What do you mean Fix the Glitch”?

The title of our 5/13/2018 blog post had a lot of people scratching their heads. What exactly does it mean?

The Value Pharmacists’  Fix the Glitch post announced that the Colorado legislature passed a bill that would allow pharmacists to legally prescribe per state wide drug therapy protocols. Since that announcement, a number of questions have come up.

  • What was the glitch?
  • Why was there a glitch?
  • Could pharmacists prescribe before the glitch was fixed?
  • Why was HB18-1313 introduced?
  • Was HB18-1313 necessary for pharmacists to prescribe under statewide protocols without a collaborative relationship with a physician?

All great questions deserving answers. To get those answers all one needs to do is review the testimony provided by the bill proponents. You can hear the entire testimony in both the House Health, Insurance and Environment Committee on April 10, 2018 and Senate Health and Human Services Committee on April 25 by going to the Colorado State Legislature web page http://leg.colorado.gov. click on “Watch and Listen” then go to the desired committee and date.

In the House Health, Insurance and Environment Committee, the bill sponsor, Representative Ginal explained it this way:

“HB 1313 is another clean-up bill. It was discovered in June 2017 there was a technical glitch which identified pharmacists would not be able to put their name on an authorized prescription order. Current law requires that a practitioner, who is person authorized to prescribe drugs must be on the prescription label but pharmacists are not yet defined as practitioners in existing statute. This is a glitch we are trying to fix. What the bill doses is it clarifies that a licensed pharmacist may serve as a practitioner and have prescriptive authority only under the following circumstances. Number one, over the counter medications under the medical assistance act  and for an authorized statewide therapy protocol.”

Co-sponsor Representative Becker, in his opening comments assured the committee with this statement:

“This bill does not allow pharmacists to prescribe independently. It does not change the pharmacist’s scope of practice.”

Emily Zadvorny, Clinical Pharmacy Specialist in Family Medicine – UC Health & CU Skaggs School of Pharmacy and Pharmaceutical Sciences and At Large Member of the Colorado Pharmacists Society, explained the glitch this way:

“In the summer of 2017 awareness was raised that there was an implementation glitch and logistical issues.”

“The bumps in the road are first, the issue of prescriptive authority. In our pharmacy practice act, the only time we are authorized prescriptive authority is the Colorado Medical Assistance Act. So although it talks about us prescribing these pre-authorized medications in the rules and the statewide protocols, there is that kind of inconsistency there. The second bump is every prescription dispensed has to have a label and on the label needs to be the name of the practitioner and the way a practitioner is defined is a person authorized to prescribe drugs. Although pharmacists are recognized as a health care provider, they are not a practitioner.”

“This bill does not change our scope of practice or allow any broad prescriptive authority. It does not increase our scope of practice. We are already doing this great work in this area. Hundreds of pharmacists have been trained, hundreds of patients have already been helped by statewide protocols. “

Why was there a glitch? The original 2016 SB16-135 bill was drafted missing or not addressing a few key points:

  • The definition of practitioner is any one licensed to prescribe. The bill did not change the definition of practitioner to include pharmacists.
  • No mention was made in the bill to modify the definition of pharmaceutical care which included the statement “does not include prescriptive authority; except that a pharmacist may prescribe only over-the-counter medications to a recipient under the “Colorado Medical Assistance Act.”
  • The word prescribe did not appear anywhere in the statute, except in the specific prohibition mentioned above.
  • The word prescribe was mentioned in the appendices referenced in the pharmacy rules The appendices contained the statewide protocols approved by the Medical and Nursing board and the Colorado Department of Health and Environment.

Many believed that since the appendices were referred to in rule that was all that was required for pharmacists to prescribe per statewide protocol. However, the Colorado State Board of Pharmacy considered changing the word “prescribe” to “dispense” in all the protocols because of the lack of statutory authority and did not promulgate rules allowing the prescriptive authority. (Refer back to our prior blog post. )

So did we answer our list of questions? Let’s review:

What was the glitch? According to bill proponents it was an oversight that pharmacists were not recognized as “practitioners” and therefore pharmacists could not use their names on the labels attached to the medicines they were prescribing.

Why was there a glitch? The text of the original 2016 bill was incomplete and did not fully address the desired outcome of the proponents so that the SBOP could promulgate appropriate rules.

Could pharmacists prescribe before the glitch fix? No. The only individuals that could prescribe by law were practitioners. Pharmacists were not practitioners.

Why was HB18-1313 introduced? HB18-1313 passage was necessary to allow pharmacists to prescribe under statewide protocols without a collaborative relationship with a physician.

Was HB18-1313 necessary for pharmacists to prescribe under statewide protocols without a collaborative relationship with a physician? Absolutely! If this bill would not have been passed, the board of pharmacy would need to continue with its efforts to change the word “prescribe” to “dispense” everywhere it appeared in the statewide protocols included in Appendices A & B. Pharmacists would have been required to have a collaborative relationship with a practitioner or group of practitioners to “prescribe” any of the drugs mentioned in the statewide protocols.

Questions? Contact me.

What do you mean”Fix the Glitch”?

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