Hey guys in one of my electives we have to do a debate. My group was assigned prescribing powers for pharmacists. We're trying to look at it from both sides. We can find lots of articles and points of view for prescribing powers for pharmacists... can't really find much on the case against prescribing powers.. you guys got any ideas?
so far all i got is..
Infringing upon Doctors turf
Pharmacist don't have adequate trraining to asses a pateint

anything else?

I know this might be tough for you guys since we're all going to be pharmacists.. but any help will be apprieciated

Thanks!

I think I know a med student you could contact for some material. Heh.

How about pharmacist workload is already heavy enough without ADDING responsibilities. Rx volume is rising, and pharmacist supply is lower. How are pharmacists supposed to do everything they do AND have time to prescribe AND not make more mistakes?

Ku06 thank for you response.. I will try to do a better job researching ;-)

..as for your question the pharmacist does not need to diagnose to presCribe.. A doctor might refer a pharmacist to a clinic after diagnosing a pateint with HIV or hypertension.. your point about liability is a good one though thanks..

OSU girl: the pharmacsts who would be prescribing would not nessarily be dispensing the medications. They would be working in clinics were the primary job would be to make reccomendations about the pateints drug therapy. A seprate pharmacist would be processing the presrcition and dispensing the meds.

thanks for your input though..anyone else?

Think about the liability this would open up for pharms. Since they are diagnosing they would need insurance, right?A prudent pharmacist will carry liability insurance of their own, even if an employer has a policy covering their employees. You should never count on someone else to cover your rear end. Policies aren't terribly expensive at this point in time. But, if prescriptive authority is granted, insurance companies are likely to catch on and jack up premiums. We could be placed in a situation where we are forced to carry our own insurance as a condition of employment. Think of how large of a dent that could take out of your income. And, salaries would probably not rise to offset the burden.

Here is one you may not have thought of:
If pharmacists are given prescriptive authority, they would have an incentive to influence patients to use a prescription medication when an OTC or adjunct method of therapy might be more appropriate.

I have $1,000,000/$3,000,000 insurance as a student. I think my annual premium is about $28. :)

Here is one you may not have thought of:
If pharmacists are given prescriptive authority, they would have an incentive to influence patients to use a prescription medication when an OTC or adjunct method of therapy might be more appropriate.

Ooh, a conflict of interest. That's a good one. :)

Drug companies would be likely to start enticing pharmacists with more expensive "freebies", making expenses go up and inflating drug costs.

Wow, we actually had the EXACT same assignment for pathophys/therapeutics. And, honestly, the two things you listed are basically everything the con side could muster.

Having Pharmacists with prescribing authority might catch the attention of drug seekers. The retail pharmacists in cities and suburbs will be hit hard, as it might be easier (MIGHT because it really depends on individual pharmacists) to obtain control drugs through a pharmacist than to go to the ED or PCP, wait for hours just to finally get a script for one.

Now the smart thing to do when someone comes up to you in pain (that can't be assuage by Tylenol/ASA) is to refer them to a doctor BUT if they are drug-seekers, they will be persistant (and rude) and sometimes violent if they don't get their drugs right there and then.

I'm sure the retail pharmacist will love dealing with that, esp at night.

Also don't forget the possibility of multi-pharmacy stops for the same drug seeker (or drug-seller seeking drugs for $$$)

Having Pharmacists with prescribing authority might catch the attention of drug seekers. The retail pharmacists in cities and suburbs will be hit hard, as it might be easier (MIGHT because it really depends on individual pharmacists) to obtain control drugs through a pharmacist than to go to the ED or PCP, wait for hours just to finally get a script for one.

Now the smart thing to do when someone comes up to you in pain (that can't be assuage by Tylenol/ASA) is to refer them to a doctor BUT if they are drug-seekers, they will be persistant (and rude) and sometimes violent if they don't get their drugs right there and then.

I'm sure the retail pharmacist will love dealing with that, esp at night.

Also don't forget the possibility of multi-pharmacy stops for the same drug seeker (or drug-seller seeking drugs for $$$)VERY good point.

How about increasing potential for abuse and diversion BY pharmacists if the prescribing and dispensing steps could be performed by the same provider in thousands of pharmacies across the country.

Everyone, go read this same thread in the Allopathic Forum. There are some great responses from medical students on this subject.

How about who is going to take care of patients that are hospitalized for medication related problems created by a pharmacist prescriber (i.e. gork a kidney 2° to metformin or lisinopril)? I doubt pharmacists can pull off getting admitting privileges at hospitals, so some poor doctor will end up taking care of problems which he/she didn't generate. It wouldn't take long to build up some real animosity between the physicians and pharmacists. And if you think I'm kidding about building up animosity, just ask a hospitalist their opinion of urgent care doctors (who don't generally admit patients).

Guess I killed another thread.......

How about who is going to take care of patients that are hospitalized for medication related problems created by a pharmacist prescriber (i.e. gork a kidney 2° to metformin or lisinopril)? I doubt pharmacists can pull off getting admitting privileges at hospitals, so some poor doctor will end up taking care of problems which he/she didn't generate. It wouldn't take long to build up some real animosity between the physicians and pharmacists. And if you think I'm kidding about building up animosity, just ask a hospitalist their opinion of urgent care doctors (who don't generally admit patients).
Don't doctors take care of problems they don't create all the time..... Other doctors stupidity/ mistakes, patient stupidity/ noncompliance/ mistakes, nursing stupidity/ mistakes?

I think you make a very good point about the admitting process as i believe most pharmacists would refer to the physician they are practicing under or the ED.
I can see if the pharmacist made some stupid mistakes they would definitely have a bad rap and the physician would probably terminate their agreement.

Technically we as pharmacists would need to tell physicians what meds we have given their patients. Not all of us would be scrupulous about it. And, even if we are good about passing information on, things aren't always charted on the other side of the fax machine.

WA has a program in place where pharmacists can change existing prescriptions so long as the physician is enrolled in the state's therapeutic interchange program, the patient is on a state sponsored insurance plan, and the prescriber did not indicate dispense as written. Retail pharmacies are supposed to participate, but hardly anyone does. They tend to throw the decisions back to the prescribers. Reasons for underutilization of the program: time constraint, inadequate pharmacist training (I work with people who say they are not comfortable for this reason), no reimbursement for time spent, no available prescriber-notification paperwork. Also, who is supposed to follow up on the changes? The pharmacist or physician? What if the patient has no PCP? What if it's an ER prescription? Around here we have problems with people on DSHS being able to find PCPs.

So now we are talking about practicing under the authority of a doctor? This was not mentioned in this thread until now... If a physician is willing to let a pharmacist prescribe under his authority, then that physician also should take on the hospital care for any problems that occur with that physician/pharmacist agreement. BTW - I think this should be the case for NP/PA prescribing as well. I can't tell you how many admits I have taken from doctors that have mid-levels practitioners who tell the patient to go to the hospital when problems happen, but then the physician does not have privileges at the hospital and I take them on my service.

So now we are talking about practicing under the authority of a doctor? This was not mentioned in this thread until now... If a physician is willing to let a pharmacist prescribe under his authority, then that physician also should take on the hospital care for any problems that occur with that physician/pharmacist agreement. BTW - I think this should be the case for NP/PA prescribing as well. I can't tell you how many admits I have taken from doctors that have mid-levels practitioners who tell the patient to go to the hospital when problems happen, but then the physician does not have privileges at the hospital and I take them on my service.The intention of this thread is to discuss independent authority, as I understand it.

In WA, pharmacist authority for the TIP program is kind of independant. State law gives pharmacists the authority to change the drug to a state formulary item. There is no prior contact needed between prescriber and pharmacist. The prescriber just signs up for the program with the state and that's it. The law says the pharmacist notifies the prescriber of the interchange afterwards (ie: so it can be charted). Prescriber consent is inferred by their enrollment in the program. The pharmacist has NO CHOICE but to participate (supposedly).

What about re-imbursement? As it stands, pharmacists are trying to venture outside of their scopes of practice and the basis of this is to provide better health care. Things like patient medication reviews certainly address a patient's health needs, but at what cost? A Dr can request that a pharmacist do a patient medication review, and through that consultation, the Dr is reimbursed a hefty sum of money. The pharmacist then runs around like a busy bee and works for hours on end to produce a full medication review, and for their efforts gets paid considerably less. So this perhaps stands as an appropriate argument against stepping outside the boundaries of pure pharmacy - that of financial viability.

Prescribing definitely holds a sense of power over a patient's health, however with that power comes responsibility (as eloquently quoted from "Spiderman") and pharmacists might not get paid adequately for the amount of responsibility that they want.

What about re-imbursement? As it stands, pharmacists are trying to venture outside of their scopes of practice and the basis of this is to provide better health care. Things like patient medication reviews certainly address a patient's health needs, but at what cost? A Dr can request that a pharmacist do a patient medication review, and through that consultation, the Dr is reimbursed a hefty sum of money. The pharmacist then runs around like a busy bee and works for hours on end to produce a full medication review, and for their efforts gets paid considerably less. So this perhaps stands as an appropriate argument against stepping outside the boundaries of pure pharmacy - that of financial viability.

Prescribing definitely holds a sense of power over a patient's health, however with that power comes responsibility (as eloquently quoted from "Spiderman") and pharmacists might not get paid adequately for the amount of responsibility that they want.
i think it will be interesting to see what reimbursement for MTMS will be...