Standard of Care: The Latest Indicator That Pharmacy Is Operating More Like the Rest of the Care Team

You have likely heard the phrase “standard of care” (SOC) before, either in a medical context or perhaps in a TV series or movie where a physician got in trouble for amputating the wrong leg. But what does it mean when applied to a pharmacist’s scope of practice (SOP)? SOC regulations rely on peer health care providers to determine what is and is not appropriate in a given health care setting, situation, or intervention when the pharmacist is being assessed and judged.¹ Timing matters because at the core of SOC is the idea that standards change over time and, therefore, peer assessment should change right along with it.

From Lowest Common Denominator to Best Care

Historically, pharmacy practice has been circumscribed by what is allowed, with practitioners staying within legislative or administrative guardrails. With a change to SOC-based pharmacy practice acts, those bounds are determined by peer practitioners, and different practitioners may have different scopes depending on their education, continuing education, and practice under apprenticeship, residency, or other means of gaining supervised repetition and experience.² We often forget that a pharmacist’s practice is also something to practice—continually, the way musicians and athletes do to stay sharp.

The Standard for Everyone—Except Pharmacy

SOC is not a new concept. Rather, it’s the way almost every other health profession is regulated—except pharmacy. Our SOP has too often been defined by what others think our limits should be, often with painfully detailed precision. This results in incremental advances, keeping a chokehold on pharmacists and preventing the most accessible health care practitioners from having a “practice.” While pharmacists let other professions define their practice, the other care team members have defined their own practice and what is allowed and expected by regulators and patients alike.

Is SOC Re-Professionalizing Pharmacy?

The idea of a professional is rooted in judgment based on didactic study and experience with past patient scenarios. Professional judgment in pharmacy practice has been extremely narrow, reserved for tasks such as emergency refills. Professional judgment governed by SOC would likely let pharmacists authorize refills only when it is safe, effective, and prudent to do so—while counseling patients on the need for a prescriber visit and, when necessary, requiring one before reauthorizing.

Why would SOC allow for pharmacist-prescribed refill authorizations? Most peers in health care would certainly expect pharmacists to exercise judgment in such circumstances and, for those who are ill-equipped to prescribe refills, to self-identify their limitations and refrain from prescribing refills. SOC doesn't mean anything goes—legislation and regulation still set “stop limits” at the outer edges—but it does allow peers to determine SOP within those limits.

Idaho First. Alaska and Iowa Next

Idaho has the most experience with SOC, followed by Alaska and Iowa—all states with large rural geographies.^2-4 As has been customary, inroads into SOP expansions have come from rural and underserved communities’ needs for accessibility, where interpersonal relationships are typically robust and durable.

I caught up with Lindsey Ludwig, BSPharm, executive director of CPESN IOWA, who works closely with more than 120 independently owned and operated pharmacies in Iowa to advance the adoption of pharmacist-provided services. She shared insight into Iowa’s new SOC-based approach to expanding SOP.

“The move to SOC practice has been exciting and frustrating for many of the forward-thinking pharmacists in the CPESN IOWA network of pharmacies. While the law allows pharmacists to practice at the top of their license, limitations like coverage for labs or [pharmacy benefit manager] coverage of prescribed medications by a pharmacist limit access,” she said. “For example, one of my pharmacies recently had a patient with an upcoming trip abroad who was in need of an EpiPen refill due to an expired product. Even though the pharmacist could exercise their judgment to allow for refills, there is no payment for the service and no insurance coverage if the pharmacist is the prescriber.”

PBMs at Odds With Pharmacist Care

Although pharmacist training and workflow and patient receptivity to receiving health care services have evolved substantially over the past half-century, pharmacy benefits have not. Pharmacy benefit managers (PBMs) and the “benefits” they administer remain largely administrative—determining which products are “covered,” at what price to the patient and the plan, and what reimbursement the pharmacy receives. Very little in the way of PBM-reimbursed services exists. So that refill authorization, provided by a pharmacist under their peer-allowed SOP, was based on both subjective and objective assessments of the patient and the scenario, with a plan of care and documentation, all for free. That doesn’t benefit the patient, the plan, or the pharmacy at the end of the day because it isn’t economically sustainable. Or worse, the service’s cost-benefit is indirectly baked into the product reimbursement, distorting the marketplace for services.

Why Boards of Pharmacy Matter More Under SOC

So which of our “peers” might determine our SOP? Likely, members of the board of pharmacy, who are often appointed by the state. Reasonable and well-informed peers can have different opinions on standards of care delivery, and the composition of these boards and their relationships with the medical, nursing, and other boards will likely become more important than ever.

Thank you to Lindsey Ludwig for contributing to this article and offering insights.

REFERENCES

1. Eid DE. Standard of care: the No.1 priority to ensure success in pharmacy practice’s future. Pharmacy Times. April 15, 2025. Accessed July 23, 2026. https://www.pharmacytimes.com/view/standard-of-care-the-number-1-priority-to-ensure-success-in-pharmacy-practice-s-future

2. Adams AJ, Chopski NL, Adams JA. How to implement a “standard of care” regulatory model for pharmacists. J Am Pharm Assoc (2003). 2024;64(3):102034. doi:10.1016/j.japh.2024.02.007

3. SB 147/HB 195: Pharmacist provided patient care services. Alaska Pharmacy Association. Accessed July 23, 2026. https://alaskapharmacy.org/wp-content/uploads/2025/04/SB-147-HB-195-One-Pager-Supporter.pdf

4. Standard of care. Iowa Pharmacy Association. Accessed July 23, 2026. https://www.iarx.org/soc