in the US

! 50% 30% $100 billion

! of patients do not adhere to of prescriptions are spent each year in avoidable
prescription medication regimen never filled at all hospitalizations as a result
[ New England Journal of Medicine, April 29, 2010, Volume 362, Number 17 ]
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Point-of-Care Dispensing Offers Multiple Benefits to your Patient
!
!
! Adherence &
! Compliance Convenience Cost Savings
!
!
!
!Providing the medication to the Point-of-Care eliminates the extra trip Most medications dispensed by
! patient in the office improves and inevitable wait at the pharmacy physicians are generic and can be
!patient compliance to doctors for elderly and those with acute sold at or below a patients
! prescribed orders. symptoms or transportation issues. standard co-pay.
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Point-of-Care Dispensing Offers Multiple Benefits to your Practice

$
$
$
$

Better Manage Less Hassle Frees Expand Offered Additional

Patients Health up Staff Time Ancillary Services Revenue Stream
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BRP
PHARMACEUTICALS
! What we do
!!!
! hasToday,
BRP been in the pharmacy business for over 100 years and repackaging medications since
!
1980. BRP is a trusted provider to over 2000 physicians, clinics, and pharmacies across the
! States, servicing clinics across 32 specialties
United
! has access to the broadest range of quality pharmaceuticals, building strong relationships
!BRP
!
! various manufacturers and distributors to gain access to all generic and branded products. If
with
a!clinic needs a product we either have it or will find it for them.
!
!
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!
! How we do it
!
! repackage bulk medications into smaller bottles, label, and ship the final product to the
We ! allowing physicians to dispense medication directly to the patients at the time of the visit.
!
office,
!BRP!
! follows rigorous safety and quality standards. We are licensed with the FDA and DEA, and
hold
! a pharmacy license in all 45 states that support physician dispensing.
!
!
!
! How we started
!
! in 2004 and headquartered in Burbank, CA,Bryant Ranch Prepack, Inc.is a leader in
! re-packaged pharmaceuticals industry. In 1980, a doctor requested that one of our stores in
Founded
the!
La! Mirada, California prepackage a few medications so that sick patients would not have to wait
for! their prescriptions to be counted out. Within a few months, the doctor asked us to provide
!
pharmaceuticals to his clinic on a regular basis, andBryant Ranch Prepackwas born.
!
!ThoughBRPhas
! continued to grow into the industry leader that it is today, the company aims to
maintain the same family run business principles established so long ago. This family mentality
is reflected in our dedication to patient care and clinical excellence.
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!
BRP PHARMACEUTICALS
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Regulatory Compliance: American Medical AssociaTIon
!
! Code of Ethics
AMAs
!
Opinion 8.06 - Prescribing and Dispensing Drugs and Devices
!
!!! Physicians may dispense drugs within their office practices
!
! provided such dispensing primarily benefits the patientIn
! all instances, physicians should respect the patients freedom
!! of choice in selecting who will fill their prescriptions as they
are in the choice of a physician and, therefore, have the
!! right to have a prescription filled wherever they wish.
!!
!!
! American Medical Association, Issued June 2002. This opinion is a consolidation of
Source:
! Opinions 6.04, "Fee Splitting: Drug or Device Prescription Rebates;" 8.06, "Drugs and
previous
! Prescribing;" and 8.07, "Gifts to Physicians: Offers of Indemnity.
Devices:
!
!W!! hat This Means for You and Your Practice
! Point-of-care dispensing places a premium on issues such as patient convenience and
!
!
compliance with medication while providing a benefit to the physician over practice revenue.
!
!
Regulatory
!Under their current Compliance:
! Who can dispense
!patients at the point-of-care,
license, physicians are allowed to dispense medications, directly to their
! from their office, with no restrictions, in 44 states.
!
!
!
!
!
!
!
! Allowed
!
! Restricted
!
!
!
!
Munger et al., Pharmacotherapy, Oct 2014, Volume 34, Number 10: 1017
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BRP
PHARMACEUTICALS
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! Benefits for your patient
!
! Convenience
! Receiving medications at the time of the office visit eliminates the extra trip to the
! pharmacy & waiting 30-60 minutes for the prescription to be filled. This is
! especially meaningful for elderly patients, patients with acute symptoms and
!
! patients with transportation issues.
!Cost Savings
!
!
! Most medications dispensed by physicians are generic and can be sold at or
! below a patients standard co-pay.
!Confidentiality
!
!
! Patients can be sensitive about privacy of their illnesses and medications, the
! confidentiality of receiving their medication at the medical office is a major plus.
! !
!
! Adherence & Compliance
! Providing the medication to the patient in the office improves the odds of patient
compliance to doctors prescribed orders.
!
!
!
! Benefits for your Practice
!
!
!
! Patient Health Management
! Increasing patient adherence allows providers to better manage patients health
! !
! ! As many as 50% of patients do not adhere faithfully to their
! ! prescription medication regimen, while 30% of prescriptions
! ! are never filled at all. The result is more than $100 billion
! ! spent each year in avoidable hospitalizations.

! !
! New England Journal of Medicine, April 29, 2010, Volume 362, Number 17

! !Increased Offered Services

!
! Medication dispensing is a primary ancillary service received by patients from their primary
! care physician:
! ! 38%
! ! 36% 34%
! !Lab Services Drug Dispensing Radiology
! !
!
! Increased Revenue Stream
Dispensing medications directly from the office allows a practice to expand offered
ancillary services, thereby increasing revenue
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BRP PHARMACEUTICALS
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! Benefits for your Staff
!
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! Staff Convenience
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! Less staff time spent on the phone with pharmacies.
!5 Steps, 2 Minutes
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! After brief and simple training, properly dispensing a prescribed medication takes
generally 2 minutes.
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! Physician Dispensing Process: 5 steps, 2 minutes
!
!
! 1 Enter
! the patient's details into the software
! !
!Select the medications to be dispensed and add them to the patients record
! 2!
!
!
! !Patient pays for medication
! 3!
!
! !Print medication label and patient education sheet, available in English or
4 Spanish!
!Apply patient-specific label to the bottle and dispense to patient. The patient
5 leaves the office with everything they need to begin recovery/treatment.

Physician testimonials
BRPs dispensing program is easy for our
patients and they really like the service.
The labels are correct so there are no
errors and the cost is usually lower than
co-pays.
Mahfouz Michael, M.D.
President, Clinica Medica San Miguel
In urgent care it is important to treat the
patient quickly and comprehensively.
BRPs program helps us give complete
care in one visit.
Konstantinos Melahouras, M.D.
President, Southland Family, Urgent Care
 BRP
PHARMACEUTICALS

startup costs and equipment

Cost to get Started: - Just the cost of the initial med order.
Use of the MDscripts Dispensing Software FREE (Comes complete with 24/7 IT support)
Personalized account management by BRPs Customer Service center and
initial webinar training program with you and your staff. FREE
Labels are FREE
Paper Dispensing Bags are FREE (Comes in Packs of 100 Bags)
Shipping and handling fees only apply if your order is under $150.00, otherwise you
receive FedEx Shipping FREE. (*Expedited shipping is available but it is at your expense.)
!Equipment Needed:
The beauty of our program is that if you have a Computer, you already have
everything you need to get started.
2D Barcode Scanner (Optional): The dispensing software supports a 2-Click dispensing
system as well as use with a scanner.
Label Printer (Optional): The printer will print out a personalized label with pertinent patient/
office info

Setting up an account with BRP pharmaceuticals

Develop the Formulary
Obtain physicians formulary with size and strength of most commonly prescribed meds
BRP will provide a detailed price analysis based on the formulary
Physicians will review the formulary analysis and select medications they would like to carry
!Staff Participation
A staff member will be assigned to oversee the dispensing system.
!Documentation
Photocopy of prescribing physicians State License
If dispensing controlled substances, a photocopy of the physicians DEA License
If required by the State, a photocopy of physicians State Dispensing License
Completed BRP Application
!Medication Order
Provide an opening order. We suggest a 2-3 week supply to start
 BRP
PHARMACEUTICALS
Legality and risk
How is this regulated?
44 out of 50 states in the United States, it is absolutely legal for physicians to do point-of-care
dispensing without restriction. Physicians have the legal right to dispense medicine to their patients under
their current license.
Malpractice Risk?
In general, the insurance industry does not view medication dispensing as an increased risk of practicing
medicine. The actual risk is in the decision regarding which medications, and combinations of medications
that are prescribed, not necessarily where medications are filled
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!Adoption trends
Are other physicians and prescribers doing this?
Ancillary services offered in physician offices are increasing, as physician reimbursement decreases and
patient satisfaction becomes more important
Lab Services, Drug Dispensing, and Radiology are three ancillary services most commonly offered by
primary care physicians
In 2010, roughly 10% of practicing physicians offered in-office dispensing, and trends indicate that
physician dispensing with grow by approximately 25% in the coming years
As an industry leader, BRP Pharmaceuticals currently serves over 2000 physicians across 44 states
!
!impact on patients
Convenience
Patients appreciate receiving medications in the physicians office to avoid an additional trip to the
pharmacy and waiting 30-60 minutes for their prescription to be filled
This is especially meaningful to patients with acute symptoms and patients who have transportation
issues
Compliance & Adherence
According to the New England Journal of Medicine, as many as half of all patients do not adhere
faithfully to their prescription-medication regimens. Furthermore, approximately 20%-30% of medication
prescriptions are never filled at all. Data estimates that more than $100 billion spent each year on avoidable
hospitalizations due to prescription non-adherence.
Providing the medication to the patient in the office improves the odds of patient compliance with
doctors prescribed orders.
!
!impact on staff
Impact on office staff training is minimal
Current technology and software platforms have created a turnkey process, automating the dispensing
process through a user-friendly, personalized software, or an internet based system.
Impact on office staff capacity is time-neutral
Many practices currently dispensing in office report that dispensing in office has reduced the number of
calls, back-and-forth, between the office staff and pharmacies
It is estimated that each call to/from a pharmacy costs $7. Reducing this traffic, and replacing it with
revenue-generating activity, practices are able to collect revenue for the prescription work that they do,
rather than waste employee capacity.
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! PHARMACEUTICALS
BRP
!
Regulatory
!
! Compliance: who can dispense
!
!
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MD, DO, DDS, DPM,
DVM, PA, NP can dispense
Limited to MD, DO, DDS,
DPM, DVM

how is in-office dispensing regulated?

No registration required
Registration required

No specific requirements
Some requirements
Must follow all
requirements

Munger et al., Pharmacotherapy, Oct 2014, Volume 34, Number 10: 1017
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BRPPHARMACEUTICALS
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! Legislative Counsel
State of California
! Article 12. Prescriber Dispensing
! !
4170. Dispensing by Prescriber: Requirements and Restrictions; Enforcement
! a) No prescriber shall dispense drugs or dangerous devices to patients in his or her office or place of practice UNLESS

! ALL OF THE FOLLOWING CONDITIONS ARE MET:

! 1) The dangerous drugs or dangerous devices are dispensed to the prescriber's own patient, and the drugs or
dangerous devices are not furnished by a nurse or physician attendant.

! 2) The dangerous drugs or dangerous devices are necessary in the treatment of the condition for which the

! prescriber is attending the patient.

3) The prescriber does not keep a pharmacy, open shop, or drugstore, advertised or otherwise, for the retailing
! of dangerous drugs, dangerous devices, or poisons.

! 4) The prescriber fulfills all of the labeling requirements imposed upon pharmacists by Section 4076, all of

! the recordkeeping requirements of this chapter, and all of the packaging requirements of good
pharmaceutical practice, including the use of childproof containers.

! i. Name of the patient, Name of the prescriber, Date of issue, Name and address of the prescriber,

! and prescription number or prescription ID, Strength of the drug or drugs dispensed, Quantity of
the drug or drugs dispensed, Directions for the use of the drug, Expiration date of the drug or

! drugs dispensed

! 5) The prescriber does not use a dispensing device unless he or she personally owns the device and the

! contents of the device, and personally dispenses the dangerous drugs or dangerous devices to the patient
packaged, labeled, and recorded in accordance with paragraph(4).

! 6) The prescriber, prior to dispensing, offers to give a written prescription to the patient that the patient may

! elect to have filled by the prescriber or by any pharmacy.

7) The prescriber provides the patient with written disclosure that the patient has a choice between obtaining

! the prescription from the dispensing prescriber or obtaining the prescription at a pharmacy of the patient's

! choice.

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b) The Medical Board of California, the Osteopathic Medical Board of California, the Board of Registered Nursing,
the Veterinary Medical Board, and the Physician Assistant Committee shall have authority with the California State

! Board of Pharmacy to ensure compliance with this section, and those boards are specifically charged with the

! !
enforcement of this chapter with respect to their respective licensees.

! 4171. Exceptions to Section 4170: Samples; Clinics; Veterinarians; Narcotic Treatment Programs; Certain Cancer
Medications

! a) Section 4170 shall not prohibit the furnishing of a limited quantity of samples by a prescriber, if the prescriber

! dispenses the samples to the patient in the package provided by the manufacturer, no charge is made to the patient
therefore, and an appropriate record is entered in the patient's chart.
! !
4172. Storage Requirements
! A prescriber who dispenses drugs pursuant to Section 4170 shall store all drugs to be dispensed in an area that is secure. The

! Medical Board of California shall, by regulation, define the term "secure" for purposes of this section.
!
! 4173. Dispensing by Registered Nurses

! This chapter does not prevent the dispensing of drugs or devices by registered nurses functioning pursuant to Section 2725.1.
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! Medications Stocking Reports, CURES reporting, invoices, and other inventory management actions are required to legally
dispense medications out of your office software has been developed to automatically manage and send these reports to the

! proper regulating entities.

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