MMA Opposes Bill Allowing Prescribing By Pharmacists

BOSTON — The Mass. Medical Society recently testified before the Joint Committee on Public Health in strong opposition to House Bill 2689, “An Act to Establish Collaborative Drug Therapy Management to Improve Pharmaceutical Care for Patients in Massachusetts.”

Alan M. Harvey, M.D., M.B.A., president of the Massachusetts Medical Society, testified on behalf of the Society’s 18,300 member physicians across the state and said that patients’ interest and safety should be the primary concerns in judging legislation of this kind.

Harvey urged the Committee not to advance the legislation because it has no patient-safety protections, has no patient protection from financial exploitation and conflicts of interests, meets no demonstrated need of the Commonwealth, provides for no appropriate educational or training standards, and does not reflect the laws or the clinical practices of the 41 other states cited by advocates of the legislation.

Harvey said the Society is concerned that this legislation would be “allowing pharmacists to prescribe, dispense, and administer drugs subject only to the constraints of as yet un-drafted regulations and written guidelines of one or more supervising physicians,” who may not know or have ever seen the patient.

While the bill is modeled on existing statutory language that governs the prescriptive authority of nurses practicing in an expanded role, Harvey noted that nurse practitioners and physician assistants have well-established histories of working with physicians and patients and have educational backgrounds consistent with direct patient care. Pharmacists have no existing comprehensive model of collaborative practice, he said.

Also calling attention to the fact that Massachusetts has been and continues to be in the forefront of patient safety efforts, which has resulted from a collaboration of a wide range of medical professionals, Harvey said the legislation as proposed in House Bill 2689 would give a pharmacist the authority to initiate, dispense and administer a prescription drug with no contact with any other medical professional. Noting that local stories about recent dispensing errors appear to be all too common, Harvey said the best way to prevent systems errors is “to increase checks and balances,” not allow complete decision-making to occur with one individual.

Harvey also said that the legislation does not address ethical issues involved in allowing pharmacists who dispense and sell medications to actually choose the medication that is most appropriate. “The conflict of interest,” he said, “in such broad authority is readily apparent.”