CVS Health, Walgreens and Walmart are pushing for more ways pharmacists can prescribe as ... [+]
Many are pushing for more ways pharmacists can prescribe medications as drugs become increasingly specialized and a shortage of primary care physicians threatens quick access to medical care.
But a battle is emerging between the biggest names in pharmacy, which are backing more provider and prescribing status for pharmacists, and doctor groups that oppose the push, saying it’s driven by pharmacy chains prioritizing profits over drugs.
Retail pharmacy giants and operators of specialty pharmacies including CVS Health, Walgreens, Walmart and Amazon already have their pharmacists prescribing certain medications like antivirals used against the coronavirus.
Through a Biden Administration “test to treat” initiative, state-licensed pharmacists have had U.S. approval for the last two years to test patients for Covid-19 and then immediately prescribe a treatment such as an oral antiviral. The idea behind this was to make sure patients could access medications like Pfizer’s antiviral Paxlovid right away to prevent more deaths and hospitalizations from Covid-19.
The “test to treat” effort is now a test case for why pharmacies say pharmacists should be allowed to prescribe in more instances and regulations need to change to expand their scope of practice. Meanwhile, pharmacy executives say medications are more complicated and pharmacists are often the first health professionals patients encounter with questions about potential drug interactions and side effects.
“When patients think of a pharmacist, they often think of the person they see behind the counter managing their prescriptions, but they are equipped to do so much more than that,” said John Colaizzi, Jr., a pharmacist and Walgreens vice president of pharmacy practice. “We are supporting the federal provider status legislation before Congress and encouraging legislators and board authority at state levels to understand that there is an underutilization of what pharmacists are trained to do.”
Walgreens, CVS, Walmart and Amazon all support efforts to expand the role of pharmacists in their roles as providers of medical care.
“Having grown up in a family of community pharmacists and being in the industry myself for 27+ years, I know first-hand the enormous impact that pharmacists have on local communities and public health outcomes,” Colaizzi said. “We are deeply passionate about and capable of getting patients the first-line, accessible care that they need. Supporting the professions’ scope to test and treat patients is the first step of many, but an important one in helping the healthcare industry as a whole become more efficient and effective, saving time and valuable dollars in care.”
More broadly, pharmacies see the ability of a pharmacist to prescribe as a way to address the widening shortage of physicians and other healthcare workers across the U.S. In addition, big retail pharmacies see “test and treat” as a way to add another healthcare service to the growing menu of medical care offerings already provided at drugstores, big box retailers and grocery stores.
"Amazon supports the ability of pharmacists to practice at the top of their license," said Laura Jensen, head of manufacturer and provider business development for Amazon Pharmacy. “We’re using newer technologies including generative AI to enable our pharmacists to focus on clinical care rather than administrative tasks. This frees up time, and improves access.”
Walmart, meanwhile, offers testing and treatment in 1,100 stores across 14 states for Covid-19, strep throat and the seasonal flu. Walmart has made test and treatment available in Alaska, Arkansas, Colorado, Florida, Idaho, Iowa, Kansas, Kentucky, Michigan, Minnesota, Nevada, South Dakota, Tennessee and Washington.
“Testing and treatment services are allowed on a state-by-state basis where pharmacists are authorized to test and prescribe, and we continue to work with states as we launch this effort at our pharmacies,” Walmart said in a statement.
But there are powerful obstacles standing in the way of the “test and treat” push in the form of U.S. physicians. And that doctor opposition is creating a battle in states across the country.
The American Medical Association and state medical societies are long opposed to expansions of scope of practice, believing care should be led by physicians.
In Illinois, for example, the Illinois State Medical Society is moving to thwart what it calls “policies by big pharmacy chains that put profit above what is best for patient care.”
“The physician members of the Illinois State Medical Society are particularly concerned with the lobbying by national pharmacy retail chains for a new business model, ‘test and treat,’ that would grant pharmacists the authority to diagnose, prescribe for, and treat a broad range of potentially serious health conditions without the requisite training and education,” said Dr. Piyush I. Vyas, president of the Illinois State Medical Society.
“Pharmacists are not generally trained to diagnose or prescribe,” Vyas said. “One-off visits with a pharmacist do not provide an opportunity to offer follow-up care, nor do they begin to approximate the critical relationships patients have with their highly-trained physicians who have access to patients’ records to develop an appropriate treatment plan. Equally important, many “test to treat” models fail to provide safe spaces that protect patient privacy.”
The Illinois State Medical Society points to a study by the Pharmacy Workforce Center that shows pharmacists are already overworked performing the tasks they are already approved to do.
The study of more than 3,000 pharmacists said 75% of pharmacists in chain settings said they have so much work to do now that everything cannot be done well. “Already overworked, pharmacists have said they are more liable to make prescription errors and there are not adequate safety protections to serve their customers when they are juggling too many tasks, so why add more?” Dr. Vyas asked.
Still, those involved with retailers and their increasingly specialized pharmacy businesses say it’s more important than ever that pharmacists have the ability to prescribe.
As one example, the Elton John AIDS Foundation is working with Walmart and Duke University to train pharmacists on how to educate patients about pre-exposure prophylaxis (PrEP), a daily pill that can help prevent HIV, the virus that causes AIDS.
It’s not uncommon for people at risk for HIV to already have another sexually transmitted disease. So when they come in to the pharmacist to pick up a medication, supporters of the ability of pharmacists to test for diseases and then quickly prescribe say that’s an opportunity to get a potentially life-saving medication to treat HIV.
"Many people in the US do not have easy access to healthcare facilities that can provide HIV testing and PrEP, a proven way to prevent HIV,” said Anne Scott, chief program and impact officer at the Elton John AIDS Foundation. “To address this access gap, the Elton John AIDS Foundation is partnering with Walmart and Duke University to train Walmart’s pharmacy and clinical staff on the benefits of HIV testing and PrEP. At the Foundation, we are committed to meeting people where they are with compassionate care, recognizing the indispensable role pharmacists play within their local communities."
