Introduction: While pharmacists in other countries have broad independent prescribing privileges, pharmacists in the United States are making progress. Pharmacist prescriptive authority in the U.S. occurs on a continuum with four identified models: patient-specific collaborative prescribing through collaborative practice agreements (CPAs), population-specific prescribing through CPAs, statewide protocols, and classspecific prescribing. States have implemented pharmacist prescriptive authority across this spectrum. As approximately 90% of Americans reside within two miles of a community pharmacy, prescriptive authority of pharmacists leads to improved public health access points and outcomes.Objective: This paper is intended to provide insight into the current landscape of pharmacist prescriptive authority in the United States through 2019 in order to provide historical context and identify opportunities for state policy considerations. This was done through a review of published literature, national professional association resources, individual state pharmacy practice acts, and state legislation and regulations. Conclusion: Significant variability regarding what medications pharmacists can prescribe exists per state statutes. According to data collected from the National Alliance of State Pharmacy Associations (NASPA), 147 bills related to pharmacist provider status were introduced in 39 states during the 2019 legislative session. The interest in pharmacist prescribing stems from current and future challenges within the U.S. health care system: access to care, cost of care, and the anticipated shortage of physicians. The challenge to standardize prescriptive authority across states presents a unique opportunity for future considerations.K E Y W O R D S collaborative practice, collaborative practice agreement, independent prescribing, pharmacist prescribing, prescriptive authority In 2015, the National Association of Boards of Pharmacy (NABP) TaskForce on Pharmacist Prescriptive Authority recommended the inclusion of language in state pharmacy practice acts regarding initiation of medications by pharmacists. Three features for pharmacist prescribing were specifically mentioned in the report: a diagnosis should either not be needed or be readily determined; a formulary listing or protocol be considered; and communication is essential between the pharmacist, patient, and primary care provider. 1 Some groups, primarily from the medical community, argue that pharmacist autonomous prescribing will result in fragmentation of care for patients. 2 Collaboration
Pharmacist contraception services are growing across the United States. Several states have authorized pharmacists to prescribe contraception, and the interest in other states continues to grow. Opposition to these practices exists and centers on discussions related to safety, training, cost, and fragmentation of care. We review these arguments and provide evidence refuting these concerns. Pharmacist-prescribed contraception increases access to care, and patients express interest in utilizing this service at the pharmacy. Pharmacists follow evidence-based recommendations. Counseling on preventative services and referral to other providers is part of contraception care by pharmacists. Training programs have been developed to equip both pharmacy students and pharmacists with the knowledge, skills, and tools needed to successfully provide these services. This article can serve as a guide for pharmacists and advocates when discussing pharmacist-prescribed contraception with policymakers, patients, and other healthcare professionals.
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