Practice at the top of your license in the Northeast
Jessica Marx, PharmD, BCPS, is an inpatient and emergency medicine clinical pharmacist at Portsmouth Regional Hospital in Portsmouth, NH.
Student Pharmacist continues its coverage of pharmacist scope of practice across the United States. In this article, the tour around the country lands in the beautiful Northeast.
Deciding exactly where to practice can be a challenging decision. Not only are you tasked with choosing a practice setting, but you also have to figure out exactly which states entice you to get licensed and begin your career. With so many different laws and regulations governing pharmacy, your day-to-day will vary depending on where you land. That said, the Northeast offers some great states that allow you to practice at the top of your license while still enjoying all 4 beautiful, distinct seasons.
I will outline some of the unique laws and regulations specific to this part of the country that will give you some insight on what to expect in the Northeast.
CPAs and prescriptive authority
As a whole, the Northeast is supportive of collaborative practice agreements (CPA), formal relationships in which licensed providers refer patients to pharmacists for care under specific protocols, allowing pharmacists to practice at the top of their licenses. Being a part of a CPA allows pharmacists to provide expanded services by practicing independently under specific guidance as outlined. CPAs are allowed in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and Pennsylvania. In New Hampshire, Vermont, and Pennsylvania, all pharmacists in all practice settings are able to participate in CPAs without any additional training.
In addition to CPAs, pharmacists in some states are able to practice with prescriptive authority and can dispense certain medications via statewide protocols and standing orders. For example, pharmacists may prescribe hormonal contraceptives in both New Hampshire and Vermont as well as tobacco cessation aids in both Maine and Vermont, as long as they meet protocols specific to each state such as patient inclusion criteria, required documentation, and communication. Similarly, pharmacists in Maine and Connecticut are able to prescribe naloxone, while pharmacists in Vermont, New Hampshire, Massachusetts, Rhode Island, New York, Pennsylvania, and New Jersey are able to dispense naloxone via standing order.
Legislative action bolsters the profession
The state of Maine has recently been in the spotlight due to some newly passed legislation. On June 10, 2021, Maine Gov. Janet Mills signed LD 603 (An Act Regarding the Practice of Pharmacy) into Maine law. This law recognizes pharmacists as providers and defines the practice of pharmacy as a “provision of health care services.” This law amends the Maine Pharmacy Act and allows greater access to pharmacist-provided services, which is particularly needed by patients who are medically underserved or live within rural areas of the state. This also grants pharmacists the ability to practice at the top of their licenses.
New Hampshire has also gained recent attention for its creation of the advanced pharmacy technician license. In July 2019, HB 463, which defined and established the duties of the advanced pharmacy technician in the state, became law. This role was created to expand the role of pharmacy technicians while freeing up pharmacists for more clinical tasks. Advanced pharmacy technicians may perform product verification in community and outpatient settings and verify unit dose packaging in institutional settings. Working with advanced pharmacy technicians allows pharmacists to allocate more time to clinical and expanded services such as counseling, medication therapy management, point-of-care testing, immunization, and more.
Additionally, many temporary authorizations were put into place as a result of the COVID-19 pandemic. Prior to the PREP Act, Rhode Island was the only state in the Northeast to allow pharmacy technicians to immunize. Now, the PREP Act allows interns and pharmacy technicians as well as retired or inactive pharmacists and interns to immunize nationwide during the COVID-19 pandemic as long as they meet training requirements. Additionally, due to the current declared state of emergencies, pharmacists in Maine, New Hampshire, Massachusetts, Rhode Island, Connecticut, and Pennsylvania may dispense an “emergency supply” of a noncontrolled prescription with no remaining refills. In Vermont, pharmacists may substitute an available drug or insulin product for an unavailable prescribed drug or insulin product in the same therapeutic class with the informed consent of the patient. These temporary authorizations have paved the way for future pharmacy legislation that will continue to expand the pharmacist’s role.
Break out of the mold
Overall, the pharmacy landscape is a moving target given the rapidly evolving roles of both pharmacists and pharmacy technicians. But not only is the northeastern United States a lovely part of the country to start your career, it has many different opportunities available for those looking to break the traditional mold of the role of a pharmacist.