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




Nancy Barto, R-Phoenix. Photo by Gage Skidmore | Flickr

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.”

Jerod MacDonald-Evoy
Reporter Jerod MacDonald-Evoy joins the Arizona Mirror from the Arizona Republic, where he spent 4 years covering everything from dark money in politics to Catholic priest sexual abuse scandals. Jerod has also won awards for his documentary films which have covered issues such as religious tolerance and surveillance technology used by police. He brings strong watchdog sensibilities and creative storytelling skills to the Arizona Mirror.

66 COMMENTS

  1. Letting non-physicians prescribe medication – what could possibly go wrong? Hope the druggists have their medical e&o insurance paid up.

    • Pharmacists have significantly more training than even physicians when it comes to medications and pharmacotherapy. It’s silly that pharmacists, the medication expert of the healthcare team, are not already more involved in prescribing.

    • Doctors are not the only ones with prescribing rights.. People with less education and experience of that of a pharmacist prescribe every day though..!?!?. I know embrace for that realization and information…God forbid someone with a higher education like a doctorate (not like that of a PA or Arnp,who can) write an abx for a positive strep test or the over priced tamiflu for positive flu tests, the same tests the nurse runs in the office or know the pharmacology and pharmacokinetics and know when I can change dosage form when unavailable because a doctor never writes for a dosage form that doesnt exist for the drug…. I shouldn’t be able to fix that either huh…gosh not educated enough to change that right… or 1 strength not available but another is that can be doubled to equal same dose depending on nature of drug..do you really want 10 pharmacies calling you about every patient everyday to change it….I know too much too handle or fathom. Pharmacists are not trying to PRACTICE medicine and diagnose non acute conditions..we already have so much too do. Just time saving things because we are the ones getting screamed at when refill requests are not done or why they cant get a drug even though dr said they can and it is on backorder and yelled at when the dr doesnt respond back to change it but it’s all about pt care right?!? Btw We will be forced to do these tasks at no extra reimbursement. I know you feel like we are invading on your territory but come on it’s really not about that…also, it’s about time pharmacist get recognized for the education and work we do. Trying to act like a pharmacist has never saved someone’s butt from a script error because a pharmacist would be the only person who would do that?? We are trusted to be able to catch the wrong scripts or DDI but not capable of writing a script or fixing a script but we must know what a wrong script is and make sure it wont kill the patient..we can be trusted to do that though.?!?. Between the staff cuts,500 plus scripts shifts,MTM, immunizations, sale goals, wrong scripts, interruptions, nonstop phones we actually answer not just a receptionist or answering service and not just one office amount of pts but every local office pt load on one person isnt enough lets add more tasks..I already deal with enough… I am not trying to play diagnosis and run strep tests and write ppl scripts that try to avoid going to the Dr. It makes corporate more money not me but would be nice to fix common things and make judgement calls on easy fixes and ect. It took me 1 week to get approval on a backorder med strength and pt was without and all I had to do was get a new script for half the dose and double the tablets to equal the same strength..and got called everyday and yelled at everyday because I never got the response because all they have to do is walk right up to my face being so easy access because they cant even get someone to return their call form the office, no less walk up anytime they want to start yelling at me while I’m already having the same issue with every patient in town on it and not getting the call back….it isnt about wanting to play MD. If I wanted to do that work i would have done that pathway. I dont want more work for less and not being possible to clone myself …I just want to do my job and fix things when needed to be fixed and move on. Promise I dont want your job. But I am still a doctor like it or not…capable of being able to change a 1mg daily to 2 0.5mg po daily and write that up right?!?! Or that to scary not capable but a receptionist can call in metoprolol and not understand the salt form difference. It’s more about that ability to fix wrong scripts issues that already exist for me… Writting 30day or 60 day refills nah they can get their 3 day emergency supply and get to their Dr but it’s not because I am not capable of writting a script. Dr refuses to see them, then they need to find someone who will see their patients and then they would stop coming to me and demanding answers.

  2. Pharmacists have been receiving the doctor of pharmacy degree (PharmD) for about 20 years. That’s when it became mandated. It was optional before that. So, 6 to 8 years of training plus 1 to 2 years of post-graduate residency. I’d say that’s comparable to physicians. Furthermore, nurse practitioners and physician assistants only obtain a master’s degree, yet, they are allowed to prescribe. Sadly, the general public does is ill-informed of what “druggists” actually do.

      • This is the same notion as “a PhD educator’s training is for x amount of years so they should be able to have the same scope of practice as a PA/NP/MD/DO.” I would expect an ill-conceived, disconnected, argumentative statement like this from my 8-year-old, not someone who has “6 to 8 years of training plus 1 to 2 years of post-graduate residency.” The focus of PA/NP/MD/DO training is significantly different than a PharmD. Our training focuses on interpreting patient history, physical exam, diagnostics and formulating differential diagnoses to initiate appropriate treatment. I can’t remember the last time I saw a PharmD perform a physical exam, interpret EKGs for potential prolonged QTc intervals, perform a head-to-toe neurologic examination in a patient with facial droop (or that matter differentiate between CVA and Bell’s palsy). I have respect for PharmD’s as I work with some of the best, but please don’t belittle our training to support your desire to be a diagnostic clinician, for which was NOT the focus of your training you elected to pursue.

        – “Just a PA”

        • Not trying to offend or belittle your training in any way, but I graduated pharmacy school in 2016 and was taught how to interpret an EKG and do a physical and neurological exam as part of my core curriculum.

        • Not trying to belittle your training in any way, but I actually was taught to interpret EKG’s, and do a physical and neurological exam in school. Our pharmacotherapy courses were designed to teach us how to diagnose. We actually have to make diagnoses on a daily basis when recommending OTC products. Also, if you read the bill carefully, there is really nothing in there that requires actual diagnosing. It’s continuation of other prescriber’s prescription (which we are already legally allowed to do for emergency supplies), prescribing pursuant to a clinical test, and then a few other items that are basically no more dangerous than OTC meds. FYI I do not want this bill to pass, but it’s not because I don’t think pharmacists are capable of these basic tasks, it’s because I’m busy enough with the work I have.

          • Learning how to interpret an EKG and do a physical exam once versus doing it a thousand times in a formal 2 year clerkship and residency is far different. Diagnosing is far different from management. Also, knowing the intricacies of a physical exam and knowing how to recognize signs is also an art.

    • A PharmD is a 4 year program. Most if working in the community do not do residency. Best case scenario is that they have 5-6 years training (4 of which was pharmacy school). Med school is 4 years. Residency programs are 3-7 years. That is 7-11 years of training (4 of which was medical school). That is VASTLY different in terms of specialty training in diagnosing AND prescribing. It is not the same. Please stop.

      • But last time I checked, doctors can prescribe as soon as they graduate medical school, not after residency. Also, in my home state there were doctors who did not do residency and went straight into primary care practice similar to nurse practitioners and PAs to meet the need to rural physicians. Finally, no one is asking for full prescribing rights, read the bill.

        • Just to clarify, most graduating MDs and DOs do not get a DEA until they have a full state medical license, which is usually after a few years of training, including of passing of USMLE Step 3. Interns and residents start with a limited medical license, which gives opportunity to get a temporary DEA that is attached to the hospital they are training at (they cannot use it willy nilly), similar to how ANPs and PAs work in a supervised fashion under an MD. Those trainees in many states cannot prescribe controlled substances with limited license, so their attendings still have to prescribe narcotics, etc for their patients.

  3. Three day gap between a refill and notifying the Doctor of having done so?

    Seriously?

    Beyond that major problem, what specific problem does this solve? For example, can supporters of the bill provide data showing rural patients have difficulty in obtaining refills through a physician?

    Or is this simply an anecdotal argument, driven more by ideology rather than need?

    My guess is, the latter.

    • But a three day plus gap in responding to refill requests and clarifications are ok?!? Thought it was about patient care. Why does it take many days to get a script.clarified by offices or responses for refills and puts are going without? Wouldnt need us to write anything if they got the response right? But am not so thrilled about 30day scripts or 60 day scripts either. 3 day emergency fill until they can be seen like normal is just fine. Pharmacist shouldn’t be used as free healthcare to avoid Dr copays. Drs dont work for free to write scripts but it ok for free medical all day anytime from a pharmacist not right either. But yes there are studies of underserved communities and in rural areas. I know people in Alaska who have no near by doctors and they have implemented tele services to reach those people. And not in rural area and doing refill request everyday yes even those people have issue getting refills and next available appt isnt until a month out. Shoot it’s been 3 days and I’m still waiting on a clarification on a script that was written incorrectly…so yup I can see people having difficulties getting refills. Pt gets 30day script no refills and follow up appt in 2 months and now dr isnt responding to refill requests…own experience for example moved to new rural town set up dr prior to move being responsible because I knew of need ahead of time but before appt bam they no longer in practice in area and now no one accepting new patients in area and is on life saving medication. What to do…had to take them to ER pay 500$ because of deductible and er copay to get a refill on RX. ER already overloaded with ppl in need and had to go to ER for a refill wasnt sick already diagnosed and no one would write it without being a patient and already been seen by their Dr. So, 500$ to walk in ask for a script and not to mention it was 1700 for 30 tablets..so who can afford that thank god I have a good salary. True story..so yes rural areas have problems getting certain care and prescriptions.

    • It is 72 hours due to not being able to speak to most prescribers on the weekend. It is a maximum allowed time, but in practice notification is usually sent the same day unless there is some sort of problem preventing that.

      Rural patients may live quite a distance from a physician’s office, and many areas of rural America are underserved. Waiting time to get an appointment can be weeks. If an elderly patient can get an antibiotic for a respiratory illness near home instead of trying to drive themselves over 100 miles round trip while sick, that is a step forward for medical care in that community. It would not make much difference in urban settings.

    • Okay, well how long does it take Doctors to respond to a refill request? I’ve seen those take over a week. 3 days ain’t shit pharmacy time lmao.

  4. Not rocket science to diagnose strep or to interpret a TB test. As already stated, physician assistants and nurse practitioners with a 2 year master’s degree have prescriptive authority. But a pharmacist with a doctorate degree specializing in pharmacotherapy isn’t qualified enough? Get over yourselves and your egos. All it comes down to is money and your precious egos. As a pharmacist, fixing doctors and PA’s mistakes on a daily basis, I know we are more than qualified to perform the tasks specified in the bill.

  5. Pharmacists have a doctorate degree, and have more schooling than PAs and NPs. Pharmacists have a deeper understanding of medications than doctors; that’s specifically what pharmacists go to school for.

  6. This is not intended for pharmacists to newly diagnose patients. And if you think physicians get more training and formal education in pharmacotherapy, you are sadly misinformed by a long shot. Mind you physicians become extremely knowledgeable and experiencedwith medications within their particular specialty, but pharmacists receive so much more training across the board. Also, despite what’s in this report, many jobs require pharmacists to complete extensive residencies.

    • No offense. You have expertise in pharmacokinetics, pharmacologics, drug interactions, new medications. I consult you when I have questions regarding medications. You do not, however, have ANY training in diagnosing or treating actual human beings. The excuse that other people with less training are already doing this does not make it any better. They shouldn’t be doing it either. Two wrongs don’t make a right.

  7. This is very simple. It allows entities such as Walgreens or CVS to have their own employees prescribe medications that they sell without the inconvenience of a physician in the way. Very clever. And as usual, legislators are making making medical decisions.

    • Yes I agree this is probably sponsored by corporate interests. Is it really better for patients to have to pay several hundred dollars to be seen by an urgent care for the same outcome though? Granted I did not support this bill from a personal standpoint, but I have to admit I think it would be better for my patients and the healthcare system as a whole.

  8. This is absolutely insane. When did a pharmacist take a history and physical? When did they learn physical exam skills? Let the bodies hit the floor!!!! Nancy Barto makes another mistake in Arizona politics. Someone please get that idiot off the ballot.

  9. So I’m a pharmacist and let me clear up some of the misinformation being bandied about. Pharmacists have no where near the same level of training as physicians do. School for a pharmacist goes like this, approx 60-70 credits of prerequisite classes that can be completed at either a 4 year school or a community college. then depending on the school, 3 or 4 years of graduate classes (most are 4, there are some year round that are 3. A rare exception is the 6 year program that rolls the prerequisites and grad school into one 6 year journey). These classes break down to 3 years of didactic (classwork) and 1 year of experientials. After you graduate, you pass your boards and you’re a pharmacist. If you want, totally optional, you can do a 1 year residency. After that residency, if you want to become even more specialized, you can do another 1 year residency in a specialty field. Again, both of those residencies are wholly optional. Now, let’s compare to a MD/DO. They are required to get a bachelor’s degree before applying to medical school. Then it is 4 years of medical school. After graduation they have to do a 1 year internship, followed by 3 years of residency. Mandatory. And that is if they only want to be a basic family practice doctor. If they want to do anything else you can count on another 1-3 years doing a fellowship. Again, mandatory, not optional like pharmacists. So no, pharmacists do not have the same level of exposure and education as physicians do. Do we know a lot about drugs? Certainly! We’re the drug specialists. But to imply that we have the same experience and knowledge as a MD/DO is fallacy.

    • That’s great. No one is saying a pharmacist is equivalent to a surgeon who’s done 5 years of residency and 2 years of fellowship. Just that pharmacists have the training and knowledge to prescribe the very limited courses of treatment outlined in the bill. Physicians are granted (almost) full prescribing rights at the end of medical school, not residency or fellowship.

  10. A couple of points to ponder:
    The term ‘doctor’ is not a job title, it’s a level of education. An MD and a Pharm.D are both doctors with different specialties which then lends to the point- a physician is not trained ‘better’- they are trained ‘different’. They are trained in diagnosis, pharmacists are trained in the treatment. With 10 years of intense college education under my belt to become a Pharm.D and 15 years of practicing, I take great offense at the implication that I am not educated enough to read a test or perform a function being fulfilled by people with as little as 2 years of medical training. Someone needs to calm their egos and stop feeling threatened. The Physician + Pharmacist cooperative is supposed to be a PARTNERSHIP- not a battle for dominance.

    Second- most pharmacists don’t really have much interest in prescribing beyond the basics. If we wanted to diagnose and prescribe all day… we would have gone to med school rather than pharmacy school.
    We know and perform far beyond ‘counting pills’ but we do it out of the public view so our contibutions to patient care and safety go highly unrecognized. Shame on the people who judge what they don’t know.

  11. As a pharmacy student in my DOCTORATE program in Arizona, I am still shocked by the ignorance of what some people view a pharmacist can do or frankly the knowledge level. Not only do we pay onwards of $30,000 + a year for our degree much like MD, DO, PA, or NP we also receive very similar training on YES how to diagnose certain conditions and perform physical exams called OSCES (Objective Structured Clinical Examination), very similar to other practitioners who currently have prescriptive authority. I’m not saying we are out here diagnosis CANCER but for heaven’s sake, we know how to interpret a skin test or culture. This is not to bash other professions .. more to help uplift ours.. but I have seen hundreds of antibiotics being prescriber from urgent care, minute clinics by PA/NPs etc for indications not necessary or frankly not adequate agents for the organism causing the infection. Whereas PHARMACISTS go to school to learn just that.. to what count your pills and put them in a bottle? Not all RPH’s out there in a community setting have a doctorate but as stated before.. over almost a decade everyone who graduates from a pharmacy school in the United States is a DOCTOR OF PHARMACY. Please educate yourselves and stop putting down a profession of highly skilled and honestly invaluable members to healthcare that will make it better by having more clinical authority.

  12. Communication is a vital component of patient safety. A pharmacist will not have the complete assessment of a patient and treatment plan. A simple example, kidney function. An rx may not have been refilled on the part of an MD bc of increases Cr and needing to communicate this to a patient. I highly value the pharmacists I work with. We are a team with very different but important overlapping knowledge. It is the MD who leads the team and we provide the safest care by communicating, not over riding each other. Assumptions are always dangerous in patient care. Those who argue NPs and PAs have presrcibing power over pharmacists, I agree they are far less knowledgeable and that it is unfortunate the liberties they have been granted to them. But using a bad example, doesn’t make for good, safe patient care.

  13. I was worried that the ego of physicians halpen only in Pakistan but i am surprised to see that it’s the same in developed countries.
    I myself, being pharmacist, have been effectively treating my diabetic and hypertensive parents at home. Very rarely and due to the only reason of lack of diagnostic facilities at home, i am ompelled to take them to a clinic.
    I rarely fill the same prescription as advised by physicians.
    My pharmacy staff prefer to consult me for their family ptients instead to take them to physicians, though i discourage them as it was not my duty.

  14. Access to care is a challenge for many Arizonans
    –Convenient, local care is critical when you aren’t feeling well.
    Arizona has 216 federally-designated health professional shortage areas. —-Within those areas, only 45% of primary care needs are being met.
    –There are over 6,000 highly trained pharmacists in AZ who are ready to help.
    –90% of Americans live within 2 miles of a community pharmacy.

    Pharmacists are extensively trained in medication management and patient care. Pharmacist training includes at least six (usually eight) years of college education with extensive coursework in pharmacology, clinical patient care, drug selection and more.

    Everything in this bill has already been authorized in other states – and in Canada, where pharmacists receive less training than U.S. pharmacists.

  15. Did everyone commenting read the actual bill? There are limitations on length of the pharmacist prescribed medication. It has to be pursuant to an uninterrupted therapy and is limited in the days supply. There is also no liability to the original prescriber. The intent of the law is to bridge gaps in patient care that are causing adverse events and increased utilization of expensive healthcare services such as urgent care centers and worse yet emergency rooms. Why does this have to be pharmacists against prescribers? Aren’t we all here to help our patients. Let the pharmacists help! We are medication experts, and spend a lot of time getting to know our patients. We just want to ensure they are getting the best possible care at all times. Please look at pharmacists as a healthcare partner, not an adversary!

  16. I was on a trip in Italy when I got a stomach virus. Went to the pharmacy & got over the counter meds (didn’t work)! Went back (by the hardest each time) & spoke to the pharmacist. She was able to give me a prescription med & said if it doesn’t work, need to check into the hospital! Worked that day after 3 days of being sick! Why can’t this happen in the USA? Thank God for that pharmacist!

  17. Sorry but don’t comment on PA education unless you are really familiar with it. Rotations in the senior year are like physician internships. I did 80 hour weeks of total immersion in medicine for over a year. All night on call and carried a pager in those years. Was an intern on a team of physicians. Our education is stellar. Have you checked the outcome studies on the profession?
    I can not believe more than one pharmacist put down PA education to make themselves look better? Not the way to treat colleagues. Actually I am shocked, but ok…
    Please.
    Personal opinion only.
    Dave

  18. I don’t understand how the pharmacist can safely prescribe medication if they dont know all the patients comorbidities and they’ve never done an exam! If they prescribe rifampin to someone with a positive TB test, will they check liver enzymes, do an exam for hepatomegaly? Get Etoh history? This is just a simple example. Also I get request from pharmacist all the time to substitute one medicine for another “in the same class”. The requests are completely inappropriate like substituting methotrexate for cellcept for lupus nephritis patient. ??! If you could hear the type of phone calls I get daily from pharmacists – your jaw would drop. It just that they don’t know the patient well enough. In contrast when the pharmacists round with us at the hospital they know the patient and it’s super helpful when we put our heads together to come up with a medication plan.

    • To clear up any confusion, the bill would only allow a TB test to be performed and interpreted. The patient would need to be referred to a physician for treatment.

  19. I think “what the hell lets let the physicians be pharmacist.” but then who would diagnose and treat the patients that get misdiagnosed and mistreated by the pharmacist?? I already deal with issues that are brought on by the walmart pharmacist making “recommendations” for certain OTC meds because they don’t consider comorbidities.
    While I enjoyed the occasional pharmacist rounding with our team the experience-in its limited scope- was entirely different than the reaidents and fellows experience.

    • You are a fool. READ the bill. A dopey pediatrician wouldn’t prescribe an antibiotic for my son until the strep test came back, because of “overprecribing of antibiotics”. EXCEPT my child had 2 antibiotic prescriptions in 12 YEARS & was VISIBLY VERY SICK. Dopey had to call me & apologize, my son had strep. Dopey gave him an antibiotic. So to all of you doctors with the God complex- get off of it. I actually trust my pharmacist MORE, At least she KNOWS her limitations! And I have met MANY GREEDY doctors

  20. This is just another sign of our age, where everyone has an inflated sense of their knowledge and abilities. True expertise is no longer valued as it should be, because now everyone’s an “expert.” Well, I for one will not accept a dangerous lowering of standards. I will only make health care decisions for me and my family through the guidance of a trained medical doctor, not from a nurse, a physician assistant, a pharmacist, an optometrist, a chiropractor, a physical therapist, a masseur, a dietician, or a beautician.

  21. Do as you prefer. No one is twisting your arm. However, when you find yourself having a problem on a weekend or holiday, and need some help, a pharmacist is well-trained to help. They have the education and knowledge to make a rational decision.

  22. Question: if the pharmacist prescribes/ changes a patient’s medications, then notifies the MD/DO in the 72 hour timeframe but the patient had an adverse reaction to the medication due to the patient’s Co morbidity is the medical provider on the hook for this if a malpractice suit occur?

  23. With respect in notifying the medical provider within 72 hours, what if you can reach the Medical provider within 24 hours and the patient has an adverse reaction to treatment due to the medication the pharmacist prescribe, who is responsible for that? The medical provider for not being available to consult with the physician after the meds were prescribed?

  24. An issue not yet addressed is capacity and payment. This legislation points out that we have an issue, one where providers are not responding in a timely manner to Rx questions and issues. Is this bill the correct solution? Will pharmacists have the time to do this work? Will the big box pharmacies that seem to rule the business staff the pharmacies to take on this work? Having obtained flu vaccines at pharmacies in the past and the length of time to complete this task, I’d say perhaps not. The real question that will ultimately result in this idea working or not working, pending passage of the bill; however, is whether or not health insurance companies will pay for it service. Or will patients be expected to pay out of pocket for the testing required before medication is ordered? When a bill passed to give pharmacists the go ahead to administer vaccines, it took a significant amount of time before they had contracts with the health plans in place, a gap for which consumers were required to pay first and hope for reimbursement later. I’m not sure this ‘fix’ is the answer to a bigger infrastructure issue within our chaotic health care system.

  25. As a soon to be pharmacist, reading through these comments is painful due to BOTH sides.

    Am I diagnostician? No, plain and simple. But, this bill is not asking pharmacists to diagnose atrial fibrillation or pneumonia. The bill is asking pharmacists to interpret a rapid strep test which has a false positive rate of what, 1 or 2%?

    The bill is also giving pharmacist the ability to screen for TB, which would possibly be helpful in catching a few latent TB cases and preventing transmission. Despite this bill, no pharmacist is going to initiate RIPE therapy based off a positive TB test, we understand there is additional workup required and necessary monitoring that needs to take place during the months of therapy, so of course the patient would get referred.

    I do agree that the additional refill provision could result in patient harm, not to mention could result in patients trying to get additional refills to avoid necessary followup appointments. I think allowing pharmacist to dispense an additional 7 days or smallest package unit to bridge patients until they can get in to see the doctor is reasonable. (Should pharmacists really be lawfully required to allow a patient to go two days without insulin, or a DOAC, or clonidine, or a rescue inhaler because they ran out on a Friday night after their PCP closed for the weekend?). Obviously there is a balance that needs to be struck between making sure patients are monitored appropriately and making sure they don’t go without their medication.

    Pharmacist are committed to providing safe and effective medication use and using our skill set to compliment that of the physician to improve patient care. Pharmacist do have unparalleled training in pharmacotherapy, but that does not mean we are trying to replace doctors in any sense. Realistically, this bill simply allows pharmacist the ability to provide simple, acute treatment for a simply diagnosed illness to patient’s who choose to see a pharmacist.

    Additionally, as a healthcare team it is discouraging to see each profession target one another. We are all trained differently and have different skill sets. A PA and NP are far and away more qualified to make a diagnosis than a pharmacist regardless of the number of years they train. On the other hand, pharmacist are not the “druggists” of the 1950’s, we are Doctors of Pharmacy that are extensively trained in the safe and effective use of medication to treat disease. END RANT.

  26. Let me clarify something. Pharmacist are the drug experts. They specialize in managing diabetes, cardiovascular diseases and neurological diseases as well as many other complex diseases. We do so by choosing the right therapy based on patients individual characteristics, other conmorbitities and drug drug interaction. Our curriculum is heavy and loaded with patient care from all medical standpoints. Do I want to diagnose? No. I would have gone to medical school if I wanted to do that. But I’m the individual who is highly trained in medication therapy, medicinal chemistry, pathophysiology, and patient care in general. No offense to anyone. Pharmacist do receive an extensive training in medicine even higher than PAs and NPs. We know our drugs. It’s insane how many scripts I see on a daily basic where I practice with a wrong indication. Flonase spray for acute cold? Hydrocodone for neuropathic pain. Seriously? That infuriates me just because I know my patient is not receiving optimal therapy at that point. I do not underestimate the training physicians go through. I respect them very much for their extensive training and diagnostic tools. But if the pharmacist would intervene in choosing the adequate therapy for the patient our healthcare would be so much better. Do you realize how many new residents recently graduated from med school have no idea what they are prescribing? They can’t dose warfarin, they have no clue what they are giving they patients. I’m a pharmacist in the ER and I don’t know how many lives I have saved just by changing or modyifing meds because either the indication is wrong or the dose prescribed is absurd. I give physicians a 5 star rating for their medical training and responsibility in patient care. In terms of medications and therapy management the pharmacists are the experts period. And no PAs and NPs do not have the training pharmacist have in medical science I’m sorry.

  27. Not a pharmacist but they’ve been doing stuff like this to other medical professions for a long time. Now that you can do something, it will be another responsibility and expectation. It will be a nice option for patients/ customers, but from what I understand, those of you in community pharm are already underpaid and overworked, like much of the medical community.

  28. How superficial of me to miss that important detail. I just committed strawman sarcasm. I hope you can forgive me, since whenever I see anything representative of Dr. Mann’s positive achievements, I tend to skim over the writing, since my sense of his positive achievements is negative.

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