Pharmacy Prescribing Rights in Certain States

[RxConfused]

Advertisement - Members don't see this ad

http://drugtopics.modernmedicine.com/drugtopics/article/articleDetail.jsp?id=136950

I just found this article. I'm sure those of you living in these states probably know about this already. Just wondering what your thoughts about this are?

 

[bw6]

http://drugtopics.modernmedicine.com/drugtopics/article/articleDetail.jsp?id=136950

I just found this article. I'm sure those of you living in these states probably know about this already. Just wondering what your thoughts about this are?

Most prescriptive authority for pharmacists applies to collaborative drug therapy management. A physician and pharmacist enter into a written agreement to manage a patient medication therapy.

Any "real" prescriptive authorities for pharmacists are a long way away. Simple fact is that it will take money away from practicing physicians. Governmental lobby for AMA > lobby for APhA. That is some pretty easy math to show why physicians will continue withholding prescriptive authority from pharmacists (though a PA has limited prescriptive authority after just 2 years of PA school - very limited pharmacotherapy in their curriculum).

In my opinion, it is a matter of checks and balances. Though physicians can give out medication, most large quantities go through a pharmacist. Many "dirty" docs in my state (Ohio) have been caught by the Board of Pharmacy and prosecuted by this same entity (along with the dispensing pharmacist - FYI if a dirty doc is writing bad scripts and you are filling them, you are equally liable whether you were aware or not).

Filling Desoxyn for the same patient for >12 weeks = criminal negligence at best or willful negligence at worst. Willful negligence will be accompanied by the same charges the doctor faces (3-7 years prison, license revoked).

My entire point being, there are a lot of sides to this prescriptive authority thing.

 

[JoBreeze]

Most prescriptive authority for pharmacists applies to collaborative drug therapy management. A physician and pharmacist enter into a written agreement to manage a patient medication therapy.

I don't get what distinction you're trying to make between these two statements...

Any "real" prescriptive authorities for pharmacists are a long way away.

Could you elaborate?

 

[bw6]

I don't get what distinction you're trying to make between these two statements...


Could you elaborate?

There is no distinction, I was simply defining collaborative drug therapy as a written agreement between phys/pharm.

To elaborate - I put real in quotations because the pharmacist can only alter medication therapy when a physician agrees to grant the pharmacist this authority. The physician is still ultimately liable for the patient. Even if pharmacists were to get prescriptive authority, it would be limited to very specific drugs such as epinephrine (drugs which you cannot always wait to see a physician to get - epi is a pretty obvious one). All other drugs will be kept outside the realm of the pharmacist's prescriptive authority because the AMA wants it that way.

For God's sake, the AMA went ape-**** over pharmacists giving flu shots. They don't do this stuff because they do not believe a pharmacist is not capable of giving flu shots or having prescriptive authority (they are supposedly the experts on drug therapy). They do it because more access to healthcare = fewer trips to physicians = less $$.

Be honest, every law is passed by Capitol Hill. Capitol Hill is controlled by lobbyists. Lobbyists are interested primarily in $$ for their constituents. More physicians = larger AMA lobby = hopeless for pharmacists. 😎

 

[All4MyDaughter]

There is no distinction, I was simply defining collaborative drug therapy as a written agreement between phys/pharm.

To elaborate - I put real in quotations because the pharmacist can only alter medication therapy when a physician agrees to grant the pharmacist this authority. The physician is still ultimately liable for the patient. Even if pharmacists were to get prescriptive authority, it would be limited to very specific drugs such as epinephrine (drugs which you cannot always wait to see a physician to get - epi is a pretty obvious one). All other drugs will be kept outside the realm of the pharmacist's prescriptive authority because the AMA wants it that way.

For God's sake, the AMA went ape-**** over pharmacists giving flu shots. They don't do this stuff because they do not believe a pharmacist is not capable of giving flu shots or having prescriptive authority (they are supposedly the experts on drug therapy). They do it because more access to healthcare = fewer trips to physicians = less $$.

Be honest, every law is passed by Capitol Hill. Capitol Hill is controlled by lobbyists. Lobbyists are interested primarily in $$ for their constituents. More physicians = larger AMA lobby = hopeless for pharmacists. 😎

1. This is a state issue, not a federal issue. So not a "Capitol Hill" matter.

2. If the AMA is so powerful and can block anything, why do pharmacists have immunizations in many states?

 

[BidingMyTime]

Hmmm, maybe that is why some pharmacists have put themselves in the role of judging whether or not someone deserves to buy OTC syringes.....it gives them a small taste of prescriptive power.

 

[bw6]

1. This is a state issue, not a federal issue. So not a "Capitol Hill" matter.

2. If the AMA is so powerful and can block anything, why do pharmacists have immunizations in many states?

Not once did I say they AMA can block anything. I simply (correctly) pointed out that AMA>APhA.

Ultimately the federal government will decide state issues. Not right away but if the feds aren't behind it, it will struggle. Let's look at dispensaries - state says they're legal, DEA still raids and closes dispensaries on a regular basis and prosecutes the owners.

Drinking age is a state law. Oh yeah, but if you don't make it 21 then the federal government gives you no money for your highways. A lot of "state issues" are not really state issues. They just make it look that way and you believe them because it is the state that votes, while the federal government and the lobbyists influence the voting.

And even if this had nothing to do with the federal government, state governments have the same lobbyists... so what is your point? It doesn't matter if it is decided on Capitol Hill or in a state's capital city, lobbyists have influence in both.

 

[All4MyDaughter]

Not once did I say they AMA can block anything. I simply (correctly) pointed out that AMA>APhA.

Ultimately the federal government will decide state issues. Not right away but if the feds aren't behind it, it will struggle. Let's look at dispensaries - state says they're legal, DEA still raids and closes dispensaries on a regular basis and prosecutes the owners.

Drinking age is a state law. Oh yeah, but if you don't make it 21 then the federal government gives you no money for your highways. A lot of "state issues" are not really state issues. They just make it look that way and you believe them because it is the state that votes, while the federal government and the lobbyists influence the voting.

And even if this had nothing to do with the federal government, state governments have the same lobbyists... so what is your point? It doesn't matter if it is decided on Capitol Hill or in a state's capital city, lobbyists have influence in both.

You need to review your constitutional law. The practice of pharmacy (and indeed the regulation of all professions, including scope of practice, is a STATE issue). This is why we have 50 state BOPs, and why we must undergo a separate license process in each state we want to practice in. There are some areas where state/federal oversight overlap (DEA, FDA) but states are still free to make laws that are MORE restrictive than federal law. Then tension comes when states seek to decriminalize behavior that's constrained by federal law (such as medical marijuana). But for the majority of legal matters pertaining to pharmacy, we look not to "Capitol Hill" but to our individual state legislatures.

I'll ask again, if the AMA is so powerful, why do pharmacists have immunization rights in many states? They didn't seem to be able to block that, did they? And pharmacists already have limited prescriptive authority in a number of situations.

You're ascribing way too much power to the AMA, and you show a basic lack of understanding of how professions are regulated and governed.

 

[JoBreeze]

For God's sake, the AMA went ape-**** over pharmacists giving flu shots.

Did they really?

I remember watching a PBS Frontline that claimed that primary care physicians actually incurred an added expense and basically no profit by supplying vaccines in their practices.

 

[owlegrad]

Did they really?

I remember watching a PBS Frontline that claimed that primary care physicians actually incurred an added expense and basically no profit by supplying vaccines in their practices.

I have never understood why pharmacies can make a profit at giving flu shots but a physician cannot. Lower overhead?

 

[VA Hopeful Dr]

You need to review your constitutional law. The practice of pharmacy (and indeed the regulation of all professions, including scope of practice, is a STATE issue). This is why we have 50 state BOPs, and why we must undergo a separate license process in each state we want to practice in. There are some areas where state/federal oversight overlap (DEA, FDA) but states are still free to make laws that are MORE restrictive than federal law. Then tension comes when states seek to decriminalize behavior that's constrained by federal law (such as medical marijuana). But for the majority of legal matters pertaining to pharmacy, we look not to "Capitol Hill" but to our individual state legislatures.

I'll ask again, if the AMA is so powerful, why do pharmacists have immunization rights in many states? They didn't seem to be able to block that, did they? And pharmacists already have limited prescriptive authority in a number of situations.

You're ascribing way too much power to the AMA, and you show a basic lack of understanding of how professions are regulated and governed.

Honestly, I love the idea of you guys giving most immunizations (not peds, but everything else). The only issue I have, and this certainly isn't unique to this situation, is not what my patients are getting and when.

Example: I have yet to meet a patient that can remember if a) they've ever had pneumovax b) if they had 1 or 2 and c) when those were. The only saving grace is my EMR. If they start getting stuff elsewhere, it'll cause me a headache and likely end up costing money with the pay for performance stuff coming down the pipe.

 

[Socrates25]

I have never understood why pharmacies can make a profit at giving flu shots but a physician cannot. Lower overhead?

the per-unit cost of buying vaccines is much higher for physician clinics as opposed to huge chain pharmacies

With some payor sources it is impossible to make a profit on vaccines, even if you can buy them in bulk for pennies on the dollar -- in that case pharmacies do better because they figure while they're getting the flu vax they can persuade people to buy other **** while they're in the store.

 

[SMDoc]

I live in a state where pharmacists have prescriptive authority in collaboration with physicians. This mostly takes place with government institutions: ie our pharmacy school faculty, AF base, etc. This is because pharmacists cannot bill for services. Thus, it isn't cost effective to pay a pharmacist his/her salary when you can hire a PA or NP for 15-20k cheaper.

It is an idiosyncrasy that PAs can prescribe with 1/3 to 1/2 of the schooling that we get.

For fun, check out the below. Pharmacists in the UK can Prescribe AND Inject Botox. 🙂

http://webarchive.nationalarchives....e/Independentpharmacistprescribing/DH_4133943

 

[Socrates25]

It is an idiosyncrasy that PAs can prescribe with 1/3 to 1/2 of the schooling that we get.

Thats a red herring. I guess you also believe MDs should be banned from prescribing as well because we dont get as much formal pharmacology training as you do.

For fun, check out the below. Pharmacists in the UK can Prescribe AND Inject Botox. 🙂

http://webarchive.nationalarchives....e/Independentpharmacistprescribing/DH_4133943

Just goes to show you that pharmacists are just as greedy as doctors.

 

[SMDoc]

Thats a red herring. I guess you also believe MDs should be banned from prescribing as well because we dont get as much formal pharmacology training as you do.

Please don't assume doc. I don't believe anyone should be banned from prescribing (except maybe NPs-but that is another story 🙄)

I just seriously question that length of pharmacy education. With an under grad degree, 4 years of pharmacy school, and 1-2 years of residency- we still have a VERY limited scope of health care practice. I was actually discussing this with my professor a few hours ago. He agreed with me, for the most part.

Nonetheless, I really do like the PA model. I now regret that I did not go to PA school. 🙁

 

[JoBreeze]

Please don't assume doc. I don't believe anyone should be banned from prescribing (except maybe NPs-but that is another story 🙄)

I just seriously question that length of pharmacy education. With an under grad degree, 4 years of pharmacy school, and 1-2 years of residency- we still have a VERY limited scope of health care practice. I was actually discussing this with my professor a few hours ago. He agreed with me, for the most part.

Nonetheless, I really do like the PA model. I know regret that I did not go to PA school. 🙁

I don't really get what the purpose of prescribing would be outside the collaborative framework mentioned above that already exists?

 

[SMDoc]

I think I want to be in more involved and actually practice medicine and surgery. I really like doing procedures and working with my hands.

Nonetheless, the collaborative practice models are slowly growing, but not very prevalent here (in my opinion) due to the lack of billing ability.

 

[Digsbe]

I think I want to be in more involved and actually practice medicine and surgery. I really like doing procedures and working with my hands.

Nonetheless, the collaborative practice models are slowly growing, but not very prevalent here (in my opinion) due to the lack of billing ability.

I support expanding the scope of practice of pharmacists, but we should never be involved in doing surgical procedures.

 

[JoBreeze]

I think I want to be in more involved and actually practice medicine and surgery. I really like doing procedures and working with my hands.

Wait... so why are you pursuing a doctor of pharmacy degree if you want to practice medicine and surgery?

 

[eagles22]

Please don't assume doc. I don't believe anyone should be banned from prescribing (except maybe NPs-but that is another story 🙄)

I just seriously question that length of pharmacy education. With an under grad degree, 4 years of pharmacy school, and 1-2 years of residency- we still have a VERY limited scope of health care practice. I was actually discussing this with my professor a few hours ago. He agreed with me, for the most part.

Nonetheless, I really do like the PA model. I now regret that I did not go to PA school. 🙁

The problem is, your training in on drug therapy. That is not diagnosis and examination. Those other professions at least have some draining in how to diagnose (albeit extremely limited). Pharmacists are the experts on drugs, but they are not the expert on figuring out who needs them.

 

[bob1234]

Most prescriptive authority for pharmacists applies to collaborative drug therapy management. A physician and pharmacist enter into a written agreement to manage a patient medication therapy.

Any "real" prescriptive authorities for pharmacists are a long way away. Simple fact is that it will take money away from practicing physicians. Governmental lobby for AMA > lobby for APhA. That is some pretty easy math to show why physicians will continue withholding prescriptive authority from pharmacists (though a PA has limited prescriptive authority after just 2 years of PA school - very limited pharmacotherapy in their curriculum).

In my opinion, it is a matter of checks and balances. Though physicians can give out medication, most large quantities go through a pharmacist. Many "dirty" docs in my state (Ohio) have been caught by the Board of Pharmacy and prosecuted by this same entity (along with the dispensing pharmacist - FYI if a dirty doc is writing bad scripts and you are filling them, you are equally liable whether you were aware or not).

Filling Desoxyn for the same patient for >12 weeks = criminal negligence at best or willful negligence at worst. Willful negligence will be accompanied by the same charges the doctor faces (3-7 years prison, license revoked).

My entire point being, there are a lot of sides to this prescriptive authority thing.

Why is filling methamphetamine for a patient negligent if done for more than 12 weeks?

 

[bw6]

Why is filling methamphetamine for a patient negligent if done for more than 12 weeks?

It is contraindicated for >12 weeks of use because it is used primarily as an anorectic. Therefore using for more than 12 weeks is no longer dieting, it is abusing. I do not believe this is used to treat ADHD as is the case with racemic amphetamine salts, S-Amphetamine, or lysdexamphetamine. It also has a much higher abuse potential (though all amphetaines are quite widely abused).

I could have a whole other thread discussing the ethical implications of prescribing or dispensing methamphetamine as an anorectic. If you haven't picked up on this yet, I am not a big fan of using Desoxyn for anything.

EDIT: I believe in some cases it is used for ADHD as well as narcolepsy.

 

[All4MyDaughter]

It is contraindicated for >12 weeks of use because it is used primarily as an anorectic. Therefore using for more than 12 weeks is no longer dieting, it is abusing. I do not believe this is used to treat ADHD as is the case with racemic amphetamine salts, S-Amphetamine, or lysdexamphetamine. It also has a much higher abuse potential (though all amphetaines are quite widely abused).

I could have a whole other thread discussing the ethical implications of prescribing or dispensing methamphetamine as an anorectic. If you haven't picked up on this yet, I am not a big fan of using Desoxyn for anything.

EDIT: I believe in some cases it is used for ADHD as well as narcolepsy.

The 12 week restriction is not legally mandated. It's a guideline. It is FDA approved for use in ADHD as well as exogenous obesity. But, any prescriber can use it off label for any indication they choose. Your statement that filling it for > 12 weeks is willful or criminal negligence is not factual. Pharmacists should do their due diligence to document appropriate prescribing for situations that are outside of the norm, but you can't make a blanket statement like "greater 12 weeks is criminal."

 

[grayscaleart]

I'm pretty sure you need to work up a patient first before writing a prescription. I've never seen a pharmacist work up a patient, so I say, pharmacists can only initiate/modify meds after collaborating with a clinician

 

[cycloketocaine]

I'm pretty sure you need to work up a patient first before writing a prescription. I've never seen a pharmacist work up a patient, so I say, pharmacists can only initiate/modify meds after collaborating with a clinician

Harrowing.