Scope of Practice
Sonya Collins
Rhode Island lawmakers in both the House and the Senate have passed a bill that will allow pharmacists to provide up to a 100-day continuation of some medications without a prescription when the prescriber cannot be reached or the patient no longer has a prescribing health care provider. The bill was sponsored by Rep. Michelle McGaw, BSPharm, a consultant pharmacist in long-term care.
The bill adds Rhode Island to a growing number of states with emergency refill legislation. Most other states, however, allow for 72-hour to 30-day supplies, far less than the more than 3-month supply that Rhode Island pharmacists will soon be able to provide.
“Rhode Island, like so many states across the country, is facing some significant shortages in providers,” McGaw said. “We are looking at opportunities for pharmacists to help fill that gap.”
Solution to a larger issue
When a patient has no refills available and the prescriber cannot be reached, or the patient no longer has a physician, the Rhode Island bill allows pharmacists to provide up to a 100-day supply of medications that, according to the bill, are “essential to the maintenance of life or to the continuation of therapy of a chronic condition.” The pharmacist must then notify the prescriber—when one is available—that the medication has been refilled.
“It ensures patients won’t have a gap in care for conditions they’re already being treated for,” McGaw said.
The larger medication supply for which the bill allows helps to address not only brief instances in which a prescriber cannot be reached, such as holiday weekends, but also the larger systemic problem of physician shortages that plague most states in the country.
“Rhode Island’s approach appears to be focused on ensuring continuity of care in situations where the patient lacks a provider, which sets it apart from traditional emergency refill laws that assume temporary unreachability,” said Brooklyn Morgan, PharmD, director of state policy for the National Alliance of State Pharmacy Associations.
The need to ensure continuity of care recently became more urgent in Rhode Island when a large medical practice, Anchor Medical Associates, announced that it would be closing its doors this summer, leaving up to 25,000 patients without a primary care provider.
“I am painfully aware of the challenges that we’re having with primary care shortages,” McGaw said. “I wanted to make sure that patients weren’t going without necessary medication.”
These shortages are persistent all over the country. The United States has more than 1,000 federally designated primary care provider shortage areas.
Other states’ laws
At least 22 other states have laws on the books that allow pharmacists to dispense a 3- to 30-day supply of an already prescribed medication when the prescriber cannot be reached to authorize a refill. These bills allow pharmacists to deem the situation an emergency and dispense the medication at their discretion. About a dozen other states allow pharmacists to refill without a prescription only during an officially declared state of emergency. The remaining states have no legislation regarding emergency refills.
“One challenge of advancing this type of legislation,” Morgan said, “is the lack of fully interoperable health information systems between pharmacies and other health care providers. Some stakeholders have raised concerns about limited real-time access to shared medical records and fragmented communication infrastructure.”
Still, many states do advance emergency refill bills in the absence of fully interoperable electronic medical record systems, which is a testament to pharmacists’ important position in the health care ecosystem.
“In many communities, pharmacists are the most accessible providers and are often the first to identify care gaps when patients are unable to reach their prescriber,” Morgan said. “Their ability to assess medication history, counsel patients, and provide a clinically appropriate refill demonstrates a high degree of responsibility and clinical judgment.” ■