editor'sNOTE: The Prescribing Pharmacist

MARCH 01, 2008

Mr. Eckel is professor and director of the Office of Practice Development and Education at the School of Pharmacy, University of North Carolina at Chapel Hill.

A few years ago, a commission representing the diverse branches of our profession came up with a vision of pharmacist practice for 2015 forecasting that pharmacists will be the health care professionals responsible for providing patient care for optimal medication therapy.

This deceptively simple statement sets a challenging goal of a much broader, patient-centered role for the profession. We are taking the first steps toward this future with the gradual yet widespread adoption of medication therapy management (MTM); establishment of a behind-the-counter category of drugs would be another step forward. Here is another intriguing possibility that would help make this vision a reality: independent prescribing by pharmacists.

Many states already allow collaborative practice between physicians and pharmacists that includes prescribing and ordering lab tests. Independent prescribing—already a reality in some other countries—could be a significant next step.

Support for this idea comes from a report released late last year by Kalorama Information predicting that as many as 6 states may allow pharmacists to prescribe independently within 5 years. Why might this happen? The study lists several reasons, including the increasing education level of pharmacists; surging demand for prescriptions that strains the existing medical system; and the potential for independent prescribing to reduce the cost of routine medical visits for both patients and insurers.

This growing responsibility will drive increasing pharmacist influence over drug purchasing, and the report suggests that pharmaceutical manufacturers adjust their marketing strategies accordingly. It is estimated that pharmacists currently influence about 29% of drug purchases worth $77 billion annually; by 2012, that could increase to 37% of drug purchases worth $145 billion.

The transition to independent prescribing will bring challenges, of course. Many of us have been hesitant to move into disease managment and MTM, and that is partly because it is difficult to switch back and forth between the mindsets required for dispensing and advisory roles. Moving into prescribing will require an even bigger jump, and we might see the pharmacy profession divide into those who prescribe and those who dispense. We also can expect opposition from medical professionals who feel threatened by the emergence of pharmacist prescribers.

Nevertheless, changes to the current health care environment are inevitable, and our extensive pharmacist training and capabilities make us well positioned to take on new and expanded roles.