PREP Act: Short and Long Term Impact on Pharmacy Practice


Liz Oler, PharmD, discusses the short- and long-term impact of the PREP ACT on expanded privileges and practice changes within the pharmacy profession.

Ed Cohen, PharmD, FAPhA: Liz, maybe you can take a moment and talk to us; we’ve seen many practice changes through waivers of privilege and state boards of pharmacy. We’re hearing that some of these changes will remain a part of our practice, and we’re also hearing the opposite, where some of this privilege that’s been given may not stay within our pharmacists and technicians. Can you talk about those changes? I know in your state, in Idaho, you have a very progressive board of pharmacy and some statutes that we would all love to aspire to. Can you talk about those waivers and the board of pharmacy changes?

Liz Oler, PharmD: Yes, it’s really exciting. To your point, I live in a fantastic state for practicing pharmacy. I feel very privileged. Our state was among the first for various prescriptive services, as well as starting pharmacy technicians in the process of administering immunizations to our patients. With that, states started to trend that way. We saw Utah, Washington, Rhode Island, and there have been more states that have passed rules allowing pharmacy technicians to administer vaccinations. With the PREP [Public Readiness and Emergency Preparedness] Act, that grew tremendously. We gained a lot of momentum, as a profession, for pharmacists because, obviously, there’s a big range of what pharmacists can do depending on the state you live in. You have some, like my state, which have independent prescriptive authority, so pharmacists can do every immunization out there on their own. Other states allow you to do those immunizations, but under a collaborative practice agreement. Then there are states that require a collaborative practice agreement, but the ability to administer all those vaccines is very limited. You might be able to do 4 or 5 vaccinations. Then, consider pediatric and adolescent immunizations. That’s a whole other scenario, where in some states, you can go down to 6 months of age, and in other states, we can’t immunize anybody under 18 years old.

With the PREP Act, we were allowed, first of all, pharmacists could administer any ACIP [Advisory Committee on Immunization Practices]-approved vaccinations to anybody down to 3 years old. That helped grow our opportunities for immunizing adolescents and children who hadn’t been immunized during the COVID-19 pandemic and to try to catch people up. Secondarily, it allowed technicians across the country to administer immunizations under supervision. With that, we can obviously immunize more of our population, because it removed the constraints limiting the ability to just pharmacists, or just medical assistants, or just doctors, or whatever. We grew the number of immunized patients astronomically. Now, with that came boards of pharmacy that were more restrictive. Some states say, “OK, a technician can only do COVID-19 vaccinations and nothing else.” There are definitely some constraints. We’re starting to see states end emergency declarations, and with that, they are reversing many of the things that pharmacists have been allowed to do under the PREP Act, which is unfortunate.

To your point, there are some states that we see these changes sticking, where pharmacists will continue to have expanded roles in administering and/or prescribing immunizations that they hadn’t previously been able to prescribe. It’s exciting in a lot of ways because I think we’re seeing more growth than anything. Most people, if they’re going back, they are going back to the status quo, but as a profession, as pharmacists, as individuals, we’ve been able to grow and expand our comfort with administering immunizations to all age groups when we hadn’t previously had that opportunity.

Transcript edited for clarity.

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