January 2012


Twitter’s @ThePharmerGuy recently posted on his blog ‘Another Day Behind the Pharmacy Counter…’ asking the question:  Why Can’t Pharmacists Prescribe?  He details a very good argument as to why pharmacists should have prescription authority.   My thoughts on this topic follow below:

I totally agree it’s past time for pharmacists to be given prescribing authority, at least on a limited basis. There are so many instances where a pharmacist could make the decision to appropriately select and prescribe from a limited formulary of medications for a number of common disease states.

Pharmacists receive more intensive training and are more qualified to make decisions regarding appropriate medication therapy than most nurse practitioners or physicians assistants I know, and probably more qualified than many MDs as well.

Prescribing authority is given to MDs, NPs and PAs, in my opinion, after receiving basic training algorithms to assist them in making prescribing decisions based on their diagnosis. They don’t receive near the training or knowledge base in pharmacology, pharmacokinetics, adverse drug reactions and drug interactions that should be used in the drug prescribing process. They are also somewhat dependent on and easily swayed by the influence of pharmaceutical sales and marketing efforts, something which pharmacists are able to sort through by throwing out the hype and making better clinical decisions based on rational therapeutic approaches.

And, from what I have seen, most prescribers are easily swayed by their patients as well. All of the direct to consumer pharma advertising has created a patient population who go the the doctor with their expectations of what should be prescribed… and sometimes get upset when they don’t get what they want!

Pharmacist prescribing would expedite patient care and lower the cost of care by facilitating or streamlining the process of finding the correct medication and dose to reach and maintain therapeutic goals. This would tie in very well with a medication therapy management type of pharmacy practice that monitors new medications and makes changes or adjustments quickly and efficiently based on patient response to therapy.

All this would help to reduce costs associated with patient medication therapy,improve and streamline the process of reaching therapeutic goals, aid in assisting, educating and counseling patients to ensure compliance and adherence to drug therapy and improve patient outcomes.

The PharmD vs. BSPharmacy status for prescribing authority will need to be addressed in some manner. Pharmacists were making decisions regarding appropriate medication selection and use decades ago. It wasn’t until the prescriber and dispenser functions began to change that pharmacists  began to lose the authority to ‘prescribe’ all but those medications given OTC status. Generally speaking, most RPhs have as much knowledge and decision making skills when it comes to prescribing as those who prescribe the prescription orders they fill and dispense. Same with PharmDs.

Yes, it is time for pharmacists to be given prescribing authority, if even on a limited basis. I would expect that this authority would be expanded after a year or two of monitoring said prescribing authority based on the positive outcomes we would see.

Nearly three years ago I wrote a blog post titled ‘OBRA (’90), Where art Thou… and Where art We?’ .  In it I wrote  the following paragraph as I was questioning why many pharmacists are reluctant to be ‘patient pro-active’ and get involved with changing trends in the profession

” I don’t understand why some pharmacists have been reluctant to get involved with the evolution of their profession and provide effective patient counseling. Perhaps those pharmacists are practicing in a workplace not conducive to patient counseling or maybe they are fearfull of patient interaction. Possibly they are just not interested in getting involved, in which case I would suggest they consider a new profession. Regardless of the specific scenario, I think it is time for another call for action. Pharmacists need to get involved in counseling and educating their patients now!”  (Pharmacy 2.0 and 1/2 March 18th, 2009).

Fast forward to the year 2012.  The pharmacy world continues to watch and wait as we follow the WAG vs. ESI saga amidst reducing third party reimbursement, changing pharmacy regulations and many pharmacy Boards extending a ‘blind eye’ towards idiotic (or insane)  ‘15 minutes or it’s free ‘ types of corporate policies that are dangerous for the public and demeaning to the practice of pharmacy.

I’ve heard it for years… pharmacists will be providing counseling and cognitive services to patients and GETTING PAID FOR IT in the near future.   I remember first hearing it before I graduated from pharmacy school in the ’70s.  I always believed it and thought OBRA ’90 legislation might be the beginning of it.  But I was disappointed to see this happening only in a few areas of pharmacy like long term care.  Many pharmacists failed to recognize the potential for patient counseling and most members of the pharmacy corporate world continued to place profits before patients, ignoring the need and disregarding the future of the profession.

But I still believed it to be true.  Pharmacists will be providing comprehensive patient counseling and cognitive services and getting paid for it.  This is a valuable service to provide to our patients and customers that will improve their lives.  This is a service that saves health care dollars in the long run.

Early this century, MTM became the new pharmacy buzz word.   According to my ‘trusted sources’ at Wikipedia, Medication therapy management (MTM) is a partnership between the pharmacist, the patient and their caregiver, and other health professionals that promotes the safe and effective use of medications and helps patients achieve the targeted outcomes from medication therapy.  (see www.pharmacist.com)

I like that definition of MTM.  Unlike the Medication Modernization Act 2003 it specifically states that MTM is a partnership between THE PHARMACIST, the patient and their caregiver.  Not a nurse, not a physician or any other health care professional.  The pharmacist is THE member of the health care team best qualified to provide medication therapy management services.

So who’s ready to get on board with MTM?  Will pharmacists finally step up to the plate and qualify themselves to be actively involved with MTM?  The future is happening right now!  Pharmacists are being paid for MTM and other cognitive services.  This is becoming reality and will become the norm in pharmacy practice.

There is power in numbers.  It will only be through the power of those involved in providing these types services.  It cannot be achieved any other way.  Not by by associations or organizations;  and certainly not through legislation or pharmacy boards.  It will only come from the strength of those providing the MTM services.  Everyone and everything else is only an appendage and supportive in nature.

Together, as a unified group, MTM pharmacists can make that happen.  You might ask “how are we to do this”?  

The Community Clinical Pharmacists MTM Group on LinkedIn is one of the ways to achieve this.  If you have not started a LinkedIn profile you need to consider it now, especially if you want to start an MTM practice.  The ccpMTMgroup is designed primarily for pharmacists who are interested in providing independent MTM consulting services.  This is the first step in setting up a network of MTM pharmacists committed to promoting and providing pharmacy MTM services.  I invite you to join this group and take part in the discussion and be part of this transition towards independent MTM consulting. As a group we can overcome the obstacles in our path and achieve this goal.

Albert Einstein  defined insanity as “doing the same thing over and over and expecting different results”.  Pharmacists cannot expect to continue with a ‘business as usual’ attitude and expect the necessary changes to take place.  We need to create an environment to accommodate these changes.

Now is the time for a new call to action that stimulates pharmacists to take steps to make this change happen. Pharmacists cannot continue (as @empress_penguin ‘s Twitter profile translates) like  “clumsy penguins swimming in the sea of mothers across health and welfare”  and expect this change to happen.  (Google Translate – Japanese to English).  (Since I don’t speak Japanese I don’t fully understand what that means but it seems to be representative and descriptive of the pharmacy profession at times.)

We need to change that now.  Pharmacists need to stop swimming ‘clumsily’ and erratically with the currents.  We need to set our sites on the goal and fight the currents in the river of Lethe we’ve been in for years.  Pharmacists must learn to swim upstream towards those goals that will maximize our efforts to improve patient care and strengthen our position as a health care professionals.

Decide now to commit to action or get out of the way of progress.  If you stood back with a ‘wait and see’ attitude when OBRA ’90 was put in place, we don’t need you now – unless you are ready to step up and make the necessary changes.  “It’s time to get down and dirty and practical, so let’s focus on what might really work to make progress on… change at the grassroots level”.  (see ‘How to Create Change’, sustainablebusiness.com)

To be successful in this endeavor MTM Pharmacists need to:

  • Decide to ‘DO IT’ and incorporate MTM opportunities into their pharmacy practice
  • Commit to a PLAN OF ACTION to facilitate the necessary changes for practicing appropriate MTM principles
  • FOLLOW THROUGH with their plan for implementing MTM within their practice setting
  • Support and encourage their colleagues who are involved with MTM and educate the public to the benefits of MTM services
We cannot continue with the ‘wait and see’ attitude that has constrained the profession of pharmacy in the past.  If we educate ourselves, educate our patients, get involved and follow the course we will gain momentum in the process and our efforts will bring positive results.  But it’s up to us, YOU and I, to work towards this end.