The Continuum of Pharmacist Prescriptive Authority

Abstract

Recently momentum has been building behind pharmacist prescriptive authority for certain products such as oral contraceptives or naloxone. To some, prescriptive authority by pharmacists represents a departure from the traditional role of pharmacists in dispensing medications. Nearly all states, however, currently enable pharmacist prescriptive authority in some form or fashion. The variety of different state approaches makes it difficult for pharmacists to ascertain the pros and cons of different models. We leverage data available from the National Alliance of State Pharmacy Associations (NASPA), a trade association that tracks pharmacy legislation and regulations across all states, to characterize models of pharmacist prescriptive authority along a continuum from most restrictive to least restrictive. We identify 2 primary categories of current pharmacist prescriptive authority: (1) collaborative prescribing and (2) autonomous prescribing. Collaborative prescribing models provide a broad framework for the treatment of acute or chronic disease. Current autonomous prescribing models have focused on a limited range of medications for which a specific diagnosis is not needed. Approaches to pharmacist prescriptive authority are not mutually exclusive. We anticipate that more states will pursue the less-restrictive approaches in the years ahead.

Preconception care and contraception services: Opportunities for community pharmacists

“…According to the continuum of pharmacist prescribing framework introduced by Adams and Weaver, CPA and statewide protocols (SWP) offer options for pharmacists to facilitate a prescription when independent pharmacist prescribing is not an option. Several studies in this review used a CPA model, where a relationship exists between the participating provider(s) and the pharmacist who work within the context of a defined protocol that is site and practice specific . Since those articles were published, pharmacists in several states across the US are able to directly provide hormonal contraception via a SWP, with additional states considering such a change to pharmacist scope of practice…”

Point-of-care testing in the pharmacy: how is the field evolving?

“…In the inpatient and clinic settings, it is common for a prescriber to delegate the authority to initiate, adjust, or discontinue therapy to pharmacist [5]. In many cases, the pharmacist utilizes available laboratory data to decide what clinical action is appropriate.…”

Should Pharmacy Technicians Administer Immunizations?

“…Indeed, pharmacists have recently made significant strides with services such as point-of-care testing, prescriptive authority for select conditions, chronic disease state management, and Medication Therapy Management, among other advanced care services. [28][29][30][31] Immunizations have critically and importantly served as a gateway to patient acceptance of these advanced care services and have bolstered pharmacist confidence for the provision thereof, but we believe the time is ripe to move the needle (pun intended).…”