Why Can’t Pharmacists Prescribe: Response to @ThePharmerGuy

27 Jan

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.


4 Responses to “Why Can’t Pharmacists Prescribe: Response to @ThePharmerGuy”

  1. Mike January 29, 2012 at 5:31 am #

    Excellent post, but what it all boils down to is the intransigence of the AMA who not only keeps pharmacists but also ARNP’s and CRNA’s “in their place.” The buzz word these days seems to be “collaboration” and teamwork but why continue to work with colleagues and an organizational structure that seeks to keep “allied professionals,” as they call us, in our place while they fiercely protect their revenue stream? The AMA is surely part of the problem and unless and until their power over legislation both at the state and congressional level is irreparably broken one should expect to see no progress on this issue.

  2. Jessica January 19, 2013 at 12:36 pm #

    I’m currently a pharmacy student and get bombarded by dental and medical students in helping them sort through medications. Even medical residents that I have spoken to agree that pharmacists should prescribe as they learn only one semester about drugs whereas pharmacists have to go through four intense years, thus “Doctorate of Pharmacy”. They always ask me questions on what to prescribe their patients and it’s scary to know how many patients get the wrong dose, wrong therapy or drug, and wrong advice that goes overlooked. One of the hospitals I was working in, they gave the wrong dose to a patient that turned them into a vegetable. If their was a pharmacist there looking over, that incident may not have happened. I know it all comes down to money and the AMA, but in other countries doctors don’t make much money and that’s the reason why their healthcare system is much better because they actually care about the patient’s best need, not really about the money in how many patients they can rush and see each day, and so called “prestige”.

    Pharmacy students learn the same thing as medical students learn when it comes to disease states, etc and we even learn some on diagnosing; however, our main learning is all about therapy and treatment. We are the treatment experts whereas the physicians are the diagnosing experts. That’s the main difference. I see the future where the physician and pharmacist work side by side because diagnosing and treatment do go hand in hand.

    When going on rounds, it’s disgusting to see how the doctors only spend 5-10 minutes tops with each patient. If they sat down and spoke to them more, it may actually solve the issues and reduce the time the patient has to be in the hospital depending on what disease state your talking about. At least in pharmacy school (not sure about the others) we get taught that the patient comes first and to work on a team to provide the best for the patient. We follow a patient-centered model approach and not a paternalistic approach and in utilizing each profession with their own specialty that their trained in. The VA system is great as they have the pharmacists directly work with the therapy and I hope that hospitals soon change their systems to have this approach.

    However, I do have to say that the social workers and nurse case managers are awesome! They know so much about the patient to best fit their needs and definitely provide the most practical and “common sense” help. For example, if you want to prescribe a patient a medication, there insurance may not cover it or they may not have enough funds.

  3. unitedbiotechunited June 25, 2014 at 3:54 am #

    Awesome !!!!
    Thanks your article is really very nice Pharmaceutical Company

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