An expanded role for pharmacists an Rx for ailing system
“In Critical Condition” and other recent Journal pieces have highlighted New Mexico’s health care challenges. There is an underutilized opportunity to improve health care availability, safety and quality by allowing pharmacist clinicians and pharmacists with prescriptive authority to take care of patients. I have been a New Mexico pharmacist clinician for 13 years and have cared for many patients in clinic thanks to a 1993 collaborative effort among state pharmacists, physicians and legislators to create pharmacist clinician licensure, allowing pharmacists with additional training to practice under an expanded scope of responsibilities in collaboration with physicians. New Mexico also grants limited opportunities for pharmacists with specified training to prescribe additional classes of medications and vaccines.
An ever-increasing number of states have mimicked New Mexico’s actions, recognizing the potential benefits offered by pharmacists, who have doctorate degrees at entry level and are specially trained on medication use, clinical skills and patient education. Their training to identify unneeded medications, notice untreated medical conditions, ensure proper dosing, avoid medication interactions, educate patients and broadly optimize medication use offers quality improvement and harm reduction opportunities. Pharmacists also are typically positioned close to patients in the community. Unfortunately, opportunities for pharmacists to improve timely access to quality care are currently compromised by lack of payer recognition and professional autonomy.
Such federal programs as Medicare and insurers in New Mexico must recognize pharmacists, or at least New Mexico pharmacist clinicians and pharmacists with prescriptive authority, as health care providers. This includes acknowledging that these professionals are capable of medical decision-making, and independent evaluation and management of patients. The N.M. House of Representatives passed important legislation in 2020 requiring New Mexico insurers pay pharmacist clinicians and pharmacists with prescriptive authority in line with other providers; however, the potential to improve access has been stifled by technology barriers, poor organizational understanding and unfortunate discriminatory practices among insurances, including refusal to credit care delivered by pharmacist clinicians toward financially significant medical clinic quality measures.
Another crucial step is allowing pharmacists the autonomy granted other doctors to determine and work within a scope appropriate to their training and expertise, while being overseen by a highly engaged Board of Pharmacy that openly and continually collaborates with other health care professionals and their regulatory boards. Dependency on supervising physician agreements and nonpharmacy boards for approval of pharmacy regulations delays patient access to pharmacist expertise.
Patients served by pharmacist clinicians recognize the benefits. This month, I spoke with a retired schoolteacher, indicating to him that one of his medications could be causing two other medical problems, each of which was being treated with an additional medication. His response, “these are the types of conversations we should be having in health care.” My hope is structural barriers are removed to enable this.
Patients, ask your insurances to cover the full scope of pharmacist services and access their expertise. Health care professionals, open your hearts and workplaces to progressive pharmacist roles, and encourage your regulatory boards and professional organizations to warmly collaborate. Payers structure contracts and technologies to promote pharmacist utilization for clinical services they are qualified to perform. Legislators and regulators recognize pharmacists as qualified health care providers, and support their inclusion and autonomy. Finally, pharmacists, stand up for your right to deliver great care to patients.