When Reyna or Justin Ansley or one of their three children feels ill and needs to be tested for strep throat or the flu, chances are they will visit their local pharmacy in Hemingford or Alliance, Nebraska. Dave Randolph, the owner of the two Dave’s Pharmacy locations, can do a quick test, give them medicine if they need it, and send them back.
“I’m a cattle rancher,” said Reyna Ansley, whose family lives about 15 miles outside Hemingford. “You don’t necessarily have time to drive to the doctor and sit in the waiting room. It’s really faster thanks to Dave.
The Ansleys don’t have health insurance and using the pharmacy, where Randolph charges $50 to $60 to get the tests done, is cheaper than paying up to $200 for an office visit with a local doctor, said Ansley. If the test is positive, the drugs usually cost between $20 and $30.
Randolph’s ability to provide treatments for influenza and strep throat is somewhat unusual. He can do this in Nebraska because he has an annual practice agreement with a local doctor that is subject to state approval.
The easy availability of pharmacists has also helped propel them into a key role during the pandemic, as they have become a go-to resource for covid-19 testing and vaccines. Yet even before covid engulfed the country, many states were giving pharmacists a bigger role in consumer health.
According to the National Alliance of State Pharmacy Associations, more than a dozen states have expanded what pharmacists can do to include testing and treating people with conditions such as strep throat, flu and urinary tract infections and HIV prevention. Some states allow pharmacists to prescribe birth control pills or drugs to help people quit smoking. Typically, pharmacists have the authority to prescribe under agreements with physicians or rules called statewide protocols.
But a limited number of states have gone further, allowing pharmacists to self-prescribe drugs to treat a wide range of conditions for which there are rapid point-of-care tests, if appropriate based on clinical guidelines. .
“We are seeing more and more states consider direct prescribing authority rather than collaborative practice agreements,” said Allie Jo Shipman, director of state policy at the National Alliance of State Pharmacy Associations. The alliance offers point-of-care testing and point-of-care treatment training programs for pharmacists and pharmacy students.
The Biden administration, which has relied on pharmacies to help fight the covid pandemic by administering vaccines and tests, is now calling for a limited number of pharmacies with retail clinics that employ doctors or other healthcare workers with prescribing authority to directly provide medicines quickly to those who test positive for the virus. the “test to treat” program is designed to ensure people with covid get antiviral treatment quickly, as it is most effective if used within five days of someone showing symptoms.
Pharmacists say their increased covid efforts have helped raise their profile.
“One of the big things that has come out of covid is that consumers understand that pharmacies provide these services that are high quality and convenient and support their health,” said B. Douglas Hoey, CEO of the National Community Pharmacists Association. , which represents the interests of independent pharmacists.
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But doctors are not necessarily in favor of this development. Physician groups have long opposed the assumption of certain types of patient care by pharmacists, nurse practitioners, physician assistants and other non-physicians unless supervised or approved by doctors.
In November, the American Medical Association, which represents doctors, announced that since 2019 it has successfully opposed over 100 pieces of legislation that would have expanded the scope of practice for non-physicians, known as scope creep. The group too issued a statement criticizing the Biden administration’s plan to allow pharmacy clinics to prescribe covid antiviral drugs, saying the program poses a danger to patient safety and risks negative health outcomes. And WADA unsuccessfully opposed a federal decision allowing pharmacists to administer covid vaccines to children under 18.
Meanwhile, the American College of Physicians, which represents internists, announced it “opposes the prescribing privileges of independent pharmacists and the initiation of drug therapy outside of a collective practice agreement, standing order or supervision of a physician, or similar arrangement .”
The AMA did not respond to questions about independent pharmacist prescribing, and the ACP declined to comment on its policy.
But are physicians correct in saying that patient safety is at risk if a physician is not involved in prescribing decisions? Pharmacists say they want to provide care in line with their training and skills and that they know their limits. And they note that timely prescribing is key to treating covid and other infectious diseases.
They also note that pharmacists are increasingly part of the multidisciplinary clinical teams that direct patient care in hospitals and health care systems.
“Pharmacists are the best trained professionals to deal with drug interactions,” said Jewish Rita, a pharmacist who is president of the Institute for Safe Medication Practices, a nonprofit organization that focuses on preventing medication errors. “We monitor patients for both efficacy and side effects. So from that perspective, it’s not a security issue. The delay in treatment is a concern.
Many pharmacists are eager to expand their menu of patient services, but payment remains an issue. Pharmacists are generally not recognized as service providers under Medicare and generally do not receive payment for spending time assessing, testing, or treating patients. Many private insurers are following Medicare’s lead in payment.
For many people, pharmacies are convenient and familiar. More than 90% of people in the United States live within 5 miles of a community pharmacy, and Medicare beneficiaries visit the pharmacy almost twice as often as their primary care physician.
Dr Jeffrey Singergeneral surgeon and senior researcher at the libertarian Cato Institute, wrote a recent blog post suggesting that physicians who oppose non-physician prescribing may be more concerned with competition than patient safety.
“Rather than working to prevent laws that might meet patient needs, it’s up to the profession to persuade people that they need to see a doctor,” Singer said in an interview, adding that he’s relies on the expertise of pharmacists in its training. “I ask them, ‘Is there a particular problem with this medicine?’ They have the software. And that’s what they are trained to do.
In Arkansas, a law 2021 gave pharmacists the authority to treat conditions for which there is point-of-care testing, as long as they follow statewide protocols established by the state board of pharmacy and board state medical.
“There are a myriad of tests on the market right now that are quick and inexpensive and can really dramatically increase access for people who don’t have the time or resources to travel to a primary care provider,” said Scott Pace, pharmacist and co. -owner of Kavanaugh Pharmacy in Little Rock, Arkansas.
But pharmacists aren’t interested in replacing doctors, Shipman said. “We want to support doctors,” she said. “We want to be another health care provider. In the midst of the pandemic, we need more help. The burden is too heavy to be carried by a single supplier.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.
