AMA House of Delegates

Delegates oppose giving pharmacists authority to prescribe drugs

The AMA voices concern that an Food and Drug Administration proposal could expand such rights.

By Alicia Gallegos — Posted July 2, 2012

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The American Medical Association House of Delegates adopted policy that opposes federal and state legislation that allows pharmacists to prescribe medication absent supervision or a valid order by a doctor.

The policy, adopted at the AMA Annual Meeting, also opposes legislation that lets pharmacists dispense medication beyond the expiration of the original prescription.

The move stems from a public meeting in March at which the Food and Drug Administration sought feedback from health and physician organizations about expanding the range of over-the-counter drugs. Under the new paradigm, the agency would allow some drugs for chronic conditions, such as asthma and allergies, to be sold from the pharmacy counter without a prescription.

The model would allow pharmacists to determine patients’ needs for certain medications and help verify their self-diagnoses. The FDA has said the change would eliminate unnecessary doctor visits and connect more patients to needed medications.

But delegates are concerned that the model broadens pharmacists’ authority to dispense drugs and compromises patient safety.

“Should the FDA move forward, it will likely have a sea of impact on the physician community,” said Joseph Sokolowski Jr., MD, a pulmonologist in Medford Lakes, N.J., and a delegate with the American Thoracic Society. The AMA should “closely monitor the FDA and seek broad approval for any [FDA] proposals and study the cost to consumers,” he said.

Some delegates disagreed with formulating a stance on the FDA’s plan until the house looks more into the issue. But most expressed support for taking a position while the plan is being developed.

“This is clearly a scope issue,” said Vicksburg, Miss.-based family physician Randy Easterling, MD, an alternate delegate for the Mississippi State Medical Assn. who spoke on his own behalf. “If we don’t speak out against it, in five years we’ll be dealing with” the consequences.

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Meeting notes: Legislative action

Issue: The health system reform law created a basic health program as an option for providing health care to low-income individuals in lieu of exchanges and other state health plans.

Proposed action: Establish principles for state basic health programs, including adequate physician and health professional networks, negotiated payment rates, and state medical society involvement in legislative and regulatory processes. [Adopted]

Issue: Pregnant women and postpartum mothers lack insurance coverage for mental health services.

Proposed action: Support improvements to mental health services for women who are pregnant or postpartum, and advocate for inclusive coverage of such services during gestation and up to one year postpartum. [Adopted]

Issue: Budget cuts have led states to eliminate or reduce coverage for mental health services.

Proposed action: Support maintaining essential mental health services, including inpatient and outpatient mental hospitals, community mental health centers, addiction treatment centers and other state-supported psychiatric services. Also support enforcement of the Mental Health Parity Act and state mobile crisis teams to treat the homeless. [Adopted]

Issue: Medical clinics sponsored by employers offer access to preventive and other health services to employees at the workplace.

Proposed action: Study employer-sponsored clinic benefits and develop guidelines on patient privacy, safety and access, and the staffing of clinics by physicians or supervised practitioners. [Adopted]

Issue: Pursuing solely punitive penal action in drug offender cases may not be the most beneficial for drug abusers and the community. Drug courts, which focus on intensive treatment and supervision of drug offenders, are being used in some parts of the country.

Proposed action: The American Medical Association should support the establishment of drug courts as an effective method of intervention for individuals with addictive disease who are convicted of nonviolent crimes. [Adopted]

Issue: Physicians are concerned that the Physician Payments Sunshine Act will be burdensome and lead to overregulation by the government. The measure, approved as part of the Affordable Care Act, requires the reporting of gifts and payments to physicians from drug and device manufacturers. The data collection will start in 2013.

Proposed action: The AMA should continue its efforts to minimize the burden and unauthorized expansion of the Sunshine Act by the Centers of Medicare & Medicaid Services. The Association also should recommend to CMS that a physician comment section be included on the “Physician Payments Sunshine Act” public database. [Adopted]

Issue: The switch from ICD-9 to ICD-10 diagnosis code sets for billing physician services will create unnecessary and significant financial and workflow disruptions for doctors. ICD-11 is on the horizon and may be a less-burdensome transition for physicians if they wait and move from ICD-9 to ICD-11 at a later date.

Proposed action: The AMA should evaluate the feasibility of moving from ICD-9 to ICD-11 as an alternative to ICD-10 and report back to the House of Delegates. [Adopted]

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