Why Can’t Pharmacists Prescribe: Response to @ThePharmerGuy

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.

 

Health 2.0 and the $4 Prescription

 

Many pharmacies are now offering their patients a thirty day supply of generic medications for the low price of $4.  Most think that this is the greatest thing since sliced bread.  I know people who were spending $40 to $200 a month or more on prescriptions that are now saving a great deal of money.  This savings not only makes most of them very happy but boosts their self image by making them feel like saavy shoppers.  On the surface it may seem like a win-win situation.  But is the $4 prescription phenonema really an answer to the need for better, more cost efficient pharmacy services?

 

Let me share a couple of experiences that may seem unrelated to the $4 prescription.  This past year I was interviewing website developers and given a number of quotes for setting up my website.  Several of them gave me bids and explanations of what they would do for me at very reasonable prices, considerably below others designers I spoke to.  But the little voice kept creeping into my head saying “you get what you pay for”.  I opted to go with a website developer who was willing to go beyond the basics of building the site; one who was willing to provide their services to me to ensure that I would be able to manage and optimize it as well.  I am not only getting a website that I can be proud of but also learning how to use other web based tools to support my business.  By doing this my life has been made simpler and I will benefit long term from their advice and support.

 

Another example that comes to mind is auto repair.  I had a car that had clutch problems that needed to be taken care of.   I sought out the nearest “shade tree mechanic” type of shop that had the lowest labor charges in town.   He installed a new slave cylinder which solved the clutch problem for about two days.  I made repeated trips to the mechanic’s shop over the next few weeks finding that he had no long term solution for the problem.   I went to another shop and found more knowledgable mechanics who solved the problem the next day.  Had I just taken the vehicle to them in the first place my life would have been simpler and it would have cost less money in the long run.  I wished that the voice would have reminded me that “you get what you pay for”.

 

Where am I going with this?  Pharmacy services are more than just counting and pouring, licking and sticking the labels that go on the $4 prescription bottles.  Ask yourself some of these questions. How much money are you saving buying ten prescriptions a month at $4 each from a pharmacist who fails to tell you how to take them correctly?  Does the pharmacist take the time to know your medical condition sufficiently and to listen to your questions and provide information needed to treat your condition?  And what of the medications prescribed that are not on the $4 list? Does the pharmacist just charge you the $89.67 price for that prescription or does he take the time to discuss less expensive alternatives with your physician?  Do you even have the opportunity to really talk to him when you need to?

 

Purchasing pharmacy services is really not any different than your other purchases in life.  You will usually always “get what you pay for”.  Many pharmacies are now understaffed trying to keep businesses profitable selling $4 prescriptions.  Their pharmacists are under a great deal of pressure trying to ensure that your prescriptions are ready when you request them.  Patients are complaining of long wait times for prescriptions as well as the lack of adequate counceling from the pharmacist.   The $4 prescription price provides instant gratification while ignoring the pharmacy services that are truly going to benefit the patient. Remember “you get what you pay for” the next time you are buying your $4 prescription and ask yourself if it’s really worth it in the long run.