Rx_Rph_prescribing_skewedSome of you might answer “of course pharmacists can prescribe!” Others might say “I don’t think so” or “I really don’t know.” What exactly does prescriptive authority mean? Do pharmacists in most states already have that authority? Well it depends on who you ask and how they define “prescribe.”

During my research on this topic, I learned that in the pharmacy community, many believe that if a pharmacist initiates or modifies therapy per protocol or collaborative agreement that this is considered prescribing. In the medical community, they believe that only doctors, dentists and veterinarians can prescribe. There have been many statements attesting to this belief made at past American Medical Association Meeting’s House of Delegates meetings, but this one is the most quoted – “There are doctors, and there are pharmacists. My responsibility is to write a prescription; it’s the pharmacist’s responsibility to fill it,” (Dr. Melvyn Sterling, AMA HOD 2013).

While this is not the opinion of all doctors, 2012_AMA_Resolution 218, introduced at the 2012 AMA Meeting’s HOD, was adopted by an almost unanimous vote. The resolution asked that the AMA oppose federal and state legislation allowing pharmacists to independently prescribe or dispense prescription medication without a valid order by, or under the supervision of, a licensed doctor of medicine, osteopathy, dentistry or podiatry. The resolution went on to state that pharmacist education and training is not equivalent to that of physicians (MDs and DOs) and that the AMA is “concerned that increasing the scope of practice of pharmacists, by allowing them to independently prescribe, goes against the ever-evolving national dialogue on health care delivery by fragmenting rather than integrating the management of patient care.” They did acknowledge that “Pharmacists are valuable members of the health care team” and “the pharmacy profession occupies an important and longstanding position on the health care team as the medication expert to assist physicians and other providers in managing patients’ medications in both inpatient and outpatient care settings. Your Reference Committee believes that when working as part of the physician-led health care team, pharmacists help to ensure that patients receive health care that is of the highest quality.”

When California recently passed their Pharmacist Provider status bill, Senate Bill 493, the pharmacy community was buzzing that pharmacists are finally able to prescribe birth control, smoking cessation products and emergency contraception. When you read the actual statute, the bill states that pharmacists may “furnish” all of the above. The word “prescribe” appears only once in California statute, section 4052.3 –“ This subdivision does not expand the authority of a pharmacist to prescribe any prescription medication. “

To better understand why pharmacists are not allowed to prescribe, a little history is required.

Pharmacists could prescribe until 1938 when the Food Drug and Cosmetic Act was passed. Regulations enforcing this act included the mandate that drugs requiring to be used under the supervision of a physician carry the wording “Caution: to be used only by or on the prescription of a physician, dentist, or veterinarian.” The two classes of drugs were not differentiated by law until the Durham-Humphrey Amendment in 1951. The law required any drug that is habit-forming or potentially harmful to be dispensed under the supervision of a health practitioner as a prescription drug and must carry the statement, “Caution: Federal law prohibits dispensing without a prescription.” It also mandated that a prescription could not be refilled without authorization from a physician. Thus, the practice of physician prescribing and pharmacist dispensing became law.

Since that time, there have been pilot projects, changes in state laws expanding scopes of practice, and government programs in the Indian Health Services and Veterans Health Administration all demonstrating the value of pharmacists initiating and modifying therapy.  43 states now permit limited pharmacist-dependent prescribing as part of collaborative drug therapy management  agreements.

So, if we are already prescribing per our definition and are being more welcomed as part of the health care team, should we seek independent prescribing authority or have we reached our end game and just need more pharmacists as players?

Share your thoughts!

Can Pharmacists Prescribe?

Post navigation

Leave a Reply

Your email address will not be published. Required fields are marked *