Maybe we need to remove gatekeeping access to drugs from the primary care physician's job so that they can focus on the other parts.
If patients need lifestyle advice then going to a highly paid physician is a waste. Those patients should start with a (cheaper) therapist, personal trainer, dietician, or social worker. We can't reasonably put the entire burden on physicians; it's too much for one profession to handle.
I've had this experience once and my wife has had it thrice (different doctors, different injuries).
By asking primary care physicians to gatekeep drugs, we're introducing a bias where when you walk in the door they assume you're after drugs. I don't have a solution for how best to gatekeep drugs, I just wish I could find a doctor who was unencumbered by that task so they could focus on healthcare instead.
Certain health insurance plans may require a referral in order be reimbursed but that's not universal.
Every time you try to change a medical policy the threat is "you'll kill grandma". the fact is that grandma's care is awful and we need radical changes.
Breaking drugs out to pharmacies, Mexican style, would go a long way to interrupt this dependency.