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Give Me That Pen: Breaking Down Pharmacist Prescriptive Authority

As lifelong learners, we pride ourselves in expanding our knowledge in all aspects of pharmacy practice and regulation. However, in a rapidly evolving healthcare landscape, further impacted by staff shortages, supply chain issues, and regulatory changes in 50 states and D.C., it's a lot to keep up.

We sat down with RSG Director of Program Management, Jennifer Baumgartner, to dive in on considerations related to prescriptive authority as part of pharmacists' scope of practice to better understand the nuances in this complex issue.

Why should pharmacists have expanded prescriptive authority? What are the benefits?

Pharmacists are among the most accessible health care professionals. Approximately 90% of Americans reside within 5 miles of a community pharmacy, and patients are reported to visit pharmacists 12 times more frequently than primary care physicians. When pharmacists are utilized to drive drug selection, their expertise can aid in minimizing duplicative, excessive or unnecessary medication. Leveraging pharmacists can result in increased patient access points in the healthcare system to provide high-quality, cost-effective care that reduces burden on other health care providers. Additionally, with the pharmacy serving as a hub for patient access, expanded roles for pharmacists to engage in patient care plans will be in demand.

What is the current landscape and opportunities for pharmacist prescribing?

States determine the scope of practice of the health care professionals they license and extent to which they may engage in prescriptive activity. Prescriptive authority for pharmacists currently exists on a continuum with states differing in how the authority is defined and the degree of autonomy. Two primary categories exist: Collaborative Prescribing and Autonomous Prescribing.

Collaborative Prescribing

A Collaborative Practice Agreement (CPA) serves as the primary means a pharmacist may initiate, modify, or discontinue medication therapy or provide other patient care services outside state law scope of practice. Nearly all states allow pharmacists to enter into a CPA, providing authority for medication management for acute and chronic diseases where a diagnosis has been made. A formal practice relationship is created between the pharmacist and prescriber, identifying specific functions delegated to the pharmacist under conditions outlined in the agreement. CPAs can be patient-specific or population-specific, serving to improve the efficiency and effectiveness of collaborative care delivery. However, states may restrict which patient populations may be cared for under a CPA as well as limiting which prescribers and pharmacists may enter into an agreement and/or where services can be delivered.

Autonomous Prescribing

Autonomous prescribing, which includes statewide protocols and category-specific unrestricted prescribing, is less restrictive than collaborative prescribing in that it gives pharmacists authority independent of agreements with prescribers. Statewide protocols refer to a framework for specific conditions under which pharmacists are authorized by a state-level protocol to prescribe specific medications or categories of medications. Authority is ratified by the state and protocols are established by Boards of Pharmacy. Current statewide protocols vary state-to-state. Some allow for pharmacists with qualifying criteria to prescribe specific medications or medication categories, while others require pharmacists obtain additional licensure, complete specific continuing education, and/or notify primary care physicians following treatment. Statewide protocols can help to create continuity of care within a state as well as a path for standardized access to care for populations in a state, often with focus on public health initiatives.