Harrison Epstein, Daily Herald

In 2022, the Utah Legislature voted unanimously to pass a bill adjusting who is allowed to provide drugs and operate as a licensed dispensing practice.

Jaren Blake, operator of the solo practice Blake Family Medicine in Provo, received the first license to provide medications to patients directly through non-employer-based clinics.

“Only in our health care system in America do we believe that adding multiple middlemen — not just one or two, but like a dozen — will make something cheaper. Health care is the only industry that we think that’s the case. And really it’s not. So what House Bill 301 did, it catches us up part way with the rest of the country,” Blake said.

Blake Family Medicine operates using direct primary care, meaning patients work with their physician directly, and does not accept insurance reimbursement. Rather than having hundreds or thousands patients, as is typical with a corporate clinic, they have around 100 neighborhood-area patients.

“I’m getting paid to take care of my patient no matter where they are, so I’m going to do about two or three virtual visits for every one in-person visit, because it doesn’t change my finances. So I can always do what’s better for my patient,” he said.

Harrison Epstein, Daily Herald

Blake was first exposed to the world of direct primary care, or DPC, while doing rural medicine in Blackfoot, Idaho. A neighboring DPC clinic opened and he was confronted with a different way to do medicine.

“You’re working directly with the patient. There’s no third-party payer,” Blake said. “Too much of our health care system is designed around putting barriers between patients and the physicians.”

Patients of Blake Family Medicine enroll in a subscription with the clinic. For $60 a month, adult patients can visit the clinic as frequently as needed and receive a host of commonly prescribed medications, as needed, under that cost. While additional prices exist for select medications and injections, along with laboratory tests, Blake argues they all still benefit the consumer.

Patients are able to contact Blake directly with questions, whether or not it is during clinic hours, and make appointments to come in for further tests or treatment.

In addition to in-house antibiotics and other medications that previously required a pharmacy visit, Blake keeps a variety of over-the-counter medicines available.

Harrison Epstein, Daily Herald

Rep. Ray Ward, a Bountiful Republican and the bill’s sponsor, said during a Feb. 14, 2022, hearing of the House Health and Human Services Committee that the legislation was a product of rethinking licensure requirements across the board.

According to H.B. 301, clinics can only provide a 30-day supply of prepackaged medications and are not allowed to dispense controlled substances.

It also simplified a process that, at the time, allowed for clinics to give patients samples of common medications to take home or administer them in an office, but couldn’t give the same medication to use as a directed treatment.

“If in-clinic a doctor or nurse practitioner wants to give a medicine to their patient — let’s say that they have a (urinary tract infection) and they’re going to give them a shot of an antibiotic, they would verbally or in writing tell their medical assistant, ‘Go get this shot in this amount and give it to them.’ That medical assistant would go off the shelf, which right now has those medicines on it, there’s two or three there, they would get that medicine off right now today and put that injection in them,” Ward explained. “(Under the bill) they would go to the shelf, pick that package off and give it to them.”

The bill was co-sponsored in the Utah Senate by Mike Kennedy, R-Alpine, and was passed by votes of 72-0-3 in the House and 26-0-3 in the Senate. Several legislators spoke in the House committee hearing in favor of the bill, along with representatives from the Utah Academy of Family Physicians and the Utah Medical Association.

Harrison Epstein, Daily Herald

Carrie Dunford, a member of the Utah Board of Pharmacy, suggested the “two layers of protection” remain in place for patients needing long-term care. She also sought standards around security, labeling and drug access that are akin to those found in a pharmacy.

Blake considers himself a guinea pig for the process, having been the first to receive the licensure to dispense medications. The biggest hurdle he’s dealt with is people, especially those paying high premiums for health insurance, who want to use their plans, even when paying out of pocket can be cheaper.

“I don’t like the third-party payers controlling most of the decision making. That’s what I don’t like. I think that power belongs to the patient,” Blake said. “For me in the DPC model, I’m just trying to give affordable medications to my patients.

“To paraphrase Steve Jobs — we’re trying to drive incredible benefits for our patients.”

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