Two colleagues who’d read my blog post summarizing the recently passed legislation recognizing collaborative practice agreements in the Colorado Pharmacy Practice Act were interested in seeing how the actual language in the bill compared to their state’s pharmacy practice act.
During the first discussion, we talked about golfing, skiing, cycling, provider status because, yes, that is what policy wonks do. The observation was made that in the newly passed amendment to the Colorado Pharmacy Practice Act, as in virtually every other state that claims pharmacists have prescriptive authority, the word “prescribe” is not mentioned. The words used are “initiate drug therapy” or “implement drug therapy.”
California received a lot of publicity when they passed legislation that specifically declared pharmacists are healthcare providers, but nothing in that legislation allows pharmacists to “prescribe” – only “furnish” or “initiate therapy.” When my colleague and I recalled states where pharmacists can actually “prescribe,” only three came to mind – New Mexico, North Carolina and Washington.
Although “initiating therapy” correlates to “prescribing” in the pharmacy community, they have different meanings. Unfortunately, “initiation of therapy” is not broadly understood as prescribing by many doctors, insurers, third party payers and the general public. In some states, this has been a barrier to pharmacists being paid for their services.
The reason for this choice of words was to limit opposition by the medical community when legislation was being drafted. In my 3/5/16 blog post “Can Pharmacists Prescribe?” you’ll find considerable detail on how 43 states permit limited pharmacist prescribing as part of a collaborative drug therapy management agreement and a closing question — should we seek true prescribing authority?
Although the choice of words may limit opposition during passage of legislation it may also limit pharmacists’ prescriptive authority.
How serendipitous that the second call came from a colleague of mine who has been a pharmacy association state executive for 27 years in New Mexico and collaborative pharmacy practice has been in his state’s pharmacy statutes for over 20 years.
He reminded me that the New Mexico Pharmacy Practice Act clearly mentions prescribing by pharmacists. The Pharmacist Prescriptive Authority Act, enacted in 1993, recognizes pharmacists as midlevel practitioners who can manage primary care patients independently in written collaboration with a physician. New Mexico law permits pharmacists with advanced training in physical assessment and board certification as pharmacotherapy specialists to
- prescribe and authorize refills, including those for controlled substances, without a physician co-signature;
- obtain Drug Enforcement Administration numbers and institutional provider numbers; and
- bill for services.
Since 2001, the New Mexico Board of Pharmacy has authorized all pharmacists, after receiving the approved training and complying with the regulations, to prescribe vaccines, emergency contraception and tobacco cessation therapy. In 2014, New Mexico was the first state to authorize pharmacists to prescribe Naloxone, a drug that can reverse the effects of opioid overdoses and keep victims alive until professional medical help can arrive. Shortly after the implementation of this new law, over 60 pharmacists completed the training necessary to prescribe Naloxone.
Bottom line, pharmacists in New Mexico are being paid for their services.
I’m writing this blog to remind my readers that, while the national effort to get pharmacists recognized as healthcare providers is important, efforts on expanding scope of practice on a state level are the most productive.
New Mexico is a great example of what can be accomplished when other healthcare providers are involved in the legislative process and the word “prescribe” is clearly included in the statute. As each state moves forward in expanding the scope of practice of their pharmacists, perhaps the word prescribe should not be avoided because it’s very important. Then pharmacists can truly demonstrate, not to just ourselves, but to other doctors, insurers, third party payers and the general public that pharmacists are healthcare providers.