When you want to become a pharmacist, you need to have a clear idea about your job role. As a pharmacist, can you prescribe medications? Or, you will not be allowed to do so? In this article, we will answer different questions regarding pharmacists and prescriptions.
First of all, you need to know that Pharmacists actual duties differ quite a bit depending on the path they take. Pharmacists work in various types of pharmacies. It includes a clinical pharmacy, hospital pharmacy, community pharmacy, ambulatory care pharmacy, academic pharmacy, etc. Your duties as a pharmacist will slightly differ depending on the type of pharmacy you are into.
What is a clinical pharmacist?
Clinical pharmacy is the pharmacy branch in which clinical pharmacists provide direct patient care to optimize medication use. Under clinical pharmacy, there are three types of pharmacists: staff pharmacists, hybrid pharmacists, and clinical pharmacists.
Staff pharmacists perform little to no clinical activities. Hybrid pharmacists perform both dispensing & order processing activities as well as clinical activities. Clinical pharmacists perform clinical activities only.
Can pharmacists write prescriptions?
Now coming to the main question, what can a pharmacist prescribe? Clinical Pharmacists in the United States can prescribe in 43 states at the time of this article being written. These mainly include only minor problems or issues where a diagnosis from a Doctor isn’t needed. Pharmacists in the states of Florida, New Mexico, Montana, and North Carolina have more privileges when it comes to prescribing including drug therapy.
Now, we know that pharmacists can write prescriptions, but there are some circumstances in which they can’t prescribe medications. Here are they:
- When there may be the presence of an undiagnosed illness.
- When there may be a decline or a change in the function of a major organ.
- When there any indications that suggest an unusual reaction to a medication.
Pharmacists can prescribe medications under some circumstances, with the use of a collaboration agreement. Now, what actually is a collaborative agreement?
Collaborative agreements are legal documents that build a relationship between pharmacists and collaborating physicians. The collaborative agreement includes certain functions, situations, and conditions that pharmacists can provide in relation to patient care.
Do pharmacists need to have a collaborative agreement for patient counseling?
No, they are not required to have a collaborative agreement for patient counseling. In fact, there are many services that pharmacists can provide without a collaborative agreement. It includes services like prescription reviews, referrals, patient counseling, and disease screening.
Can a pharmacist prescribe an antibiotic?
Yes, a pharmacist can prescribe antibiotics, but only for some ailments. They can prescribe medications only for listed minor ailments, not for all. The minor ailment is when the patient’s medical condition is not severe, and he/she does not require any blood or lab tests.
Here’s the list of 32 possible minor ailments a pharmacist can treat:
- Allergic Rhinitis
- Calluses and Corns
- Contact Allergic Dermatitis (skin reaction from coming into contact with an allergen)
- Cough
- Dandruff
- Dysmenorrhea (menstrual cramps)
- Dyspepsia (indigestion)
- Emergency Contraception
- Fungal Infections of the Skin (such as Athlete’s Foot)
- Gastroesophageal Reflux Disease (acid reflux)
- Hemorrhoids
- Herpes Simplex (cold sores)
- Impetigo
- Mild Acne
- Mild Headache
- Mild to Moderate Eczema
- Mild Urticaria (including bites and stings/hives)
- Minor Joint Pain
- Minor Muscle Pain
- Minor Sleep Disorders
- Nasal Congestion
- Nausea
- Non-infectious Diarrhea
- Oral Fungal Infection (thrush)
- Oral Ulcers
- Smoking Cessation
- Sore Throat
- Threadworms and Pinworms
- Uncomplicated urinary tract infection
- Vaginal Candidiasis (yeast infection)
- Warts (excluding facial and genital)
- Xerophthalmia (dry eyes)
These 32 minor ailments are not for all the states. In fact, in some states, these ailments are limited to 12. Here are those 12 ailments:
- Mild acne
- Atopic dermatitis (eczema) requiring the use of low-to-moderate potency corticosteroids
- Diaper rash in newborns
- Cold sores (oral herpes)
- Thrush following the use of corticosteroid inhaler (pumps for respiratory problems)
- Allergic conjunctivitis
- Allergic rhinitis
- Mouth ulcers
- Dysmenorrhea (painful menstruations)
- Urinary tract infections
- Vaginal yeast infections
- Hemorrhoids
In what states can pharmacists write prescriptions?
First of all, keep in mind that not all pharmacists are allowed to write prescriptions. Even those who are allowed to write, they are limited to certain types of drugs.
The laws for whether pharmacists can write prescriptions or not differs from one state to another. In some states, you will notice that they allow pharmacists to write prescriptions under certain circumstances, while in some states, you will notice that they don’t allow pharmacists to write prescriptions at all.
Typically, writing prescriptions is the task of a physician. But, in some circumstances and in some U.S. states, pharmacists are allowed to write prescriptions. Here are those states:
- California
- Colorado
- Hawaii
- Maryland
- New Hampshire
- New Mexico
- Oregon
- Tennessee
- Utah
- Washington
- West Virginia
Also, this is limited to clinical pharmacy. In other pharmacies, pharmacists may not be allowed to write prescriptions. Pharmacists are not allowed to write prescriptions for all types of drugs. These are limited to some types of drugs, like birth control and hormone patches.
Can pharmacists prescribe in New York?
As we have already discussed, whether or not pharmacists are allowed to prescribe medications will differ from one state to another. Also, they can’t write prescriptions in all cases. This is limited to certain drug types only.
Now the question is, can pharmacists prescribe in New York?
No, pharmacists can’t prescribe in New York. In the above list, we have mentioned some states where pharmacists are allowed to write prescriptions (in some cases). In New York, they are not allowed to prescribe.
According to the new law, nurse practitioners, midwives, dentists, podiatrists, physicians, physician assistants, and optometrists are allowed to issue prescriptions electronically directly to a pharmacy in New York state (with limited exceptions).
Pharmacist Prescribing Medication – Opinions Of Real Pharmacist
So we didn’t want you to just take our word for it on this matter so we went out to Pharmacist forums and websites to gather opinions from other Pharmacists. We curated this information so nothing has changed except where grammar or spelling needed to be.
1. Imperial Frog “Florida for sure” – Florida pharmacists are the only ones with prescribing authority, but it is quite limited in the medications which can be prescribed. We’re not talking about OxyContin here, but minor drugs which the customer probably isn’t seeing a doctor for in the first place.
2. Kwakster928 “Certain states” – some of the pharmacist has scipt rights in certain states. and if you are in the VA system i believe you have that right as well. We as pharmacist should never be the initiating the first precription. we dont have the knowledge and tools available to make a diagnosis, and come up with the right medication. however, i do think it is reasonable to adjust dosage in certain drugs that drug therapy has been already established initially by a physician. will write more.
3. Lexian “Clinical Pharmacists” –
Many hospitals and clinics (i.e. pharmacists working in a physician run clinic) have clinical pharmacists that have the power to prescribe under protocol. That being said, clinical pharmacists are not necessarily diagnosing, because what ends up happening most likely is that a physician diagnoses and then leaves the actual decision of which drug treatment to start the patient on to the pharmacist. Patients who regularly see a clinical pharmacist for management of their meds can have their prescriptions modified (i.e. switch hypertensive drugs if the patient doesn’t seem to be responding well to one type) or dosages changed by the pharmacist, again, under protocol. All changes must be logged in the patient’s chart and is open for review by the physician.
In the retail setting, in some states, a pharmacist can change a prescription from brand name to generic, or vice versa, depending on what the insurance will cover and what the patient is willing to pay. For example, if the patient really wants brand name but insurance will only pay for generic, the pharmacist can go ahead and give the brand name if the patient is willing to pay it all out of pocket (no co-pay) and this change is of course documented and a record is sent to the physician. Hopefully that’s mostly accurate, maybe someone else can fill us in a little more and correct any mistakes I might have written.
Pharmagirl “There are prescribing rights” – I don’t have references, but I am 99% sure that there are several situations in which pharmacists that have prescribing rights. Some can prescribe pretty much everything except narcotics. A prime example would be some of the clinical pharmacists that work in VA (Veterans) Hospitals. THey do still work “under” the supervision of a physician though, as far as I know
4. BananaFace “Collaborative Agreement” – What pharmacists are engaging in in many practice settings in many states are “protocols”. The ability of these pharmacists to prescribe is based on another medical provider’s prescriptive authority. For a protocol to be established, state law must allow this type of collaborative agreement. I am unaware of any situation in which simply being a pharmacist practicing within a state allows one the “right” to prescribe.
5. PACtoDOC “To prescribe or not to prescribe” – EXACTLY!! Just because a pharmacist has prescription priviledges does not mean that they have any clue what to prescribe for what conditions. I see patients all the time who say, “the pharmacist looked at my rash and told me to use XXXX”, when the problem was so far removed from needing XXXX, that the only person capable of diagnosing this would be the PHYSICIAN. I find it comical how many pharmacists think they are dermatologists. I have seen Shingles treated by a PharmD who recommended cortisone cream for “poison ivy”, antibiotic cream for psoriasis, and even allergy eye drops of purulent conjunctivitis. Bottom line…pharmacists are not clinicians and have no business presribing anything.
6. Pharm B “VA Pharmacists” – VA pharmacists can prescribe within a certain scope of practice (Diabetes, psychiatric, etc.)
The Texas State Board of Pharmacy has a small list of pharmacists authorized to prescribe, so they do exist. I don’t know the details behind these individuals, though.
7. LovinPharmD “New Mexico” –
PHARMACIST CLINICIAN
The State of New Mexico has one of the most progressive pharmacy practice acts in the United States. Currently, all pharmacists actively licensed in New Mexico have the ability to administer immunizations (both children and adult) and to provide emergency contraception without the order of a physician. In order to provide these services, the pharmacist must provide the Board of Pharmacy (BOP) with documentation of completion of a BOP approved certificate-training program and have a protocol approved by the BOP.
In addition to the above, New Mexico enacted the “Pharmacist Prescriptive Authority Act”. This act grants pharmacists that have met the requirements of a “pharmacist clinician” prescriptive authority according to a BOP approved protocol or guideline. Prescriptive authority means the authority to prescribe, administer, monitor or modify drug therapy. Monitoring drug therapy involves the following: obtaining patient medical and medication histories, ordering and interpreting pertinent laboratory studies, and measuring routine vital signs and, if necessary, performing appropriate physical examination procedures.
In order to become certified as a pharmacist clinician, pharmacists must meet one of the following requirements:
1. If the applicant is an actively licensed pharmacist, achievement of national certification as a physician assistant; or
2. Satisfactory completion of an academic curriculum which includes a minimum of sixty (60) hours of physical assessment training followed by nine (9) months of supervised clinical experience involving assessment skills (all Pharm.D. graduates); or
3. Satisfactory completion of a 60- hour physical assessment course approved by the Board and a 150-hour, 300 patient contact preceptorship supervised by a physician and approved by the Board, and achievement of a passing score as defined by the Board on an appropriate exam approved by the Board; or
4. If the applicant is certified by the Indian Health Service’s Pharmacist Practitioner Program, documentation of 600 patient contacts within the past two years as a pharmacist practitioner, accompanied by a supporting affidavit from the supervising physician.
Therefore, all Doctor of Pharmacy graduates from the University of New Mexico College of Pharmacy are eligible to become pharmacist clinicians based on criteria #2 above. In addition to the above requirements, a certified pharmacist clinician seeking to exercise prescriptive authority must submit an application to the BOP.
The guidelines or protocol must include the following:
1. Name of the practitioner authorized to prescribe drugs and name of the pharmacist clinician;
2. Statement of the types of prescriptive authority decisions the pharmacist clinician is authorized to make, including, but not limited to:
a. types of diseases, drugs or drug categories involved and the type of prescriptive authority authorized in each case;
b. procedures, decision criteria or plan the pharmacist clinician is to follow when exercising prescriptive authority;
3. Activities to be followed by the pharmacist clinician while exercising prescriptive authority, including documentation of feedback to the authorizing practitioner concerning specific decisions made; documentation may be made on the prescriptive record, patient profile, patient medical chart or in a separate log book;
4. Description of appropriate mechanisms for reporting to the supervising practitioner; and
5. Description of the scope of practice of the pharmacist clinician.
A pharmacist clinician may prescribe controlled substances, provided that a New Mexico Controlled Substances registration and a Drug Enforcement Agency registration have been obtained and controlled substances prescribed are within the parameters of written guidelines or protocols.
Currently there are approximately 100 pharmacist-clinicians that are certified with the BOP. These clinicians are practicing in a multitude of healthcare environments, such
as long term care (nursing homes), institutional (hospital), physician offices, and community pharmacies. There is currently no additional fee to apply for pharmacist clinician certification. However, pharmacist clinicians must renew their license annually and are required to obtain an additional 10 hours of annual continuing education (either American Council of Pharmaceutical Education approved or Category I of the American Medical Association approved live continuing education) in addition to the 15 hour annual requirement for active pharmacist licensure. The New Mexico Pharmaceutical Association’s website has more detailed information regarding the pharmacist clinician regulations and also has several examples of pharmacist clinician protocols posted http://www.nm- pharmacy.com/pharmacist_prescribing.htm.
Final Thoughts
Pharmacists may prescribe medications, but only under some circumstances. With the use of a collaborative agreement, clinical pharmacists can prescribe medication in some cases. In short, not all states allow pharmacists to prescribe medications. And, states which allow, they are limited to certain drug types.
If you are looking to seriously become a Pharmacist I would keep this in the back of your mind that you may be asked to prescribe at some point especially if going the clinical route. However, if you are looking to get into Pharmacy so you can prescribe I would definitely look at another profession such as becoming a Physician. Pharmacists have many roles and take on lots of responsibilities so trying to take on the role of the prescriber as well is in most Pharmacists opinions not a good idea. There are circumstances where this is needed and works best of course.
