Current status of prescriptive authority by pharmacists in the United States

Gloria Sachdev BSPharm, Pharm.D., Mary Ann Kliethermes B.S., Pharm.D., Veronica Vernon Pharm.D., Sandra Leal Pharm.D., MPH, George Crabtree

Abstract

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 class-specific 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.