Limited numbers of providers, cost of care, limited time, and limited mobility all reduce a person’s ability to access basic care. One way states have begun to address this issue is through scope of practice adjustments for pharmacists, granting those pharmacists with proper training the ability to become a provider themselves and prescribe certain drugs to certain patients that may otherwise be unable to obtain care.
The Maryland state legislature is the most recent to make such changes, allowing pharmacists to prescribe birth control to those over the age of 18. This has become a growing trend for a variety of drugs including nicotine replacement therapy, emergency contraception, and drugs to reverse an opioid overdose. While pharmacists in several states have had the ability to provide care through collaborative agreements and oversight by a physician, that level of care has been limited and still requires access to physicians in many cases. In Maryland, pharmacists will now be labeled as “providers” and are permitted “prescribe” birth control, which Medicaid is then required to cover.
These changes are made through state statute in a variety of ways, all intended to increase access to certain drugs. Some states, like Maryland (for hormonal birth control) and Maine (for nicotine replacement therapy) have added the ability to “prescribe” directly to the definition of the practice of pharmacy. Other state statutes, such as California’s, have achieved a similar impact using words like “furnish” or “order,” rather than “prescribe.” New Mexico and Colorado have taken a slightly different approach, allowing pharmacists to provide certain health care services under statewide protocols developed by the board of pharmacy. This approach provides the board with language flexibility as well as the ability to make changes, including changes to the type of drugs a pharmacist may prescribe, through regulation rather than state statute.
State statute allowing pharmacists the ability to prescribe medications appears to be taking the same trajectory as pharmacist-administered immunization legislation took in the mid 1990’s. In 1995, only nine states allowed immunization by pharmacist. Today, pharmacists have the authority to administer immunizations in all 50 states, the District of Columbia, and Puerto Rico. As pharmacy immunization campaigns developed over this same time period, the number of individuals being immunized increased significantly.
With the United States ranked among the highest in the developed world for unintended and teen pregnancies; and tobacco use remaining the leading cause of preventable death across the country, states can look to the success of expanded access to immunizations as a precedent for relief. As trusted, highly trained, and highly accessible providers, pharmacists are well positioned to increase public access to a variety of fundamental and preventative health care services, such a hormonal birth control and nicotine replacement therapy. Pharmacies are prevalent in communities where a primary care office may be hard to reach and easily accessible with extended hours. Additionally, patients are often in frequent and regular contact with their pharmacist in a way that are not able or willing to do with their primary provider.
Allowing pharmacists to practice at the full extent of their education and training has the potential to address and improve some of the most pervasive and ongoing health care issues in the United States. In all of these situations, a pharmacist’s ability to provide health care services is limited by what their education and training has prepared them to provide. States often include other medical professional boards when creating the regulations and protocols that permit a pharmacist to prescribe medications, ensuring comprehensive care for patients and proper parameters for pharmacists. Patient safety is of primary importance as changes in this area are made.
A state making changes in this area must consider the level of training required for prescriptive authority for each drug, the type of patient best served by pharmacists (age limitations and restrictions for patients with certain medical conditions), how pharmacists must educate the patients they serve, the level of evaluation needed prior to writing a prescription, and when a pharmacist must refer a patient to a primary care provider or specialist. States where pharmacists are already permitted to perform patient evaluations and prescribe medications have had issues defining a pharmacist as a provider as well as issues coding these services for insurance reimbursement.
A comprehensive approach is needed for state level changes to the profession of pharmacy; however, these policy changes may serve as a low cost, highly effective approach to solving numerous public health concerns across the country.
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This blog post was developed by Mellissa Sager, Staff Attorney, Network for Public Health Law - Eastern Region. The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.