Physician Dispensing State by State Comparison
Dispensing regulations Overview
Please start by reviewing this excellent 2014 review entitled National Evaluation of Prescriber Drug Dispensing (page 6 contains the most useful chart). Here is a 2011 Physician Dispensing Survey by the National Association of Boards of Pharmacy.
When dispensing please note whether the medication is available over the counter (rather than prescription only). In most states OTC medications are subject to sales tax. In most states prescription only medications are not subject to sales tax (except Illinois and Louisiana).
ID, KS, AR, MS, AL, and VA are the six states that restrict dispensing to MD, DO, DDS, DPM, DVMs (NPs and PAs will not be permitted to dispense in these states).
Alabama - The Alabama Board of Medical Examiners does require that dispensing physicians register. The one page form is not much of a burden and there appears to be no cost associated with the registration. Only those dispensing "controlled substances" need to register, so the board's definition of a controlled substance might be worth clarifying prior to registration. NPs and PAs are not permitted to dispense medications.
Physician Dispensing Defined
Physician Dispensing Overview Page
Dispensing Physician's Registration Form
Arizona - Physician Dispensing is permitted in Arizona. Physicians do need to register with their appropriate board of medicine. DOs may use this form and MDs may use this form. This DO FAQ form might also be a useful reference.
Arkansas - The in-office dispensing of medications can be more difficult in Arkansas compared to other states. A permit must be obtained from the state medical board. NPs and PAs are not permitted to dispense medications.
California - Physician dispensing is permitted. This practice was challenged and upheld in Park Medical Pharmacy v. San Diego Orthopedic Associates Medical Group, Slip Op. No. D038051 (June 11, 2002), 2002 Cal App 4225. Please see the case above and the California page for a detailed discussion.
Colorado - Permitted. No registration requirement.
Connecticut - Permitted. No registration requirement.
Delaware - Permitted. No registration requirement.
Florida - Physician Dispensing is permitted in Florida. They do have a formalized process where the physician must complete the simple three page dispensing form listed at the top of this page and pay a $100 fee. Their detailed description of their dispensing rules can be found on this page. If you would like to dispense medications you should register as a "dispensing practitioner" with the Florida Board of Medicine. Some of the most important language is outlined on the Florida page.
Georgia - Dispensing medications is permitted in Georgia and physicians that wish to dispense must notify the Georgia Composite Medical Board. The Georgia Department of Public Health does have a recommended Drug Dispensing Procedure. The law is cited below, but this set of frequently asked questions from the Drug and Narcotics Agency of the State of Georgia is especially helpful. The law is a good example of clear guidance for physicians, and might be used by physicians in other states with little guidance if they are looking for a reference to develop their own policies and procedures around dispensing. It is discussed in more detail on the Georgia page.
Hawaii - Permitted. No registration requirement.
Idaho - Permitted. No registration requirement. NPs and PAs are not permitted to dispense medications.
Kansas - NPs and PAs are not permitted to dispense medications.
Maine - Permitted. No registration requirement.
Maryland - For a Maryland physician to dispense medications the physician must submit a detailed application to the Maryland Board of Physicians and include a $1,050 fee. A litany of requirements must be met (some are listed at the bottom of this page). Customized continuing education related to dispensing is required (here is a group of them available from the Maryland State Medical Society). One must submit to inspections and submit information to the board. Dispensing must be "in the public interest" - which in the board's eyes means that a pharmacy is not conveniently available to the patient.
"Licensed dentists, physicians, and podiatrists are required to obtain a dispensing permit if they dispense prescription drugs to patients under their direct care who have informed the provider that a pharmacy is not conveniently available. The licensee shall maintain documentation that should include a single form in each patient's chart for each patient to whom prescription drugs are dispensed. At a minimum, the form shall:
(1) Indicate the reason, as stated by the patient, that a pharmacy is not conveniently available to that patient;
(2) Include a statement signed by the patient indicating that the patient understands that the determination that a pharmacy is not conveniently available is made solely by the patient; and
(3) Be signed and dated by the patient before dispensing prescription drugs to the patient for the first time. See COMAR 10.13.01.04."
Massachusetts - Prohibited.
Michigan - Permitted. No registration requirement.
Minnesota - Permitted. No registration requirement.
Mississippi - NPs and PAs are not permitted to dispense medications.
New Hampshire - Physician dispensing here is essentially prohibited. They are limited to providing a three day supply of medications for the “immediate needs” of the patient. “72 hours: In the ambulatory patient treatment areas of an institution, a medical practitioner may dispense drugs for the immediate needs of the patient but not to exceed a 72-hour supply and only if permitted by the institution.”
New Jersey - NJ Rev Stat § 45:9-22.11 makes it clear that "A physician shall not dispense more than a seven-day supply of drugs or medicines to any patient. The drugs or medicines shall be dispensed at or below the cost the physician has paid for the particular drug or medicine, plus an administrative cost not to exceed 10% of the cost of the drug or medicine." There are exceptions if you practice any of the following settings "hospital emergency room, a student health center at an institution of higher education, or a publicly subsidized community health center, family planning clinic or prenatal clinic."
New York - NY - Education Law, Article 137, Pharmacy §6807. Exempt persons. "No prescriber…, may dispense more than a seventy-two hour supply of drugs, except for:
- persons practicing in hospitals as defined in section twenty-eight hundred one of the public health law;
- the dispensing of drugs at no charge to their patients;
- persons whose practices are situated ten miles or more from a registered pharmacy;
- the dispensing of drugs in a clinic, infirmary or health service that is operated by or affiliated with a post-secondary institution;
- persons licensed pursuant to article one hundred thirty-five of this title;
- the dispensing of drugs in a medical emergency as defined in subdivision six of section sixty-eight hundred ten of this article;
- the dispensing of drugs that are diluted, reconstituted or compounded by a prescriber;
- the dispensing of allergenic extracts; or
- the dispensing of drugs pursuant to an oncological or AIDS protocol."
North Carolina - While North Carolina has historically made it difficult to conduct in-office dispensing, a review of their updated rules demonstrates few restrictions, but you will need to register as a dispensing physician and a review of the NC Board of Pharmacy's FAQs will also be helpful.
North Dakota - In 2015 Mark J Hardy, Pharm D, Executive Director of the ND State Board of Pharmacy published this helpful Administrative Guidelines for Practitioner Dispensing in North Dakota. See the North Dakota page for a discussion of requirements, which include a discussion of detailed record keeping rules, etc.
Ohio - Permitted. No registration requirement. In office dispensing is permitted in Ohio. The State of Ohio Board of Pharmacy requires that dispensing physicians obtain a Terminal Distributor of Dangerous Drugs license. All the details and applications can be found on this Ohio Board of Pharmacy website.
Pennsylvania - Permitted. No registration requirement.
South Carolina - Permitted. No registration requirement.
South Dakota - Permitted. No registration requirement.
Texas - For those seeking additional information about in office dispensing hurdles, please review the text of the Texas Occupations Code, Title 3 Health Professions, Subtitle B Physicians, Chapter 158 Authority of Physician to Provide Certain Drugs and Supplies. The problem is also discussed on pages 6 & 7 of this review manuscript on dispensing. Attempts have been made to correct this law, but the pharmacy lobby has repeatedly opposed any updates.
Utah - Historically the state had a total prohibition of in office physician dispensing. Modifications occurred in 2014 and 2015. As described in Utah Code Section 58-17b-801 to 58-17b-806 all physicians are now permitted to submit an application for a license as a "dispensing medical practitioner." These code sections are now part of the entire Utah Pharmacy Practice Act. If the license is obtained the physician will now be able to dispense only "cosmetic drugs," "injectable weight loss drugs," or a "cancer drug treatment regimen." These exceptions do not do much for most DPC practices. On-site "employer sponsored clinics" receive favorable treatment and are permitted to dispense routine medications that are "prepackaged drugs" that are provided "in a fixed quantity per package by a pharmaceutical wholesaler or distributor." If you want to open a DPC practice in Utah where you can dispense medications, then you need to do it as an onsite clinic treating only employees (not open to the general public) and you need to be able to dispense the medications without the use of a pill counter (which obviously requires repackaging - a prohibited move). For those that which to prescribe controlled substances (not recommended) additional rules apply. Here is the link to the Dispensing Medical Practitioner application. Here is a link to the Dispensing Medical Practitioner Clinic application.
Vermont - Permitted. No registration requirement.
Virginia - NPs and PAs are not permitted to dispense medications.
Washington - Permitted. No registration requirement.
West Virginia - Permitted. No registration requirement.
Wisconsin - Permitted. No registration requirement.
Wyoming - Permitted. No registration requirement.