kwizard said:
I hear what you are saying and I've been a practicing pharmacist for a minute myself. However, the Illinois case in particular is concerning b/c of the potential for it so set a precedence for how states view the role of pharmacy (independent of any ethical issues). For instance in MD they just passed a bill referred to by the press as the "Walmart Bill" which was a supposedly a bill supported by other supermarkets and their unions to ensure that Walmart contributes a certain amount to health care coverage as a means to limit Walmart growth in the area. As a small point of clarification the bill had some generic name, but was deemed by the press and others oppose to it to be directly aimed at Walmart bill. The specifics of the case are a bit much, but the end outcome is that the bill was passed and the impression is that b/c of the bill, Walmarts scheduled for future construction in various areas have cancelled plans for construction and ceased expanding in the state. Forgive me if I am a bit sketchy on the facts, but this bill was initially consdired to just be an isolated situation in Maryland. Well about 2 weeks after passing a similar bill gets brought to the attention of the legislators in Kentucky.
First the case in Illinois, now the case the one in Massachusetts.
For the record I would have no problems dispensing EC pill and yeah I know pharmacists agree to dispense to pts (basically the primary role of the profession in community sector), but is the EC pill only dispensing. Obviously prescribing practices are more liberal in California and in Washington state, but the EC pill is PRESCRIBING and DISPENSING and the two shouldn't be so easily. Why aren't all the OC pills OTC is they are so safe. I'm familiar w/ the statistics that 68% of people took the pill appropriately, but what is happening to the other 32% and how deeply are we really following outcomes.
I am fine w/ agreeing to disagree, but in my opinion the prescribing and dispensing of the EC pill is just an example of an issue that other professions may not of wanted to deal w/ directly so they figured Oh.. just make the pharmacist do it.
kwizard - hope you got some sleep last night! I certainly didn't mean to come down on you after such a long day & I do hope you take my sentiments in the manner you intended - as a lively discussion only - not judgemental at all.
First...for EC...yes, in CA we have 2 options for how pharmacists deal with this drug. It can be filled like any other rx from a prescriber (which includes midlevels here - NP, PA as well as MD/DO). The second option is for pharmacists who have completed a training program (we become a midlevel prescriber and are recoginzed as such legally.) We have been allowed to prescribe & dispense EC under a statewide protocol since 2002. The protocol was developed as a joint effort between the American College of Obstetricians & Gynecologists, CPhA, the CA State Dept. of Health Services & CA State Board of Pharmacy. This prescribing protocol has massive support by the medical community in our state since access to medical practioners is so difficult. CA actually has many legend drugs in which phamacists can furnish without an rx if done under an protocol. Those of us who chose to be trained and furnish EC as pharmacists are as comfortable with doing this as we are with advising on the use of Prilosec because we know what it does & does not do.
As for outcomes - we actually have years of use. For safety outcomes, the data indicates the drug used OTC is safe. As for effective, again the data is clear. EC is most effective if used within 5 days of unprotected intercourse. It will NOT cause an abortion, interrupt an established pregnancy or harm a developing fetus. This data was in place well before our legislature chose to allow the law to pass.
Now, why are OC's not OTC? Because there are risks associated with OC's you do not have with EC. Because of this you must have an H&P, a PE & continuing medical followup. There really is a difference between 2 tablets of levonorgestrel & using Micronor daily. The medical community knows this and so do we. IMO, we can say the sky may fall - a patient may have a pulmonary embolism from using EC, but the reality is that they don't, however they do from OC - which is the crucial difference. Experience in CA & WA indicate it is safe and effective. I have always chosen to think at the edge of pharmaceutical care & in my state, this is an effective way to promote good pharmaceutical care without impinging upon individual beliefs.
Finally, the Walmart bill you refer to has to do with labor issues - not pharmaceutical issues. Walmart traditionally has employed part-time folks who do not qualify for medical insurance (because they are scheduled for less hours per week than Walmart requires for health benefits) which is how they keep their labor costs low. Unions, state government, businesses who don't have labor forces like this all dislike this because these employees do have to utilize the healthcare system (everyone at some point sees an MD if its for a URI or MI) and they are often on public assistance for their healthcare needs. Other businesses (like the supermarkets you refer to) can't compete because the unions over the years have negotiated healthcare even for the low end wage earners. States are forcing Walmart (& Target is sometimes in this same situation) to contribute to the state fund for healthcare compensation to offset the burden these employees place when they do utilize the healthcare system.
All states have issues with this kind of labor practice which is why states are following others lead. This is a political issue - some will agree with Walmart, others won't - I don't choose to side with either on this forum.
I apologize for being so long winded. I feel strongly one of our main issues as pharmacists is to educate the public. But, first, we need to educate ourselves on these controversial issues. One of the negatives of our profession, IMO, is how difficult it is to really find out what others are doing in other parts of the country. We can read about an off label use of a drug in a journal and accept if far more readily than different practice patterns in other states. I feel this lack of good communication professionally is a barrier to how we educate the public - not just our own state's public, but the public in general - perhaps a failing of our national organizations? I hope you and other pharmacy professionals know I firmly respect those choices each of us makes - I've been given that benefit many, many times and I would willingly extend that to all in the profession. Respectfully.....
