House panel approve bill to let pharmacists write prescriptions, over doctors’ objections

A bill that would allow pharmacists to administer tests for things like strep, flu and tuberculosis, as well as allow them to prescribe certain medications, narrowly cleared a House committee this morning.

Pharmacists and physicians voiced opposing views during a hearing in the House Health and Human Services Committee on House Bill 2548. Pharmacists argued the measure would increase patient safety, while doctors said it would do the opposite.

The bill, brought to Barto by the libertarian Goldwater Institute, was passed by the committee on a 5-4 vote along party lines, with Democratic legislators voting against it.

In Arizona, licensed pharmacists can already prescribe certain medications related to therapies that help with nicotine addictions. HB 2548 would allow pharmacists to prescribe a larger pool of medications.

Specifically, pharmacists would be able to prescribe medications that a patient already has had a prescription for for an additional 30 to 60 days, as long as the prescription is not a controlled substance. Pharmacists would then have 72 hours to notify the doctor that the prescription had been issued.

One doctor who spoke before the committee was worried about that provision, in particular.

Dr. Mandy Boltz said she was concerned that a pharmacist could restart a medication she intentionally stopped and she would not be notified for as many as three days.

She also expressed concerns that the bill would hurt collaboration doctors and pharmacists already have and create silos in which each will then begin to independently operate instead of communicating about patient care.

Other doctors who spoke in opposition echoed those sentiments, as well as arguing that things such as tuberculosis tests can result in false positives which could lead a pharmacist to wrongfully prescribe medications to a patient, especially children.

But pharmacists who came to speak before the committee said those fears were unfounded.

Mark Boesen, a Gilbert attorney and pharmacist, said on top of 186 hours of training, pharmacists will often undergo 1,500 hours of an internship, making them more than capable of diagnosing things such as strep or the flu.

Boesen also said that pharmacists are often “conservative” in nature, and if symptoms are anything but “textbook,” they’d send the patient to a physician.

He also argued that the test for strep is simple, and compared it to pregnancy tests which are easy to read and give a, more often than not, definitive answer.

Rep. Amish Shah, D-Phoenix, said the training was still far less than that of a physician which was what worried him.

“By the end of medical school you just don’t have enough information to make a physical diagnosis, that’s why we do residencies,” Shah, a medical doctor, said. He added that, to his knowledge, pharmacists are not required to do residencies.

Residency is when a physician works at a place such as a hospital under the direct supervision of a senior clinician.

“It’s not beyond our scope of knowledge,” Kam Gandhi, executive director at Arizona’s Board of Pharmacy said before the committee. “We’d just be implementing what we’ve learned.”

Christina Sandefur, an executive at the Goldwater Institute, said the bill would help rural communities who can’t see a doctor in a timely manner get the medical care they need.

Similar legislation has been passed in Ohio and Oregon.

The vote

“This is all about patient safety, but it’s also about something else,” Barto said ahead of the committee’s vote. She said the bill also helps “get government out of the way” and improves health of Arizona citizens.

Rep. Kelli Butler, D-Paradise Valley, said the “expansion is alarming,” adding that the legislation’s overly broad language could cause harm if done incorrectly.

“We’re talking about folks who simply do not have the level of training (doctors) have,” Shah said.

Jay Lawrence, R-Scottsdale, originally opposed the bill but changed his mind.

“I learned a valuable lesson today,” Lawrence said explaining his vote. “Don’t shoot off your mouth until you’ve heard all the testimony.”