Could Prescribing Become a Daily Duty for Pharmacists?

MAY 19, 2016
Time and time again in pharmacy school, I was taught that pharmacists are the drug experts. It’s the pharmacist’s job to verify that the medication that the patient’s receiving is the right one and that it won’t counteract with any other medications the patient’s taking or any allergies the patient might have.
 
Pharmacists have a heavy education load, as a PharmD can take 5 to 8 years to obtain, along with the option of postgraduate residences that require even more time. Pharmacists take more pharmacology and pharmacotherapeutic classes than any other health care professional, and yet, in most states, pharmacists are still unable to prescribe medications.
 
However, some recent changes at the state level have led to me wonder whether prescribing could become a daily duty for pharmacists in the future.

The roles and responsibilities of the pharmacist are already expanding throughout the country. For example, an Oregon law allows pharmacists to prescribe hormonal contraceptive patches and oral contraceptives to women 18 years and older upon completion of a board-approved training program. This law not only gives pharmacists prescriptive authority, but also makes birth control more accessible.
 
Instead of scheduling an appointment with a physician, patients in Oregon and California can walk up to a pharmacy counter, fill out a health questionnaire, get their blood pressure checked, and, if everything’s okay, obtain the contraceptive from the pharmacist.

California passed a similar law that took effect in April 2016 and declares pharmacists to be health care providers. The law further expands pharmacists’ scope of practice by not only allowing them to prescribe hormonal contraceptives to any age group, but also permitting them to use their skills in many more ways.
 
Under California’s law, pharmacists are able to initiate certain prescriptions, as well as provide clinical advice to their patients. Other provisions permit pharmacists to:
·      Prescribe nicotine replacement therapy, which normally requires a prescription from a physician.
·      Prescribe medications for travel health purposes, such as scopolamine patches and promethazine.
·      Mandate tests to monitor and maintain the efficacy and toxicity of drug therapies for patients with comorbidities, such as diabetes, hypertension, and hyperlipidemia.

According to the California State Board of Pharmacy, a pharmacist must meet 2 of 3 conditions in order to receive this prescriptive authority:
1.     Earn certification in a relevant area of practice, such as ambulatory care, critical care, oncology pharmacy, or pharmacotherapy.
2.     Complete at least a 1-year residency program upon completion of pharmacy school.
3.     Provide clinical services to patients for 1 year under a collaborative practice agreement or protocol with a physician or other health care provider.

Along with Montana, New Mexico, North Carolina, and North Dakota, California gives pharmacists mid-level practitioner status, allowing them to enter into a collaborative practice agreement with any physician in order to initiate and modify any type of drug therapy, including controlled substances. However, federal law requires pharmacists to obtain a DEA registration number before prescribing controlled substances. With this mid-level practitioner status, patients can now walk into a pharmacy for immediate attention concerning their pain management, which is very convenient for them.

In Florida, pharmacists are allowed to prescribe a variety of medications on a formulary that was created by the state Board of Medicine, Board of Osteopathic Medicine, and Board of Pharmacy. The formulary consists of any medicinal drug encompassing fluoride or lindane in any strength; any topical anti-infectives, with the exception of eye and ear topical anti-infectives; any medicinal drug that contains any antihistamine or decongestant as a single active ingredient or in combination; and any medicinal drug recommended by the FDA Advisory Panel for transfer to OTC status pending approval by the FDA.
 
Pharmacists must abide by this formulary and only prescribe those medications for reasonable conditions while continuing to use their professional judgement. The prescriptive authority law requires that the prescriptions are legibly written or typed, the quantity of the drug is written in numerical and textual format, the date of the prescription is written in textual letters, and the practitioner signs the prescription on the day it’s issued.

With these laws in place, pharmacy could be heading in the direction of prescribing. In the future, we could see pharmacists with prescriptive authority nationwide, allowing them to prescribe medications that are included in a formulary determined by legislators and state boards. Pharmacists may even be required to register with the DEA so that they can prescribe controlled substances and be allowed to mandate tests and labs, which we already see in some states.
 
Plenty of states are already allowing prescriptive authority in some shape or form, so it’s only a matter of time before more states jump on board. Pharmacists are the true drug experts, so it makes sense that choosing the appropriate medication should be part of their job.
 
What’s your opinion on this matter?


Shelby Leheny, Pharm D, B.S
Shelby Leheny, Pharm D, B.S
Shelby Leheny received her Doctor of Pharmacy Degree from Lake Erie College of Osteopathic Medicine (LECOM) and her Bachelor's of Science degree at the University of Pittsburgh. She is a pharmacist at CVS.
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