Prescription for Payment by Danielle Dresden
Published: 6/15/2003
PharmacyWeek Vol. XII - Issue 21

We've heard "You get what you pay for." But when it comes to pharmacists prescribing, it seems the trend is to do what you're paid for.

One-quarter of the pharmacists responding to a 2002 survey worked in states where they had legal authority to prescribe medication. However, only 42% of those who could prescribe chose to do so.

Thomas Savino, RPh and Director of Pharmacy at WebRx Pharmacy Palace, lives in Florida, which has had a "pharmacist prescribing law" since 1986. Under the law, pharmacists can charge for their services, bill insurance companies and independently prescribe medication from a select formulary approved by a commission appointed by the governor. However, pharmacists have not taken up prescribing in great numbers.

Across the country in Washington state, under local law pharmacists prescribe through collaborative practice agreements with physicians. Pharmacists usually do charge for their services in community settings, according to Jackie Gardner, Ph. D. and associate professor of Pharmacy at the University of Washington, but not in hospitals.

At the pharmacy where she works, Gardner said pharmacists prescribe emergency contraceptives so frequently they are on the "fast mover" shelf.

Savino suggested Floridian pharmacists are reluctant to prescribe for three reasons:

• chain stores will not charge for the service;
• liability issues;
• fear of the unknown.

Chain stores worried about pharmacists charging varying fees for their services, confusing the public and interfering with company pricing, Savino said, so the chains decided not to allow their staff to charge for prescribing.

Chain pharmacists thus had no incentive to take on the extra work and increased responsibility involved with prescribing, Savino explained. Unlike most states, in Florida pharmacists have independent prescribing authority. For many medications no review by a physician is necessary, he said, although the same pharmacist who prescribes a medication is required to fill it.

Savino said he is not afraid to do what he knows how to do, but many pharmacists are leery of increased liability from prescribing. In addition, he said, "Pharmacists are not generally trained to be entrepreneurs and their training has not prepared them to be innovative."

But some try new things. Savino has opened his own business, RxPalace.com, an Internet-based resource which follows state criteria for prescribing. He also knows of several independent pharmacists who use prescribing in their practices.

While emergency contraception is a new service provided by Washington's pharmacists, Gardner said other practices, like adult vaccination, have been around for while. Collaborative agreements in hospital clinics have allowed pharmacists to change therapy and manage drug regimens for some time.

As the pharmacist's role in health care continues to evolve and expand, many expect to see more pharmacists prescribing, especially if payment procedures keep pace with the practice.

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