Oregon has long been a pioneer in the expansion of the scope of pharmacy practice in the state.
Pharmacists in Oregon have enjoyed expanded authority through collaborative practice agreements for nearly 40 years, and Oregon was also the first state to allow pharmacists to independently prescribe hormonal contraception (birth control pills and patches) without a prescription from a physician.
“That’s been very successful for us,” said Joshua Free, an industry consultant who is the past president of the Oregon Pharmacy Association and currently is chair of the Oregon Pharmacy Coalition. “There are a lot of pharmacists in community settings and other settings that are prescribing birth control very effectively.”
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He said the process was very well thought out and, importantly, allows pharmacists to bill as medical providers for those clinical encounters. Oregon quickly became a model for other states across the country to allow pharmacists to prescribe hormonal contraceptives.
In addition, Oregon in 2015 passed landmark legislation that requires payers to reimburse pharmacists for any clinical services within the state’s pharmacy scope of practice.
Then, in 2017, the Oregon Public Health and Pharmacy Formulary Advisory Committee was formed, which has opened the door to further expansion of scope. The committee, which includes three pharmacists, two physicians and two advanced practice registered nurses, allows the Oregon Board of Pharmacy to expand the scope of pharmacy practice without going through the state legislature.
“That group reviews requests, usually from pharmacists, for things that pharmacists ought to be able to do independently,” Free said.
The goal is for pharmacists to be able to prescribe in specific situations, but not to diagnose patients’ conditions. “We’re not looking for pharmacists to take over primary care or to be completely independent practitioners,” he said.
The committee allows pharmacists to prescribe in situations where the diagnosis is obvious or is already known, or when a diagnosis is not needed.
“If a patient needs something as simple as a prescription for a spacer for an inhaler, why go back to the physician for that? Or if they need to re-up on their test strips for their blood glucose,” Free said. “These scenarios happen in retail pharmacies every single day.”
Scope of practice
- Pharmacists can prescribe hormonal contraceptives, tobacco-cessation therapies, naloxone and HIV pre-exposure and post-exposure prophylaxis (PrEP and PEP);
- Since 2009, Oregon pharmacists have been able to bill for medication therapy management services;
- Since 2015, payers have been required to reimburse pharmacists for any clinical services within the state’s pharmacy scope of practice; and
- In 2017, the creation of the Oregon Public Health and Pharmacy Formulary Advisory Committee further expanded pharmacists’ prescribing authority in the state. The new formulary contains post-diagnostic items, such as diabetic testing supplies, epinephrine autoinjectors, albuterol inhalers, rapid strep tests and spacers for inhalers, among other items. Pharmacists and others can suggest new items to be added to the formulary, and the committee can approve or reject them without going through the state legislature to expand the scope of practice.