Expanded pharmacist scope of practice can improve access to care

Pharmacists are permitted to dispense drugs based on prescriptions they initiate, standing orders issued by the state, or collaborative practice agreements (CPA) with licensed prescribing providers. The Center for Medicaid & Chip Services (CMCS) within CMS encouraged states to provide flexibility to pharmacists to prescribe, modify, and monitor drug therapy for beneficiaries that may not have adequate access to care.

Pharmacy scope of practice

States establish the scope of practice for each type of licensed provider within the state through legislation or by a state department. Pharmacy scopes of practice are typically tailored to meet the public health needs of a jurisdiction or specific institution, and CMCS noted that providing the power to dispense drugs under certain arrangements, such as pharmacists’ prescriptions, can be an important tool for addressing national public health challenges.

Necessity for some populations

Allowing pharmacists to initiate their own prescriptions provides another access point to important drugs. Medicaid beneficiaries may not have established a relationship with a primary care provider, but may be able to obtain prescriptions more easily from a nearby pharmacy. Providing access to more medications through these channels may also result in decreased wait times, encouraging beneficiaries to pursue the treatment they need.

Timely access to life-saving drugs and other therapies

The informational bulletin presented the opioid epidemic as an opportunity for pharmacists to save lives. The opioid overdose reversal drug, nalaxone, prevents or reverses overdose effects, such as sedation and respiratory depression. In order to ensure that an overdose victim resumes normal breathing, Naloxone should be administered quickly. In most states, naloxone can only administered under a prescription or medication order, and it is typically provided by emergency responders either in an ambulance or emergency room. However, 40 states allow pharmacists to dispense naloxone under standing orders from licensed providers or by the states’ top medical officials.

California and New Mexico have allowed pharmacists to provide tobacco cessation therapy, such as nicotine replacement. The effect of allowing pharmacists to initiate, modify, and manage this treatment has resulted in an improved patient experience, including adherence to the therapy.

Pharmacist services include the provision of flu shots in a community pharmacy in an effort to avoid an influenza epidemic. Additionally, although some emergency contraception pills are available over the counter, prescriptions are required for Medicaid and third-party payer reimbursement. If a pharmacist is unable to dispense emergency contraception under a standing order or expanded scope of practice, these beneficiaries must first contact an authorized prescriber.