Debate continues over expanded role for pharmacists

Female pharmacist with surgical mask behind cash register holding tablet in her hands
Pharmacists are considering adding heart failure to the list of conditions they can treat.

Florida pharmacists and physicians continue to wrangle about medical treatment patients will be able to receive at pharmacies.

After nearly three hours of discussion Monday, members of the Florida Board of Pharmacy Rules Committee voted to add “heart failure” to a list of chronic conditions, enumerated in a proposed rule, that pharmacists could treat.

The full Board of Pharmacy will consider the proposed regulation at a meeting Wednesday.

The proposal fleshes out a new state law that allows pharmacists who have written collaborative agreements with physicians to treat designated patients for chronic health conditions. The rule also would carry out another part of the law that allows certain pharmacists to test and treat patients for influenza, streptococcus, lice, skin conditions and minor, uncomplicated infections so long as the pharmacists have written protocol agreements with physicians.

The law, passed during this year’s legislative session, was a priority of House Speaker José Oliva, a Miami Lakes Republican who has focused on revamping the health-care system.

The Board of Pharmacy Rules Committee vote Monday was unanimous despite warnings that adding heart failure to the part of the rule about collaborative agreements would slow down the rule-making process and could even thwart the regulations from being in effect for the start of the 2020 flu season.

But Rules Committee member David Wright said the board shouldn’t be worried about potential legal threats and should, instead, be focused on what would best help patients.

“I think no matter what, this thing is going to be rule challenged. And I don’t think that should guide us. I think we, as pharmacists, know what the best outcome for the residents of Florida are. And we know what we can do as pharmacists to help that,” said Wright, a pharmacist in Fort Pierce.

In an attempt to make health care more affordable and available, Oliva persuaded lawmakers to pass the law (HB 389) allowing pharmacists to enter into collaborative arrangements with physicians to treat patients for chronic medical conditions that include arthritis; asthma; chronic obstructive pulmonary diseases; Type 2 diabetes; human immunodeficiency virus or acquired immune deficiency syndrome; and obesity.

The law allowed the Board of Pharmacy to expand the list of chronic medical conditions to include “any other chronic condition adopted in consultation with the Board of Medicine and Board of Osteopathic Medicine.”

Physician groups have long raised concerns about proposals to expand the scope of practice for groups such as pharmacists and advanced practice registered nurses. In part, physicians contend those groups do not have as much training as doctors in treating illnesses.

Members of the Board of Medicine and the Board of Osteopathic Medicine met twice over the summer with the Board of Pharmacy Rules Committee about the proposed rule. At a July 29 meeting, members of the Rules Committee gave tentative approval to a proposed rule that added opioid abuse disorder; hypertension; hyperlipidemia; smoking cessation; and anticoagulation management to the conditions that were identified in the law.

But the Rules Committee announced last week that it would revisit the proposed regulation.

Members of the Rules Committee initially considered adding the broader term  “heart/cardiovascular disease” to the list of chronic conditions that pharmacists could treat. But committee member Jeenu Philip recommended changing it to the more narrow “heart failure,”  noting that the literature that was given to committee members specifically touched on heart failure.

“To me, this is where the compromise comes into play,” said Philip, who lives in Saint Johns, outside of Jacksonville. Philip added that evidence can back up putting heart failure on the list.

Jacksonville health care attorney Chris Nuland, who represents physician groups, said the change from the broader heart/cardiovascular disease to the more narrow heart failure shows that the Board of Pharmacy members understood a potential challenge to the rule could lie ahead.

“The board seemed to understand that it needed to show that it had ‘competent substantial evidence’ for its decision and tailored the rule accordingly,” Nuland told The News Service of Florida. “Whether it met that standard may be for an administrative law judge to decide.”

Meanwhile members of the Board of Pharmacy Rules Committee agreed to delay until October discussions about whether mental health should be added to the list of chronic conditions that could be treated.


Republished with permission from the News Service of Florida.

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