Idaho Leads the Nation Toward Expanding Pharmacists’ Scope of Practice

Marc Joffe

With the national shortage of doctors and the cost of visiting a physician, policymakers should be offering patients the option to use other qualified medical providers. Aside from nurse practitioners, physician’s assistants, and nurse midwives, a category of professionals that can often step in for doctors is pharmacists. Because pharmacists have deep knowledge of drug benefits and side‐​effects, they are qualified to prescribe medications in many cases. Since patients often schedule medical appointments just to obtain or change prescriptions, empowering pharmacists to make certain prescribing decisions can reduce the burden on doctors and healthcare costs.

Many states are now allowing pharmacists to dispense contraceptives, emergency HIV preventatives, and vaccinations without involving a doctor. And, as my colleague Jeff Singer noted last year, the FDA has authorized pharmacists to prescribe Paxlovid to patients suffering from COVID-19.

But with the passage of HB 182 in 2019, Idaho has gone much further, allowing pharmacists to prescribe statin drugs to people who are on diabetes medications (statins have been shown to reduce the risk of cardiovascular disease in people with diabetes), short‐​acting beta‐​agonists for those suffering asthma, nebulizers, influenza medications, and several other categories of prescription drugs and devices.

As explained by Alex Adams, formerly Executive Director of the Idaho State Board of Pharmacy, the state’s laws and regulations are intended to facilitate pharmacist prescribing if one of the following four conditions is met:

A new diagnosis is not required;
The condition to be treated is minor and generally self‐​limiting;
The condition has a test waived under the federal Clinical Laboratory Improvement Amendments (CLIA) to guide diagnosis; or
There is an emergency situation, whereby the patient’s health or safety is threatened without immediate access to a prescription.

The last category could have significant implications for health care costs as well as patient wellbeing. Quickly receiving the right prescription in an emergency may enable patients to avoid costly and time‐​consuming visits to the emergency room. That said, the Idaho law limits the amount of a medication a pharmacist may prescribe in an emergency situation to the quantity a patient needs until he or she can see another provider.

Other states are moving in Idaho’s direction. In 2021, Colorado adopted SB 21–094 which gave pharmacists the authority to change or extend physician’s prescriptions. It also authorized pharmacist prescribing for conditions in the first three categories included in the Idaho law: those involving no new diagnosis, those that are minor and generally self‐​limiting, and those identified by a CLIA‐​waived test.

Colorado‐​based Safeway pharmacies responded by offering “oral contraceptives, EpiPens, glucagon, diabetes supplies and treatments for UTIs, cold sores, acne, strep throat, flu, and migraines” without a doctor’s prescription.

Earlier this year, the Montana legislature passed SB 112, which, like Colorado, allows pharmacist prescribing in the first three categories covered by Idaho’s legislation. The bill passed with large majorities despite opposition from the American Medical Association.

Extending pharmacist scope of practice to include prescribing authority is a commonsense reform that more states should consider.