There is a way both to increase the quality of healthcare in our country and at the same time to reduce its cost. This can be achieved by allowing pharmacists to provide certain medications that presently are only available through a prescription from a physician.
The United States is one of only a few developed countries in the world that divides drugs into two strict categories: “prescription-only” and “over-the-counter.” Many other countries such as Australia, Canada and many countries in Europe also have a third category, which is “behind the counter.” This category of drug can be provided to an adult without a prescription, but only after a consultation with a licensed pharmacist.
In today’s healthcare world, the talents of licensed pharmacists are vastly under-utilized. This is extremely wasteful, because licensed pharmacists generally are better schooled about the effects, risks and benefits of drugs and combinations of drugs than most physicians. So why in many cases should patients be forced to take the time and pay the cost to visit a physician for advice and a prescription for drugs in more routine cases when a pharmacist generally has more information and actually specializes in this area? And why must the patient repeat the process 12 months later for a refill on the same prescription?
To be licensed, pharmacists must complete a minimum of five years of college, but most even extend for a sixth year for a doctorate of pharmacy degree. In addition, they must pass a national standardized licensing examination, a practical exam and also an individual state pharmacy law test. And after they are licensed, they must obtain continuing educational credits for the renewal of their licenses.
For years one of the main reasons for pharmacists not independently to give professional advice in their specialty about the risks and benefits of drugs and combinations of drugs was that their advice might foreseeably contravene that of the physicians. This could in turn interfere with the relationship between physician and patient. But under the reality of today’s “managed healthcare,” the amount of time that most physicians are able to spend with their patients for either medication selection or an explanation of the risks and benefits of the medications has been seriously reduced. So that objection has lost much of its validity.
Accordingly, I suggest that our laws and regulations be changed in two important ways. The first is to allow adults to be able to obtain some drugs like birth-control pills, cholesterol and migraine medications, or maybe even all drugs except for antibiotics and those that are addicting from licensed pharmacists without a physician’s prescription. Second, before any such drug could be provided, the pharmacist would have to consult directly with the patient and refer to the patient’s drug history chart, which would be stored electronically. For privacy reasons only the patient would have the password to give access to the pharmacist. But once any medication was provided, the drug history chart would be updated to reflect that fact.
What would be the results of this program? Just like in the countries mentioned above, patients would have access to appropriate medications at greatly reduced cost. But far from receiving their medication “from a vending machine,” the professional pharmacists would probably be providing more expert and individually-tailored advice than patients are generally receiving today.
A discussion of other benefits would be addressed by asking the following question: who has the most to lose by overdose or misdiagnosis of medications? Obviously the answer is the patient. As a result, patients would increasingly have the incentive to become more educated about their own conditions instead of blindly following the advice of their overworked physicians. That would in turn shift the relationship between physician and patient from one of paternalism to one of partnership.
As importantly, with all of a patient’s drug history being found in one place, the ability of a drug abuser to go from one physician to another, tell a fabricated story and obtain larger quantities of drugs to abuse would be significantly reduced. Similarly, with the complete record to be found in one place, the pharmacists would be better able to identify possible risks of side effects, allergies and usage with combinations of other drugs, including alcohol. This would further enhance the medical safety and health of the patients.
Finally, since pharmacists would be treated like the healthcare professionals they are, if they fell below the standard of care for their profession, they would be held civilly liable for their negligence, just like any other healthcare professionals. Of course, this would encourage pharmacists who were uncertain about what medications the patient should take to recommend the patient to go see a specialist, and place that recommendation in the patient’s chart.
All of these various benefits we have discussed are becoming so apparent that the Food and Drug Administration is right now looking into this new approach. I invite you to join with me in encouraging them to proceed with their inquiry.
Overall, I acknowledge that this new program would still have the problem of drug manufacturers seeking lucrative marketing opportunities by providing favors for pharmacists in exchange for influencing them on their recommendations of medications. But that problem would not be worse than the one we already have today with physicians. Otherwise I believe this proposed system would go a long way to increase everyone’s access to competent healthcare and medications, while at the same time materially reducing their cost.
And by the way, this change in approach would also have the beneficial effect of encouraging people in general to be more active and responsible in matters affecting their own health and that of their children. In my view this movement toward individual responsibility would justify the change all by itself.
Judge Jim Gray (Ret.)