We should allow pharmacists to prescribe some medications
Fairly or unfairly, one unambiguous result of the COVID-19 pandemic has been a fall in status for some of America’s once-deified public health institutions. The FDA, for example — historically among the most trusted federal agencies — is seeing a decline in public trust. The rise in online conspiracy theories and citizens elevating their own internet “research” over the advice of experts is also a sign of an erosion of confidence in once-sacred institutions.
There is at least one group of medical professionals that not only has survived the pandemic mostly unscathed but may even emerge more trusted than ever before: pharmacists.
When it comes to testing and vaccinating, pharmacists have been irreplaceable. Nearly 200 million doses have been administered and reported by retail pharmacies. Even pharmacy technicians — the support staff at pharmacies — have proven they can vaccinate people safely, thanks to emergency deregulation that empowered them to do just that.
The American public is learning that a vital public health resource has been lurking in plain sight for years. Now, as the pandemic spills into a third year, the argument for expanding the role of pharmacists even further is stronger than ever.
Consider, for example, that America is facing a primary care physician shortage. A growing number of health care professionals are looking to exit the profession, in part due to burnout from the pandemic. And there’s the looming prospect of pay reductions due to Medicare cuts on the horizon.
Pharmacists could help address these problems. They’re highly educated medical professionals with extensive knowledge of state-of-the-art treatments. There are more of them than there are primary care physicians, and they work in our neighborhood convenience and grocery stores. They are open longer hours than most doctors’ offices, and no appointment is needed.
Those benefits can be a game changer, especially in rural America. While just 11 percent of the nation’s primary care physicians are located in rural areas, over three quarters of independent community pharmacies serve areas with populations below 50,000.
During the pandemic, these advantages have proven invaluable. To further leverage these assets, qualified pharmacists should be allowed to prescribe medication in more situations too.
In most states, pharmacist prescribing is illegal, except perhaps in a few narrow instances. One of the easiest reforms a state can undertake is to gradually allow pharmacists to prescribe more specific, low-risk pharmaceutical products. Many states have used that approach for naloxone for opioid overdoses, epinephrine auto-injectors (e.g., EpiPens), and immunizations.
This approach allows the legislature to carefully vet expansions of authority and subsequently monitor the effects of reforms.
States could also consider granting state pharmacy boards the right to select what products and medicines pharmacists can prescribe, within certain limits. Pharmacists in Oregon can prescribe drugs and devices authorized by a public health advisory committee and the Oregon Board of Pharmacy. Examples include diabetic blood sugar testing supplies and products for quitting smoking. This year, Utah’s legislature authorized its board of pharmacy to make rules designating drugs and devices that may be prescribed by a pharmacist.
The most ambitious state approach to-date comes from Idaho. Through a series of legislative changes, it adopted a model whereby pharmacists are now free to prescribe medications as they deem appropriate, so long as ailments are minor, already have a diagnosis, are easily diagnosable with a test, or require emergency treatment.
Some people express concerns over granting pharmacists the freedom to prescribe medications, arguing that pharmacists aren’t capable of properly diagnosing illnesses. But expanded prescriptive authority is merely aimed at allowing patients with minor illnesses to get the care they need. States that have expanded authority for pharmacists in this area have also set up rules or imposed protocols so that, when in doubt, patients are referred to a physician.
What’s more, pharmacists have at times proven even more capable than other medical professionals. One study found that 40 percent of prescriptions written by physicians for urinary tract infections had to be modified by pharmacists to better conform with clinical guidelines.
In the face of new waves of COVID infections and imminent health care staff shortages, it’s time for states to step back and look at the big picture.
Pharmacists have proven they are up to the task at a time when other public health institutions have fallen short. Yet state laws and regulations continue to stand in their way. This new year, there’s one resolution everyone should be willing to get behind: Let pharmacists step into the breach.
James Broughel is a senior research fellow and Elise Amez-Droz is a program manager with the Mercatus Center at George Mason University. They coauthored the recent study, “Expanding Pharmacists’ Prescriptive Authority: Options for Reform.”