Pharmacist Prescribing Is Expanding: Are We Truly Ready?

Physician demand is estimated to grow over supply through 2033.¹ The projected shortage is expected to range between 54,100 to 139,000 physicians. This shortage will involve both primary care and specialty physicians. The reasons for the shortage are multifactorial, involving population growth and aging, a large number of physicians nearing retirement age, and the need for physician care in underserved populations. In addition, a cross-sectional study showed physician work hours consistently declined in the past 20 years so that physician work hours lag behind US population growth.² This development was counterbalanced by an increase in advanced practice professionals (APPs).  

Pharmacists have a duty to provide direct patient care to the US population as APPs, since APPs have the ability to prescribe. However, pharmacist prescribing is still limited across the United States. In interviews, community pharmacists were open to pharmacist prescribing, particularly when prescribing is restricted to a limited set of conditions or medications.³ Interestingly, reimbursement decision-makers were receptive to pharmacist prescribing. Pharmacist-perceived barriers to prescribing were consumer interest in the practice, training to prescribe, potential conflicts of interest with the patient’s care team, and liability issues.

Pharmacist prescribing is now authorized in various forms in 11 states.⁴ States which have authorized prescribing for minor acute conditions now include California, Florida, Idaho, Iowa, Massachusetts, Montana, New Mexico, New York, North Carolina, Ohio, and Oregon. Licensure, requirements for prescribing, and regulations vary between these states.  

Given that pharmacist-perceived barriers to prescribing include training to prescribe, I cover the British Pharmacological Society’s 10 principles of good prescribing.⁵ These include the following:

1. Be clear about the reasons for prescribing
2. Take into account the patient’s medication history before prescribing
3. Take into account other factors that might alter the benefits and harms of treatment
4. Take into account the patient’s ideas, concerns, and expectations
5. Select effective, safe, and cost-effective medicines individualized for the patient
6. Adhere to published guidelines and local formularies where appropriate
7. Write unambiguous legal prescriptions using the correct documentation
8. Monitor the outcomes of treatment, both beneficial and adverse
9. Communicate and document prescribing decisions and the reasons for them
10. Prescribe within the limitations of your knowledge, skills, and experience

Pharmacists can prescribe with proper training, staying constantly abreast of new health and drug information, following the 10 principles of prescribing, and, above all, placing the patient’s best interests in the prime position of care. 

References:

1. HIS Markit Ltd. The complexities of physician supply and demand: Projections from 2018 to 2033. Association of American Medical Colleges; June 2020. Accessed March 8, 2023. 
2. Goldman AL, Barnett ML. Changes in physician work hours and implications for workforce capacity and work-life balance, 2001-2021. JAMA Intern Med. 2023;183(2):106-114. doi:10.1001/jamainternmed.2022.5792 
3. Feehan M, Durante R, Ruble J, Munger MA. Qualitative interviews regarding pharmacist prescribing in the community setting. Am J Health Syst Pharm. 2016;73(18):1456-1461. doi:10.2146/ajhp150691
4. Evans A. Prescribing authority for pharmacists: Rules and regulations by state. GoodRx Health. July 22, 2022. Accessed March 8, 2023. https://www.goodrx.com/hcp/pharmacists/prescriber-authority-for-pharmacists  
5. Aronson JK. Ten principles of good prescribing. University of Oxford Centre for Evidence-Based Medicine. May 10, 2017. Accessed March 8, 2023. https://www.cebm.ox.ac.uk/resources/top-tips/ten-principles-of-good-prescribing