IN MASSACHUSETTS, a doctor who diagnoses someone with pneumonia has to send the patient off to a pharmacy to fill a prescription for antibiotics. In most other states, the doctor can dispense the prescription right in the office, saving the patient time and money.

“Part of the reason drugs cost so much is that middlemen — commercial pharmacies and pharmacy benefit managers—add substantial costs over wholesale prices,” according to a new report from the free-market think tank Pioneer Institute. “Allowing prescribers to dispense routine drugs — often at a fraction of the price — would give patients a more affordable option. As a policy matter, this is low-hanging fruit in Massachusetts’ quest to reduce prices and increase access to care.”

The advocacy group Health Care For All said it does not have a position on the direct dispensing question. “Changes that make care and medications more easily available also have to consider potential impacts on safety and costs,” the organization said in a statement. “What is needed more broadly is for stakeholders to come together to consider ways to make prescription medications more affordable by eliminating and reducing co-pays for widely used chronic condition medications, and reviewing and reining in the cost of the most expensive prescription drugs.”

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