Isn’t it Time for Pharmacists to Prescribe-Part III
- Jonathan Jacobs
Current Prescriptive Realities
The industry still continues to resist giving pharmacists more authority to write prescriptions. As things stand, prescriptive authority is primarily limited to collaborative practice agreements, in which a partnering physician specifies the authority allowed and the conditions required for specific pharmacists.
The other route is through statewide protocols and standing orders, in which a state specifies the authority and conditions for all pharmacists in the area. These have generally been prompted by public health issues of particularly high need. For example, the opioid crisis motivated every state in the U.S. to allow pharmacists to dispense naloxone without a prescription. The recent Pandemic has of course influenced some recent decisions on allowable prescription writing for pharmacists.
As the challenges of the COVID-19 pandemic mount, pharmacists are quickly being identified as an underutilized resource in healthcare.
Regulatory agencies are now allowing pharmacists to expand their prescriptive authority, This includes prescribing chronic medications for patients and ordering lab tests (including COVID-19 tests). Many are now compounding medications and products where shortages exist. Pharmacists are providing services through tele-health electronic platforms. Although COVID-19 has brought significant new challenges to our nation and world, I am encouraged by how the profession of pharmacy is uniquely positioned to serve patients in their time of greatest need.
Collaborative practice agreements generally allow greater authority while protocols mostly focus on specific medicines for minor conditions that require no diagnosis, such as cold sores. Within each state protocol, scope of authority varies widely. A few states, like New Mexico and California, have a more liberal scope for pharmacist prescribing. But in most states, pharmacist authority remains minimal.
However, the tides may be turning. Two laws enacted in the last two years, one in Idaho and one in Oregon, have expanded prescriptive authority for pharmacists through statewide protocols. In Idaho, pharmacists can now prescribe and dispense drugs for a long list of issues, such as cold sores, seasonal influenza, strep throat, uncomplicated UTIs, and diabetic conditions. In Oregon, pharmacists can now prescribe and dispense drugs that appear on a state-authorized formulary, which will continue to grow upon request and approval. Potential items on the formulary include diabetic testing supplies, smoking-cessation aids, epinephrine autoinjectors, albuterol inhalers, rapid strep tests, and spacers for inhalers.
A Swiss study, for instance, found physician dispensing leads to a 34% increase in drug costs per patient, as doctors overprescribe and prescribe more expensive medications.
An evaluation of pharmacist prescribing in the United Kingdom found it was safe, clinically appropriate, and was generally viewed positively by patients.
Similarly, two Canadian studies of pharmacist prescribing for urinary tract infections and patients at risk of heart problems found pharmacist prescribing led to better clinical outcomes. The researchers also found it was safe, cost effective, and associated with a high level of patient satisfaction.
Extending the scope of practice for pharmacists has the potential to lower costs to the health system because of fewer GP visits, be more convenient for consumers, and free up busy general practitioners to spend time on high-value care. Pharmacists have consistently proved to rise to the challenge wherever and whenever presented with such for the benefit of the consumer and this priveledge to write prescriptions is just one other. We should all allow them to do so and they’ve earned the right to!
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