Bulletin Today
Under new law, pharmacist scope of practice expands in Tennessee
Governor Bill Lee of Tennessee signed legislation that expands pharmacists’ scope of practice in the state. The law took effect immediately upon the governor’s signature on May 1.
“This law adds to the definition of pharmacy practice and provides the ability for pharmacists to independently issue prescriptions or medical orders for a select group of medication classes and disease states,” said Anthony Pudlo, PharmD, CEO of the Tennessee Pharmacists Association (TPA).
Pharmacists can use their new independent authority to prescribe antivirals for treatment of influenza or COVID-19, progesterone-only hormonal contraception, naloxone, PEP for non-occupational exposure to HIV, and epinephrine autoinjectors. They can also be listed as the prescriber of record for all adult immunizations and for pediatric immunizations against influenza and COVID-19.
“With this law, pharmacists no longer have to undertake the steps to obtain a CPPA [collaborative pharmacy practice agreement] for such activities,” said Pudlo.
For administering vaccinations, that authority was previously granted under a locally signed immunization protocol with another type of prescriber. And for other medications that can now be prescribed, like Tamiflu, PEP, and topical fluoride agents, pharmacists in Tennessee can independently prescribe them now instead of having to be under a formal CPPA.
“Patients will benefit from direct access to health care services and medications for common ailments and improvement in public health,” said Pudlo. “As evidenced by efforts in other states as well as the research published in the medical literature, pharmacists can improve the quality of care delivered in the health care system, especially in our rural and other medically underserved communities.”
The bill was endorsed by TPA and the Tennessee Medical Association (TMA). Pudlo said TMA testified in support of the legislation. Tennessee legislators also heard from a strong grassroots advocacy push from pharmacists across the state.
In 2017, Tennessee enacted Public Chapter 82, which paved the way for pharmacists to be credentialed and reimbursed as medical providers in commercial health plan medical provider networks. In addition, Tennessee Medicaid and its managed care organizations have pathways for pharmacists to be credentialed and reimbursed as medical providers.
“TPA will continue to guide pharmacists on these pathways so they can be compensated for the services tied to the authorities now granted with the passage of Senate Bill 869/House Bill 282,” said Pudlo. ■
Fentanyl tablet seizures have quadrupled in the last 6 years
Law enforcement seizures of illicit fentanyl increased dramatically in both number and size between 2017 and 2023 in the United States, especially in tablet form, according to a new study funded by the NIH National Institute on Drug Abuse.
The findings, published online in the International Journal of Drug Policy on May 13, 2024, highlight the trends in the illicit drug supply and the risk of tablets not coming from a pharmacy.
The number of individual pills containing fentanyl seized by law enforcement was 2,300 times greater in 2023 compared to 2017, with 115,562,603 pills seized in 2023 versus 49,657 in 2017.
The proportion of fentanyl tablet seizures to the total number of fentanyl seizures more than quadrupled, with tablets representing 49% of illicit fentanyl seizures in 2023 compared to 10% in 2017.
The study also found a significant increase in the number and weight of fentanyl-containing powder seizures during this time.
“Fentanyl has continued to infiltrate the drug supply in communities across the United States and it is a very dangerous time to use drugs, even just occasionally,” said Nora D. Volkow, MD, director of the National Institute on Drug Abuse, in a press release. “Illicit pills are made to look identical to real prescription pills but can actually contain fentanyl.” ■
UF Health will lead CDC-backed hypertension pharmacists’ program
University of Florida Health has been awarded a stipend by CDC to run a program that aims to connect patients with high BP to community pharmacists.
Patients in the program, launching this summer, will see a specially trained pharmacist at a community pharmacy and receive individualized care and education.
The program model, which originated at University of Michigan Health in Ann Arbor, includes pharmacists who work alongside a patient’s primary care physician. Patients with hypertension are seen for individualized BP control either at a primary care clinic or a community retail pharmacy—whichever is most accessible.
In 2019, CDC conducted a rigorous evaluation of the model, called the Michigan Medicine Hypertension Pharmacists’ Program (HPP), and found that the program improved BP control rates for participants. Specifically, CDC found that 66% of patients who met with an HPP pharmacist had their hypertension under control within 3 months, compared with 42% of patients who did not meet with a pharmacist. At the 6-month mark, 69% had their BP under control, compared with 56% of nonparticipants.
Earlier this year, CDC announced it will bring the program to predominantly Black populations in the southeastern United States.
UF Health Jacksonville will work to replicate and scale the program in the Southeast. The program is facilitated by the UF Health Jacksonville Office of Community Engagement and a collaboration among the UF Health Total Care Clinic-Jacksonville, the UF College of Pharmacy, and Panama Pharmacy.
“As a pharmacist, I see the impact of social determinants of health every day in clinical practice,” said Chardaè Whitner, PharmD, a clinical assistant professor at the UF College of Pharmacy’s Jacksonville campus, who is leading the effort. “We have to think about actionable models that provide access to care. Collaborating with a community pharmacy like Panama Pharmacy, which can provide accessibility through evening and weekend hours and quality, patient-centered care from clinical pharmacists, ensures we can bridge that gap and see better patient outcomes.”
Kevin Duane, PharmD, who owns two Panama Pharmacy locations in Jacksonville, noted in a UF press release that the program’s collaborative approach helps to ensure there is a continuity of care with a large, diversely trained team of providers.
“It’s very important that community pharmacy is involved in clinical and decision-making activities when it comes to a patient’s plan of care,” he said. “At Panama Pharmacy, we believe in a lot more for our community pharmacists than just dispensing medications. The ability to do this work alongside UF Health Jacksonville and the CDC presents a great opportunity to help patients better manage their blood pressure; to do it for a historically underserved community makes it even sweeter, especially considering this is the community that our pharmacy lives to serve every day.” ■
Coming off GLP-1s slowly could be key to preventing weight regain
Despite concerns about patients regaining weight after stopping GLP-1 receptor agonists such as semaglutide and tirzepatide, new research suggests that such gains aren’t necessarily the case. The key, the findings suggest, lies in gradually weaning off the drug instead of withdrawing abruptly and completely, and then continuing to make healthy choices.
Researchers from a Copenhagen- and London-based digital weight loss clinic called Embla also found that lower doses were just as effective as higher doses and that slowly reducing medication while focusing on lifestyle changes prevented weight regain.
In the study, 353 of the 2,246 patients started to “taper off” semaglutide after they had reached their target weight. This involved gradually reducing their dose to zero over an average of 9 weeks while still receiving coaching on diet and exercise. Their average weight loss during the 9 weeks of tapering was 2.1%.
At a 26-week follow-up, 85 patients for whom data was available had maintained a stable weight even after completely terminating the medication.
The researchers conclude that patients who tapered off semaglutide maintained a stable body weight for the first 26 weeks after tapering.
“The combination of support in making lifestyle changes and tapering seems to allow patients to avoid regaining weight after coming off semaglutide,” said Henrik Gudbergsen, MD, lead researcher for the small study and chief medical officer of Embla, in a press release.
The results were presented at the European Congress on Obesity held in Venice, Italy. ■