Mark Buck, a doctor and pharmacist in Helena, Montana, said he has seen more patients turn to urgent care clinics when they run out of medication. Their doctors have retired, relocated or left the field as they burn out during the covid-19 pandemic, leaving patients with few options to renew their prescriptions, he said.
“Access is where we’re really suffering in this state,” Buck said.
Senate Bill 112, sponsored by Republican Sen. Tom McGillvray, would address that need by expanding the limited authority Montana already grants pharmacists to prescribe drugs and devices. Supporters said the measure could help fill health care gaps in rural areas in particular, while opponents feared it would give pharmacists similar authority to a doctor without the same education.
Eleven states, including Montana, give pharmacists the authority to prescribe drugs to some extent such as birth control, naloxone, smoking cessation products, HIV preventative drugs, and travel-related drugs. The FDA has allowed pharmacists across the country to prescribe the covid drug Paxlovid during the public health emergency.
According to a 2021 report from George Mason University’s Mercatus Center, there were approximately 228,000 primary care physicians nationwide in 2019 and more than 315,000 pharmacists in 2020. The report found that patients using Medicare visit a pharmacist twice as often often compared to a primary care provider and the difference is even greater in rural areas.
Pharmacists, who often work in grocery stores, “are open longer than most doctors’ offices and no appointments are required,” the Mercatus Center study authors wrote.
Under the bill, pharmacists could prescribe for patients who don’t require a new diagnosis, for minor conditions or in an emergency. They couldn’t prescribe controlled substances.
During a January 18 committee hearing on the bill, supporters said pharmacists would also be able to provide strep and flu tests, along with supplies for diabetics.
Buck, Helena’s physician-pharmacist, said the bill wouldn’t solve the shortage of suppliers, but it would “put an inch in the leaky dam.”
According to data from the Population Health Institute at the University of Wisconsin, Montana had one primary care physician for every 1,210 people in 2019. Some counties don’t have primary care providers, but they usually have a pharmacy, said Kendall Cotton, executive director of the Frontier Institute, a public policy think tank in Montana. For example, Powder River County doesn’t have a doctor, he said, but a grocery store in the county seat of Broadus has a pharmacy.
As a clinical pharmacist of 15 years, Travis Schule of Kalispell wouldn’t be much affected by the passage of SB 112. In Montana, providers like him with additional education and training already have the authority to prescribe under Montana’s existing rules.
But he sees the bill’s potential to expand access to care in Montana. In some cases, people may have to drive three hours to see a doctor, and SB 112 would allow a pharmacist to serve as “first triage” before driving that long distance, Schule said.
“This bill is a patient-centered bill,” Schule said. “It’s not for pharmacists. It’s for the patients.
SB 112 is modeled after a bill passed in Idaho. Tim Flynn, a pharmacist at an Albertsons grocery store in Meridian, Idaho, said the legislation allows patients to be treated for minor conditions, such as urinary tract infections, when they can’t make a doctor’s appointment or travel to a urgent care clinic.
The Montana Medical Association and the Montana chapter of the American Academy of Pediatrics oppose SB 112. They say SB 112 would fragment care, jeopardize patient safety, and substitute pharmacists for emergency room physicians.
But Montana Medical Association CEO Jean Branscum said there is an opportunity to build on the Idaho model, bringing pharmacists and doctors together and making sure patients receive the same standard of care.
“Let’s find a model of care that allows pharmacists to do more than they do now, be part of that team, practice at the highest level, and also appreciate the value of physicians as part of that team,” Branscum told lawmakers at the conference. hearing of 18 January.
Keely Larson is a KHN Fellow for UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association and Kaiser Health News. Larson is a graduate student in environmental journalism and natural resources at the University of Montana.
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