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The Problem With the Model Practice of Pharmacy Act: Part I
One of the fundamental differences between the Essentials of a State Medical Practice Act (MPA) and the Model Pharmacy Practice Act (PPA) is that the MPA is proscriptive, and the PPA is prescriptive. What does this mean? Proscriptive means forbidding or restricting something.
The MPA allows innovation in practice to occur, but still holds the practitioner to the duty to care and treatment of the patient with the degree of skill, care and diligence as possessed or expected of a reasonably competent physician. The PPA is a prescriptive document based on the current practice norm or standard. The PPA allows a pharmacist only to practice within established standards of practice. Innovation in pharmacy practice is therefore restricted. Liability is centered on following physician orders, maintaining equipment and supplies, security, personnel issues, and recordkeeping. I believe it is time to rethink the prescriptive nature of the PPA.
This is part I of a three-part series on the Model Practice of Pharmacy Act. This part outlines the problem with the current model act.
The Federation of State Medical Boards Essentials of State Medical and Osteopathic Practice Act from 2015 states following:
- “The practice of medicine is a privilege granted by people acting through their elected representatives.
- Offering or undertaking to prescribe, order, give, or administer any drug or medicine for the use of any other person.
- Offering or undertaking to prevent or to diagnose, correct, and/or treat in any manner or by any means, methods, or devices any disease, illness, pain, wound, fracture, infirmity, defect, or abnormal physical or mental condition or any person, including the management of pregnancy or parturition; offering or undertaking to perform any surgical operation upon any person.
- Rendering a written or otherwise documented medical opinion concerning the diagnosis or treatment of a patient or the actual rendering of treatment to a patient within a state by a physician located outside the state as a result of transmission of individual patient data by electronic or other means from within a state to such physician or his or her agent.
- Rendering a determination of medical necessity or a decision affecting the diagnosis and/or treatment of a patient.”
Please note that throughout the Model MPA, restrictions on practice are minimized, thereby allowing innovation to flourish, to be studied, presented and published, and then adopted into practice without the need to change the MPA.
The National Association Boards of Pharmacy Model Pharmacy Act/Rules from 2019 states: “The ‘Practice of Pharmacy’ means, but is not limited to, the interpretation, evaluation, Dispensing, and/or implementation of Medical Orders, and the initiation and provision of Pharmacist Care Services. The Practice of Pharmacy also includes continually optimizing patient safety and quality of services through effective use of emerging technologies and competency-based training.” Please note under Pharmacist Care Services a prescriptive listing of care services that a pharmacist can provide—the standard has been set.
The PPA, by listing the Pharmacist Care Services, stifles innovation. By a pharmacist starting a new practice role, he/she begins immediately practicing outside of the PPA, thereby placing themselves in legal jeopardy. This stifles practice!
Could practice innovation be undertaken within a collaborative practice agreement? The answer is yes. However, I have found that physicians are reluctant to try new means or methods that are not their idea.
It is time for a new paradigm in writing the PPA. There is a US health care crisis of drug misadverturing that requires immediate innovation in pharmacy practice. Allowing pharmacist ingenuity to be unleashed can bring about positive changes in drug misadverturing.
Read part II of Dr Munger's commentary on the Model Practice of Pharmacy Act.
Read part III of Dr Munger's commentary on the Model Practice of Pharmacy Act.
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