States OKing pharmacists to prescribe medications

Growth tempered by limitations, failed efforts

The number of states that allow pharmacists to prescribe medications is growing: up to 17 currently, compared with just seven in 1995. But while state legislation makes prescribing possible, individual health care providers must set up collaborative agreements or protocols to allow it to happen.

Many state laws include restrictions and have different approaches for actual prescribing vs. maintenance therapy. Still, the trend is obvious, and the industry expects it to continue. The shift to prescribing hasn’t always been smooth sailing, however. Florida, for example, is often touted as the only state where independent prescribing authority is allowed, and that’s true on its face. The formulary from which Florida pharmacists can prescribe is limited to drugs also available over-the-counter at lower doses, and it consists mostly of decongestants or antihistamines, topical antifungals and antidiarrheals, fluoride-based vitamins, and heavy-duty antacids.

Unlike states where real prescribing can be set up under collaborative practice agreements or protocols, no such provision exists in Florida, and pharmacists there say few of their peers pursue the prescribing that is allowed. For that formulary to expand, a drug must be approved by a panel of seven professionals.

An attempt to amend Florida law to authorize pharmacists to initiate or modify drug therapy while in a collaborative practice was withdrawn last spring by its sponsors after the bill failed to pick up key endorsements in the legislature. Since then, the Florida Hospital System Pharmacists (FHSP) and Florida Pharmacy Association have drafted a combined bill to try again this spring, explains FHSP legislative consultant Lawrence Gonzalez, an attorney in Tallahassee. "Essentially, it is the same bill as last year’s, but it leaves more of the details to the state board of pharmacy."

A similar bill in Pennsylvania failed last year in part due to opposition from the Pharmaceutical Research & Manu-facturers of America. Pennsylvania officials say they will attempt to get the bill through in 1998. In Massachusetts, a task force is being put together to begin drafting language for a prescribing bill in that state.

According to the National Association of Boards of Pharmacy, here is a rundown on the states’ variations of pharmacy prescribing laws:

o Arkansas

In cases of adverse drug reactions, pharmacists can modify drug therapy if a physician cosigns and can change a prescription in terms of drug product only if an alternative is already present under a collaborative protocol.

o California

Pharmacists can start or change drug therapies in managed care or licensed facilities via authorization protocols with physicians.

o Florida

Independent prescribing from a limited formulary is allowed without physician approval. The state’s pharmacy board and other professional representatives can combine as a seven-member panel to consider adding to the formulary.

o Hawaii

In acute care settings, pharmacists can adjust dosing regimes if a physician or prescriber cosigns or authorizes.

o Indiana

Acute care settings and private mental health institutions can set up protocols whereby pharmacists can adjust specific dosage regimes.

o Iowa

Collaborative practice agreements are allowed between pharmacists and physicians.

o Kansas

Physicians and pharmacists can develop collaborative protocols, based on state law allowing physicians to delegate functions within the realm of their practice.

o Kentucky

Written collaborative practice agreements can be adopted allowing a pharmacist to start, maintain, or stop drug therapy.

o Michigan

Under the state’s definition of a "prescriber," pharmacists can be delegated to prescribe if a physician cosigns, simply a variation of a collaborative protocol.

o Mississippi

State board-approved protocols submitted by a health care facility can allow pharmacists to begin or change drug therapy.

o Nevada

Physician collaborative practice agreements allow pharmacists to begin, change, or maintain drug therapy in licensed facilities.

o New Mexico

Collaborative agreements give "specially certified" pharmacists prescriptive authority.

o North Dakota

While schedule II drugs are prohibited, pharmacists can prescribe in hospitals or nursing homes pending approval of the state’s pharmacy and medical boards.

o Oregon

Physician-approved guidelines or protocols can set up a collaboration for dependent pharmacy prescribing.

o South Dakota

Allows for physician- or health system administration-approved protocols for pharmacists to begin or change drug therapy.

o Texas

Written collaborative protocols allow drug therapy management, initiation or modification.

o Vermont

Pharmacists can change drug doses if the drug in question is part of an established protocol.

o Washington

State board approval is needed for each collaborative protocol seeking to allow pharmacists to begin, change, or maintain drug therapy.

[For more details, contact the National Association of Boards of Pharmacy, 700 Busse Highway, Park Ridge, IL 60068. Telephone: (847) 698-6227.]