A law enacted by the General Assembly last year allows pharmacists to give more immunizations, creating new business for drug stores.
By Brenda Porter-Rockwell
North Carolina is among the growing number of states to expand pharmacy practice laws, offering pharmacists a more visible, public role in helping manage patient care. A law enacted last year by the state legislature that went into effect in October increases the number and types of vaccines pharmacists’ can now administer in North Carolina. The law also opens the door a little wider to allow the number of in-store pharmacy clinic services to grow.
“The public’s perception of a pharmacist is tied to the product – the compounding, the filling of prescriptions,” said Stefanie Ferreri, clinical associate professor at the UNC Eshelman School of Pharmacy in Chapel Hill. “But we are turning into a more service-focused profession. We are getting more involved in public health.”
The law, an extension of North Carolina’s Pharmacy Practice Act, allows pharmacists to become certified as “immunizing pharmacists,” provided they meet certain continuing-education requirements and work under the supervision of a licensed physician.
The legislature’s actions mirror a growth across the U.S. in-pharmacy retail clinics. According to a study by the consulting firm Accenture, the number of in-pharmacy clinics is expected to reach 3,000 by the end of 2015.
Rapid expansion in N.C.
As of September 2013, the North Carolina Board of Pharmacy had recognized nearly 11,000 licensed pharmacists in North Carolina. Of those, more than 5,000 have added the title of immunizing pharmacist since the law took effect, said the pharmacy board’s executive director, Jay Campbell.
While pharmacists were already administering a limited number of vaccines, under the new law they can administer any vaccine recommended by the Centers for Disease Control and Prevention.
The bill also includes a provision for pharmacists to have access to the online state immunization registry. The N.C. Immunization Branch of the Department of Health and Human Services began phasing in participating pharmacies last fall.
On the business side, retail pharmacy clinics like Walgreens and CVS now offer walk-in services where patients can be diagnosed and treated for certain disorders by a medical professional. While pharmacists in most states, including North Carolina, do have the authorization to treat symptoms or manage patients’ medication use, their role in the clinic as health advocates, Ferreri said, is just as important.
“CVS, for example, recently announced it would no longer sell tobacco products, so we as pharmacists are involved with clients seeking advice about smoking cessation,” she said. “We can also provide blood-pressure management and diabetes education.”
Modern health care
The extension of the law comes amid a changing health care environment. Specifically, pharmacists and other experts say they can help fill the void between a growing patient population and too few primary-care physicians.
“The role is evolving and expanding with the expansion of medical knowledge and the implementation of various new initiatives in preventive care and health maintenance,” explained Daniel L. Barbara Sr., executive director of the North Carolina Association of Pharmacists.
Barbara called pharmacists’ care “essential to the comprehensive patient-care program, whether that contribution comes in the form of collaboration with a primary-care provider regarding medication interactions, effective treatment strategies or counseling with a patient regarding medication management” and treatment and medication adherence.
With pharmacists’ growing medical role in communities, some might argue that they are encroaching on physicians’ territory. A 2002 position paper by the American College of Physicians and the American Society of Internal Medicine states: “To improve patient safety and reduce medical errors, ACP-ASIM supports physician-directed pharmacist-physician collaborative practice agreements limited to pharmacist involvement in patient education and hospital rounds.”
The North Carolina law was supported by local physician groups, provided that physicians would be involved in the vaccination process.
“We want to enhance the care [physicians] provide by partnering with the patient and the rest of the health care team to focus on what we do best,” said Mollie Ashe Scott, regional associate dean and clinical associate professor at the Eshelman School of Pharmacy at UNC-Asheville. “[That] includes ensuring patients can afford their medicines, that they take them correctly, that they do not experience adverse drug events or drug-drug interactions, that the regimen is evidence-based and that the medications meet the needs and expectations of the patient.”
“Pharmacists do not want to be physicians,” she said.
Preparing for the future
Pharmacists and advocates say the new law is another step toward recognizing the full potential of pharmacists’ contributions to better public-health outcomes.
To prepare the next generation for a future as part of a complementary care team, pharmacy schools now require students to complete a doctor of pharmacy (PharmD) degree, which requires four years of education beyond pre-pharmacy studies.
In some pharmacy specialties, practitioners assist with patient care outside of the standard brick-and-mortar drug store. Scott, who has practiced in an ambulatory-care pharmacy for 17 years, sees patients at the Mountain Area Health Education Center clinic in Asheville. There she works as a clinical pharmacist practitioner, which means she is recognized by the boards of medicine and pharmacy to manage drug therapy in collaboration with the physicians on her team.
For example, Scott said the MAHEC clinic has a pharmacist deployed to help a small medical practice in the region improve quality indicators for patients at risk for stroke. The practice, she said, identified patients who had high blood pressure and high cholesterol and weren’t reaching their goals but who could benefit from seeing the pharmacist.
“The pharmacist met with the patients and recommended drug-therapy changes to the physician that helped more patients reach their drug-therapy goals, which in turn improved quality indicators,” said Scott.
Additionally, pharmacists at MAHEC are now responsible for providing Medicare Wellness Visits so that the physicians can focus on more complex patient issues. They also partner with an inpatient family medicine team and triage nurses to provide comprehensive transitions in care services for those patients recently discharged from the hospital.
But for all of the advanced training and cross-discipline working arrangements, reimbursement is still an issue.
“Because we are not recognized as providers, our abilities to be reimbursed for clinical services is limited, which makes the financial feasibility of hiring a pharmacist challenging,” Scott said.
Earlier this year, legislation was introduced in Congress to amend the Social Security Act to allow pharmacists providing services to underserved patients or in underserved areas to be recognized as providers under Medicare Part B.
“This would increase the viability of the model of embedding pharmacists into physician practices,” said Scott.
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