News
AMA Opposes Giving Pharmacists Prescription Authority
Daniel Weiss, Senior Editor
Published Online: Tuesday, July 10, 2012
The country’s largest association of medical doctors has come out against expanding the role of pharmacists in prescribing medications.
The American Medical Association’s House of Delegates has adopted a policy against allowing pharmacists to prescribe medication without oversight by or an order from a physician. The policy, adopted at the organization’s annual meeting held last month in Chicago, opposes federal or state legislation that would give independent prescribing power to pharmacists or allow them to extend a prescription past its expiration.
The policy was adopted in reaction to a proposal floated by the FDA in March to shift certain prescription drugs for chronic conditions to a new category of OTC drugs that could be dispensed by pharmacists provided that “conditions of safe use” are met. The FDA argues that the move would help improve access to needed medication for many patients, but the AMA has countered that the proposal could jeopardize patient safety.
“While pharmacists are valued members of the patient care team, they do not have the statutory authority to prescribe drugs,” Robert Orford, MD, an assistant professor of medicine at the Mayo Clinic in Arizona, said during an AMA committee meeting, according to MyHealthNewsDaily. “Pharmacists' training is not even close to the comprehensive systematic training of physicians.”
The FDA proposal was based on the concern that many patients with chronic conditions such as hyperlipidemia, hypertension, migraine, and asthma fail to take necessary medication due to the cost and time required to get a prescription from a physician. In order to ensure that patients receiving medication under the new paradigm would be properly diagnosed and monitored, the FDA proposal raised the possibility of employing technology as well as expanding the role of pharmacists. For example, patients could access diagnostic technologies at a pharmacy or via the Internet, and pharmacists could perform routine monitoring using diagnostic tests and determine whether a patient should take a given medication.
According to MyHealthNewsDaily, an FDA representative pointed out that medications approved under the new category would have to go through an FDA approval process to establish that they could be safely administered using the new means of diagnosis and monitoring.
By contrast with the AMA, a number of pharmacy organizations, including the National Community Pharmacists Association, the National Association of Chain Drug Stores, and the American Pharmacists Association, have expressed qualified support for the FDA proposal. All of these organizations registered their appreciation for the expanded clinical role of pharmacists envisioned by the proposal but emphasized the importance of providing reimbursement in exchange for the added responsibilities it would entail.
To read more on this topic, click on the following links:
The American Medical Association’s House of Delegates has adopted a policy against allowing pharmacists to prescribe medication without oversight by or an order from a physician. The policy, adopted at the organization’s annual meeting held last month in Chicago, opposes federal or state legislation that would give independent prescribing power to pharmacists or allow them to extend a prescription past its expiration.
The policy was adopted in reaction to a proposal floated by the FDA in March to shift certain prescription drugs for chronic conditions to a new category of OTC drugs that could be dispensed by pharmacists provided that “conditions of safe use” are met. The FDA argues that the move would help improve access to needed medication for many patients, but the AMA has countered that the proposal could jeopardize patient safety.
“While pharmacists are valued members of the patient care team, they do not have the statutory authority to prescribe drugs,” Robert Orford, MD, an assistant professor of medicine at the Mayo Clinic in Arizona, said during an AMA committee meeting, according to MyHealthNewsDaily. “Pharmacists' training is not even close to the comprehensive systematic training of physicians.”
The FDA proposal was based on the concern that many patients with chronic conditions such as hyperlipidemia, hypertension, migraine, and asthma fail to take necessary medication due to the cost and time required to get a prescription from a physician. In order to ensure that patients receiving medication under the new paradigm would be properly diagnosed and monitored, the FDA proposal raised the possibility of employing technology as well as expanding the role of pharmacists. For example, patients could access diagnostic technologies at a pharmacy or via the Internet, and pharmacists could perform routine monitoring using diagnostic tests and determine whether a patient should take a given medication.
According to MyHealthNewsDaily, an FDA representative pointed out that medications approved under the new category would have to go through an FDA approval process to establish that they could be safely administered using the new means of diagnosis and monitoring.
By contrast with the AMA, a number of pharmacy organizations, including the National Community Pharmacists Association, the National Association of Chain Drug Stores, and the American Pharmacists Association, have expressed qualified support for the FDA proposal. All of these organizations registered their appreciation for the expanded clinical role of pharmacists envisioned by the proposal but emphasized the importance of providing reimbursement in exchange for the added responsibilities it would entail.
To read more on this topic, click on the following links:
User Comment(s)
Comment(s)
Your comments are valuable to us. Thank you.
Morris Burgess III, PharmD
July 10th, 2012 - 06:22:41 PM
"[Robert Orford, MD, an assistant professor of medicine at the Mayo Clinic in Arizona, said during an AMA committee meeting, according to MyHealthNewsDaily. “Pharmacists' training is not even close to the comprehensive systematic training of physicians.”]"
To Dr. Orford, I would like to say that while admittedly pharmacists may need more systematic training, it certainly does not mean that pharmacists are not capable.
Pharmacists have ample knowledge in the areas of pharmacology, pharmacokinetics and dosing standards as well as a learned knowledge base of viable alternative therapies that many physicians do not seem to have adequately mastered. In the hospital setting, I and many of my colleagues are routinely consulted for medication dosing, dosing and monitoring patients' warfarin or other anticoagulant therapies, vancomycin and aminoglycoside kinetics (and dosing), and the associated monitoring of patient's lab values because the physicians KNOW that pharmacists are more than capable of performing these highly skilled tasks and choose to use this time to attend to more patients. So why is it that the double standard exists?
The FDA's proposal involves maintenence medications that can easily be monitored. Many of the required lab monitoring can be easily and safely moitored as well, by a pharmacist. The associated safe standards of care, indications, diagnosing, recommended treatments and monitoring are taught in pharmacy school and in some cases even to the level of specialization and certification via residency. This proposal makes sense and, as the FDA would hope, would allow many patients the ability to receive their routine medications without the usual frustrations associated with trying to schedule an appointment with a doctor who is often overbooked, overworked and over-extended. Some patients can wait weeks to get in for treatment and then must "follow up" with the physician simply to get a refill of their prescription, many times without the benefit of even basic monitoring. Isn't the welfare of the patient more important than the AMA's posturing? I would hope so for the sake of the patients Dr. Orford so eagerly wants to serve. The statement that the necessary knowledge "isn't even close" simply does not hold water.
To Dr. Orford, I would like to say that while admittedly pharmacists may need more systematic training, it certainly does not mean that pharmacists are not capable.
Pharmacists have ample knowledge in the areas of pharmacology, pharmacokinetics and dosing standards as well as a learned knowledge base of viable alternative therapies that many physicians do not seem to have adequately mastered. In the hospital setting, I and many of my colleagues are routinely consulted for medication dosing, dosing and monitoring patients' warfarin or other anticoagulant therapies, vancomycin and aminoglycoside kinetics (and dosing), and the associated monitoring of patient's lab values because the physicians KNOW that pharmacists are more than capable of performing these highly skilled tasks and choose to use this time to attend to more patients. So why is it that the double standard exists?
The FDA's proposal involves maintenence medications that can easily be monitored. Many of the required lab monitoring can be easily and safely moitored as well, by a pharmacist. The associated safe standards of care, indications, diagnosing, recommended treatments and monitoring are taught in pharmacy school and in some cases even to the level of specialization and certification via residency. This proposal makes sense and, as the FDA would hope, would allow many patients the ability to receive their routine medications without the usual frustrations associated with trying to schedule an appointment with a doctor who is often overbooked, overworked and over-extended. Some patients can wait weeks to get in for treatment and then must "follow up" with the physician simply to get a refill of their prescription, many times without the benefit of even basic monitoring. Isn't the welfare of the patient more important than the AMA's posturing? I would hope so for the sake of the patients Dr. Orford so eagerly wants to serve. The statement that the necessary knowledge "isn't even close" simply does not hold water.
Mike
July 11th, 2012 - 10:11:20 AM
As a practicing pharmacist with 20 years of clinical experience and an RN it seems strange to me that the AMA will support Nurse Practitioner and Physician Assistant prescribing, yet they will not support Pharmacist prescribing under protocol or regulations? Pharmacists have far more medication training that a LNP or PA. My assumption would be that allowing physician extenders such as LNPs or PAs puts money in a physicians pocket, but allowing a pharmacist with 4 years of medication training takes money out of their pocket. Easy to see why they do not support this measure. Its not about the patient and improving access to critical meds. Its about the money.
CM Butler
July 11th, 2012 - 12:44:46 PM
Who do we think we are ?
That would be like a chef allowIng a dishwasher to cook a steak!
Please, Bob, get off your high horse.
You might be a chef but we certainly
Aren't your dishwasher, rather a chef in a different restaurant.
That would be like a chef allowIng a dishwasher to cook a steak!
Please, Bob, get off your high horse.
You might be a chef but we certainly
Aren't your dishwasher, rather a chef in a different restaurant.
Bill
July 13th, 2012 - 12:52:06 PM
Dr. Orford, I certainly take issue with you comments about pharmacists training compared to physicians. One might want to look at the classroom time spent by pharmacy students versus medical students in the areas of Pharmacology, Kenetics, Compartment Theory etc. and I think you might find some significant disparity. Today's pharmacists are a far cry from those of 30 years ago and posess the knowledge to manage patients theraputic needs. My daughter is a 4th year Pharm D student to be followed it by a 2 year residency program. Contrast that with an APRN or PA with full prescriptive power and I think you can see where I'm going.
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