Health care is notoriously more difficult to provide for rural communities than urban ones. Rural Americans are less likely to have a health care provider they trust and have more difficulty reaching doctors and hospitals. Nearly two-thirds of rural communities, including those in Nevada, suffer from a shortage of primary care physicians. However, several states have faced this challenge by using the local community nature of pharmacies to make up some of the difference.
The United States is 64,000 doctors short of need, with the gap expected to grow. As the shortage gets larger, the health care system needs to adapt, especially in underserved areas. Several states provide examples of how expanding pharmacists’ prescription authority can make access to basic and routine health care more accessible, especially in rural areas.
Every state allows some pharmacist prescribing, such as for COVID-19 treatment. However, some states go further than others. Only eight states allow pharmacists to independently prescribe smoking cessation tools, making quitting smoking, which is already infamously difficult, even harder. As of 2023, only 17 states allow pharmacists any authority to prescribe prophylactic medicine to prevent HIV.
While not all medical care can be devolved to a pharmacy setting, pharmacists can bring many health solutions closer to patients while simultaneously relieving pressure on the limited supply of doctors and lowering patient costs. Numerous states, including Nevada, are allowing pharmacists to have prescription authority. Eleven states have expanded their pharmacists’ prescribing authority.
The specific conditions pharmacists are allowed to prescribe for vary by state but include diabetes, COVID/cold/flu, contraception, post-exposure HIV treatment, HIV/AIDS, arthritis, asthma, chronic obstructive pulmonary disease and more.
Pharmacies have shown success in increasing patient access to medicines. In Idaho, pharmacists were granted broad prescription privileges in 2018, resulting in direct increases in patients obtaining drug refills, inhalers and insulin supplies. Other studies have estimated potential savings of $1 trillion associated with pharmacist prescriptions for blood pressure alone.
Given the positive effects of granting more prescription authority, it is unsurprising that the number of pharmacists prescribing grew 122 percent from 2019 to 2022. This comes with the benefit that pharmacists have been shown to be better at adhering to dosing guidelines and making fewer prescription errors.
However, there are barriers to expanding pharmacist prescriptive authority, even in states that have expanded the practice. One obstacle has been in states employing a tiered license system, which requires pharmacists to get additional credentials. This system usually ends with a few pharmacists bothering to jump through the hoops. One example is in California, where tiered pharmacist licenses have resulted in only 2 percent of pharmacists having expanded prescriptive authority.
Other states also have separate licenses for pharmacists with prescribing power, such as New Mexico, North Carolina and Montana. These states would see more pharmacists prescribing directly to patients by following Florida and New York’s examples of not requiring an additional credential for pharmacists to obtain prescription privileges.
Among the states that do not require additional licensing, there is still a division. Some states grant prescriptive authority to pharmacists only under physician supervision. Requiring physician supervision increases the doctor-shortage problem without providing better healthcare outcomes.
Independent prescription authority for pharmacists makes many routine services more convenient and less expensive. Most states that allow an independent role for pharmacists provide a limited list of conditions for pharmacists to prescribe medicine; however, three states have explored another option.
Colorado, Idaho and Montana have taken the idea further with a “standard of care” framework. Instead of an exhaustive list of what pharmacists can prescribe, pharmacists can act based on their professional judgment. This model allows pharmacies to play as significant a role as possible to make health care more accessible and less expensive.
As health care challenges continue to mount, state legislatures would be wise to examine how pharmacists have been used to expand health-care coverage from New Mexico’s original Pharmacist Clinician program to the new standard of care models being created more recently.
Justin Leventhal is a policy analyst for the American Consumer Institute. He wrote this for InsideSources.com.
