AMA to protect patient access to medications

Chicago -- The American Medical Association is taking new steps to guarantee that patients are not denied access to medication when pharmacists refuse on moral grounds to dispense drugs.

The AMA House of Delegates, meeting here in June, adopted new policy stating that the Association supports legislation that requires pharmacists or pharmacy chains to fill valid prescriptions or make an immediate referral to another pharmacy. Delegates also voted to press for new laws that would allow physicians to distribute medication to their patients when there is no willing pharmacist within a 30-mile radius.

"The AMA strongly believes that patients have to have access to their medications," said AMA Trustee Peter W. Carmel, MD, a pediatric neurosurgeon from New Jersey.

Delegates were responding to reports nationwide that some pharmacists refused to fill certain prescriptions, such as emergency contraceptives, based on moral objections. Physicians have complained that some pharmacists also refused to return the prescriptions, making it more difficult for patients to get medicine.

Several medical organizations, including the American College of Physicians and American Academy of Family Physicians, said 14 states had introduced conscience-clause legislation to protect pharmacists who refuse to distribute medication based on religious, moral or personal grounds, and nine states had proposed measures allowing refusal for any reason.

The Washington, D.C.-based American Pharmacists Assn. (APhA) has policy that recognizes a pharmacist's right to exercise conscientious refusal. The conscience-clause policy also "supports the establishment of systems to ensure a patient's access to legally prescribed therapy without compromising the pharmacist's right of conscientious refusal."

"Just as physicians are not required to provide all medical services, pharmacists should not be required to provide all pharmacy services," APhA Executive Vice President and CEO John A. Gans said in a statement.

Gans said it was unfortunate the AMA and APhA did not discuss the issue before the House of Delegates took action. But he said his association welcomed dialogue with the AMA.

"Just like doctors, pharmacists abide by a Code of Ethics for the delivery of health care. And yes, just like doctors, pharmacists make sure that patients are getting the prescriptions they need without interruption at the pharmacy," he said.

Many AMA delegates said the Association needed to take action on the issue. They said some pharmacists were imposing their wills on others and leaving patients without their medication.

Pharmacists initially were declining to fill contraceptive drugs, but now they also are turning down prescriptions for pain medications and other drugs, physicians said.

AAFP President Mary Frank, MD, of California, said she respects a pharmacist's right to refusal, "but we do believe the patient's need has predominance in this issue."

Arkansas internist William Golden, MD, voiced concerns that pharmacist refusals upset the physician-patient relationship. "This is a very important issue for the AMA to get engaged in," he said.

The AMA will work with state legislators and pharmacist groups to ensure that a patient's health and the physician-patient relationship is not harmed by a pharmacist's refusal, Dr. Carmel said.

Dr. Carmel said that if a pharmacist won't dispense a drug, he or she should tell patients where they can go to get the medication.

The new policy calls for the AMA to work with state medical societies to support legislation to protect patients' ability to have prescriptions filled.

The AMA also will engage in dialogue with various groups, such as the APhA and American Society of Health System Pharmacists, to make sure that a patient will be referred immediately to an appropriate pharmacy when a pharmacist exercises a conscientious refusal.

"This is an issue of access to care for patients," Dr. Frank said.