AMA Does Not Want Pharmacists to Prescribe Medication

Lara C. Pullen, PhD

June 22, 2012

June 22, 2012 (Chicago, Illinois) — American Medical Association (AMA) delegates passed a resolution opposing federal and state legislation allowing pharmacists to independently prescribe or dispense prescription medication without a valid order by a licensed physician, here at the AMA 2012 Annual Meeting.

The medical service reference committee heard extensive testimony on the subject. The testimony largely focused on the fact that pharmacist education and training are not equivalent to physician training. The AMA was further concerned about increasing the scope of practice of pharmacists by allowing them to independently prescribe.

Testimony also covered the topic of immunizations, but the AMA tabled the subject and noted that the issues associated with immunizations are complex and warrant a separate conversation.

The resolution was proposed in response to a February 28, 2012, US Food and Drug Administration (FDA) announcement in the Federal Register of a new prescription paradigm. At this time, the FDA approves drugs as either prescription or nonprescription. Prescription drugs can only be dispensed on receipt of a prescription from a practitioner licensed by law to administer the drug.

The FDA recognizes that many common diseases or conditions are undertreated. The new paradigm would allow medications for certain diseases or conditions to be made available without a prescription, as long as certain conditions of safe use are met.

The new paradigm may leverage new technologies that allow consumers to self-screen for a particular disease or condition and determine whether a particular medication is appropriate for them. The FDA would then create a third category of drugs: those that are approved for use without a prescription as long as there is some sort of pharmacist intervention as a condition of safe use.

In these cases, the same drug product may be available as both prescription and nonprescription with conditions of safe use. In the Federal Register, the FDA called for input on what types of evidence would be required to classify a drug as nonprescription with conditions of safe use.

On April 30, 2012, the American Academy of Family Practitioners (AAFP) sent a letter detailing its opposition to "regulations and legislation that would allow pharmacists to dispense medication beyond the expiration of the original prescription for reasons other than emergency purposes."

The AAFP feels that the new paradigm speaks to the relationship between patients, physicians, and pharmacists. Rather than create a new class of drug, they called for an environment in which physicians and pharmacists can work together to combine their expertise.

Both the AMA and the AAFP acknowledge the significant role of the pharmacy professional in healthcare service, and they also acknowledge the expertise of the pharmacist.

Pharmacist testimony at the reference committee captured this shared understanding: "The pharmacy profession occupies an important and long-standing position on the healthcare team as the medication expert to assist physicians and other providers in managing patients' medications in both inpatient and outpatient care settings."

On May 7, 2012, the American Pharmacists Association (APhA) wrote a letter to the FDA in support of the paradigm shift. The APhA describes pharmacists as "the most accessible health care provider to many patients," and they see the new paradigm as an opportunity to leverage the success of pharmacist-administered immunizations to other aspects of healthcare. In June 2011, the Centers for Disease Control's National Center for Immunization and Respiratory Diseases congratulated the APhA for its extensive work in the area of immunizations.

The APhA believes that it is possible to build on the pharmacy profession's success with immunization to establish conditions for safe use for medications. This could then increase consumer access to necessary medical care and improve public health.

American Medical Association (AMA) 2012 Annual Meeting. June 16-20, 2012.