Colorado, Idaho, and Montana have broadly expanded the prescribing authority of pharmacists to make health care more accessible and to lower costs, a new report states.
Expanding pharmacists’ scope of practice can decrease the burden on emergency departments and help cover physician shortages for basic care, especially in rural areas, because pharmacists are more numerous and accessible than primary care physicians, say Marc Joffe, a federalism and state policy analyst, and Jeffrey A. Singer, M.D., a senior fellow, both of the Cato Institute, in “Let Pharmacists Prescribe,” a study published by the institute on March 21.
Expanding pharmacists’ scope of practice can decrease the burden on emergency departments and help cover physician shortages for basic care, especially in rural areas, according to Joffe and Singer, because pharmacists are more numerous and accessible than primary care physicians. In several countries, they have broader prescribing authority than in the United States.
Less Costly than Emergencies
Though many states have expanded pharmacists’ scope of independent practice to include vaccinations, Idaho enacted broader prescribing reforms in 2019, Colorado in 2021, and Montana in 2023.
Idaho law (H.B. 182) allows pharmacists to prescribe drugs if a new diagnosis is not required, the condition is minor and generally self-limiting, laboratory tests are not required for diagnosis, or immediate care is required to avoid an emergency. The law limits the amount of a drug prescribed in emergencies to the quantity needed until a patient can see another provider.
“There is already evidence that pharmacists and patients are willing to use the new independent prescribing at scale,” wrote Joffe and Singer. “This new class of legislation appears to be having a greater impact than previous reforms.”
Pharmacies in many states have expanded into clinics, and in four states, Safeway pharmacies are already prescribing for strep throat, according to Joffe and Singer.
“Safeway pharmacies have expanded their practices to include prescribing in several states,” wrote Joffe and Singer. “But only in Idaho and Colorado does the chain advertise prescriptions for medications to treat cold sores, men’s hair loss, migraines, motion sickness, topical acne, and (urinary tract infections).”
Routine, Emergency Health Care
Many health conditions—such as urinary tract infections, strep throat, middle ear infections, vaginal yeast infections, and influenza—are simple and short-lived, Singer told Health Care News.
“States should allow patients to access pharmacists for a wide array of routine medical problems, which would save them time and money and improve access to primary health care,” said Singer. “State lawmakers should expand pharmacists’ scope of practice to allow them to independently treat a wide range of medical conditions.”
Patients are using expensive emergency room treatment because wait times for an appointment with a physician are growing, says Singer.
“It’s getting more and more difficult to get in to see a doctor,” said Singer. “The average wait time in the U.S. for a first-time visit is 26 days. Many people with these simple problems might resort to hospital emergency rooms or urgent care centers, which cost more than a doctor’s office and may have even greater wait times.”
Joffe told Health Care News that “pharmacists are well-positioned to prescribe in other situations as well, such as extending previous prescriptions or addressing emergencies.”
Physician Groups Balk
The American Medical Association (AMA) has repeatedly opposed federal legislation that would expand the scope of practice for pharmacists, citing the lack of “extensive education and training,” compared to physicians.
In 2022, the American Academy of Pediatrics and the American College of Physicians co-signed a letter to legislators stating that expanding pharmacists’ freedom to treat could “undermine the physician-led, team-based care models that have proven to be most effective in improving quality, efficiency and, most important, patient health.”
Though physicians have legitimate concerns about pharmacists’ training, pharmacy education covers many of the subjects as medical school, says Chad Savage, M.D., president of DPC Action and a policy advisor to The Heartland Institute, which publishes Health Care News.
“While physicians can certainly critique the adequacy of the training of physician extenders, they are at least trained in the same areas of history, examination, diagnosis, and treatment, even if not as robustly,” said Savage.
Lack Diagnostic Training
Pharmacists’ lack of diagnostic training could lead to major health repercussions for patients, says Savage.
“Pharmacist training is dramatically different despite some areas of overlap,” said Savage. “Pharmacists are not trained in physical examination.”
Singer says that in his own surgical experience complex problems outside of his purview require referrals, which is not only ethical but avoids liability.
“There is no reason to think a pharmacist will not act the same way,” said Singer. “They would not test and treat for a routine condition without taking a history. And if they are concerned that the condition may be complex, they can refuse to test or treat and tell [a patient] they must see a doctor.”
Impact on Insurance Premiums
If patients can avoid emergency room visits, that could reduce insurance premiums, says Joffe.
“Insurance premiums are heavily influenced by the cost of care,” said Joffe. “If patients can avoid physician visits and especially emergency room visits while getting relief for their conditions, cost of claims will be lower which should bring down insurance rates.”
Insurers could not vouch for the quality of care, however, says Savage.
“Premium increases are reactionary to poor care and not proactive,” said Savage. “Basically, many patients could be harmed before any adjustment is made. If reliant on malpractice lawsuits, those cases do not always correlate with the quality of care provided but are more highly correlated with subjective qualities of the care experience.
“For pharmacists to assume the provider role they would truly need to massively change their training, expanding into history, examination, diagnosis, care management, and care coordination of patients,” said Savage. “Essentially they would have to go to medical school.”
Ashley Bateman (bateman.ae@googlemail.com) writes from Virginia.
Overall, this is a very good and fair article and I appreciate the inclusion in it. However, I think there is a slight misinterpretation of my comment about Physician Extenders.
Physician Extender training refers to Nurse Practitioners and Physician Assistants and not Pharmacists. NPs and PAs are trained, even if less extensively, in the similar areas of history, diagnosis and treatment as physicians.
Pharmacists are expert in pharmacology, which is only one aspect of treatment, with omission of the former categories of training.
Otherwise very well written and fair
Thank you, Dr. Savage, for the clarification. With the growing economic and access pressure on our health care sector, it is important to get this right. AnneMarie Schieber, Managing Editor.