Pennsylvania

Pennsylvania has no DPC laws at present. Prior efforts were publicly opposed by the insurance commissioners office. In prior years HB 1739 passed but SB 926 did not make it across the finish line.  The Pennsylvania Academy of Family Physicians has actively supported the DPC movement.  Multiple DPC practices are located within the state, and the largest, R-Health is attempting to form a network of DPC providers.  Be sure to review the Pennsylvania Insurance Code when planning your DPC practice.  Also note Pennsylvania's definition of a Health Maintenance Organization: PA Code Section 301.2 Definitions "An organized system which combines the delivery and financing of health care and which provides basic health services to voluntary enrolled members for a fixed prepaid fee."  Language like this may be found in many states and provides one more reason why it is often safer to bill in arrears (thus avoiding any "prepaid" argument) and why passing through lab work & medications at cost rather than including them in a bundled price is also often recommended (avoiding the "fixed" argument).

Pennsylvania has no physician dispensing registration requirement and no specific requirements for physician dispensing. Thanks to Kim Corba, DO for this excellent example of an in office dispensing policy!

The 2013 PA House Bill No. 1846 has been a source of the confusion for some regarding dispensing.  The thirty-day limit described in this bill is applied when a patient is seen pursuant to workers comp regulations.  DPC practice dispensing is generally outside of workers comp program, thus the 30 day limit typically would not apply.

PA Code Title 28 § 25.95. Mandatory compliances.

Any practitioner who is registered or licensed by the appropriate State Board to dispense drugs to patients is required to comply with § § 25.93 and 25.94 (relating to labeling—drug code number; and expiration date of drug).

§ 25.93. Labeling—drug code number.

The label on a dispensed drug container shall include the name of the drug, using abbreviations if necessary, the quantity, and the name of the manufacturer if the drug is a ‘‘generic’’ drug. In those situations where a practitioner specifically indicates that the name of the drug should not appear on the label, the recognized national drug code number should be placed on the label if such a number is available for the product. When a drug is dispensed by a practitioner other than a pharmacist, the label shall also bear the name and address of the practitioner, the date dispensed, the name of the patient, and the directions for the use of the drug by the patient.

§ 25.94. Expiration date of drug.

Drugs which at the time of their dispensing have full potency for less than one year, as determined by the expiration date placed on the original label by the manufacturer, may only be dispensed by a practitioner with a label that indicates said expiration date. The label should include the statement: ‘‘Do not use after (manufacturer’s expiration date)’’ or similar wording.

PA Code Title 28 § 25.114. Persons exempt from registration. (3) Practitioners licensed by law to prescribe, administer or dispense drugs or devices when operating under the authority of the licensure. Registration is required if practitioners engage in the manufacture or distribution of drugs or devices.

The language of 49 Pa. Code § 18.158 describes dispensing for Physician Assistants.  It does not appear to restrict them to any specific number of days.  It does state that they may not prescribe more than 30 days’ worth of a schedule 2 controlled substance.