Isn’t it Time for Pharmacists to Prescribe-Part II
- Jonathan Jacobs
Originally pharmacists prescribing medications was an idea put forward as a way to help address doctor shortages. The proposal said pharmacists could prescribe either under a structured prescribing arrangement, under supervision or autonomously. Ecare networks believe they can handle this with their participating pharmacies by aligning pharmacists with doctors that will perform the annual medication review along with the patients’ primary care physicians. 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.
Studies have shown Pharmacists are better at adhering to dosing guidelines when prescribing by protocol and make significantly less prescribing errors when charting patients’ usual medications on admission to a hospital. Prescribing has helped pharmacists around the world assume a more significant role in patient care. Pharmacist prescribing has been associated with positive outcomes including improvements in blood pressure, diabetes control, and cholesterol.
Additionally there is of course push-back from physicians and physician groups arguing against Pharmacist-Prescribing. In my opinion a pharmacist prescribing drugs could have two effects:
1) It could undermine the physician, perhaps the drug of choice wouldn’t match up with other treatments the physician has in mind. Even though pharmacists have a much greater understanding of pharmacology, and biochemistry, physicians have a greater knowledge of disease and treatments.
2) One argument for pharmacists being able to prescribe meds would be to save physicians time in having to write refill prescriptions or changing medications due to side effects etc. But my argument to this is: Maybe the drug choice was not working because the problem was initially misdiagnosed and it would take a physician to re-evaluate the matter. Also, patients need to check in with their doctors periodically to keep them apprised of their condition(s). If pharmacists could prescribe medications it’s entirely possible patients would visit their doctors less which could result in unwanted (poor) outcomes. We are already seeing some downstream effects of patients ignoring there own personal care during this Covid-19 Pandemic only to suffer further complications in whatever ailment or condition they’ve ignored. Regular MD visits are essential to optimum healthcare for us all!
Aside from patient-specific interventions, Managed care pharmacists also play an essential role in promoting cost-effective and clinically-sound drug therapy through the practice of formulary management, routinely utilized by health plans, PBMs, hospitals, and accountable care organizations. In the current landscape of rapidly increasing drug prices, the clinical expertise of pharmacists can assist in mitigating the costs incurred by payors due to growing utilization, innovations in drug therapy (e.g., cell and gene therapy), and lack of manufacturer competition in drug classes for rare disease states. Managed care pharmacists have the ability to assess and compare clinical consensus guidelines and drug-therapy recommendations, review data from clinical trials, and evaluate economic impact to develop appropriate treatment algorithms and frequently used formulary management tools, such as step therapy and prior authorization requirements. With the Food and Drug Administration (FDA) approving record numbers of new drug entities in recent years, the role of the pharmacist in reviewing new and complex drug technologies is critical in ensuring patients are receiving appropriate, cost-effective therapy on both the spectrum of individual and public health.
The role of the pharmacist in public health has been transforming and expanding in recent years. For example, in many states, including Massachusetts, pharmacists can become certified to provide injections such vaccinations and long-acting antipsychotics without the appointment and trip to the doctor’s office. In 2012, the number of vaccines administered by pharmacists was expanded from just the flu shot, to include a total of 10 adult vaccines for prevention of illnesses such as shingles, hepatitis A and B, meningitis, and more. In many cases, vaccines are available through prescription insurance without a copay or the cost of an office visit. In many states, pharmacists have the authority to recommend and prescribe routine medications such as smoking cessation agents and oral contraceptives, as well as interpret common diagnostic tools such as for influenza and strep throat. The trend continues to expand in many other states as the need for accessible and affordable healthcare continues to grow and an untapped resource of providers is being recognized. 43 States now allow pharmacists to prescribe drugs for minor health problems and ailments which do not require a diagnosis. Pharmacists in Florida are also able to write prescriptions for a limited set of drugs. Only New Mexico, Montana, and North Carolina allow pharmacists to prescribe drug therapy.
Aside from the ability to independently prescribe basic medications in a community pharmacy setting, for many years pharmacists have been able to work in tandem with physicians through what’s known as collaborative practice agreements (CPAs), where pharmacists are involved in the provision of expanded direct patient care through comprehensive disease management. Examples of pharmacist responsibilities in these settings include performing patient assessment activities, ordering and interpreting laboratory tests, developing therapeutic plans, and ultimately utilizing prescriptive authorities to initiate, adjust, or discontinue drug treatment.
As of 2011, CPAs between physicians and pharmacists were authorized by 44 state pharmacy boards, including Massachusetts. In a 2008 survey of prescribers who had worked collaboratively with pharmacists through these types of agreements, 96% of physicians who responded reported numerous benefits, including improved disease management outcomes and the allowance of the physician to shift their workload to more critical patients. Arrangements such as CPA’s take the pharmacist-prescriber consultative structure to a level of a healthcare partnership which integrates pharmacists as primary care providers, rather than responders to a predetermined decision.
Your local pharmacist, although able to prescribe in some circumstances, is NOT able to prescribe for any condition or illness where the following warning signs are present in a patient.
- If there may be the presence of an undiagnosed illness
- If there are any indications that suggest an unusual reaction to a medication
- If there may be a decline or a change in the function of a major organ
As the healthcare industry shifts from a reimbursement structure based on volume towards a reimbursement structure based on value, the unsung role of the pharmacist as an integral healthcare team member will come to realization. As practitioners trained to assess the whole-patient picture, pharmacists connect the dots between prescribers and impact the clinical and economic effects of drug therapy in an ever-changing healthcare system. Professional medical and pharmacy organizations remain instrumental in advocating for the underutilized resource of pharmacists in any healthcare setting. Please check back again to view our next piece on this all important topic.
Isn’t it Time for Pharmacists to Prescribe-Part III Current Prescriptive Realities
National Sales Manager
Point of Care Systems
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