AMA to evaluate “expanding scope of pharmacists’ practice”

APhA spearheads effort to assuage House of Delegates’ concern about MTM, disease state management, collaborative practice agreements.

Meeting in Chicago on June 18–22, the House of Delegates of the American Medical Association (AMA) adopted a resolution that directs the organization to “develop model state legislation to address the expansion of pharmacist scope of practice that is found to be inappropriate or constitutes the practice of medicine.” The adopted language was scaled down considerably in tone and rhetoric from two original resolutions after APhA, representing a consortium of 10 pharmacy organizations, came forward with information about pharmacists’ roles on the health care team.

“We look forward to continuing to work with AMA as this process goes forward,” Anne Burns, Senior Vice President of Professional Affairs at APhA, told “It will be beneficial for both professions and especially for our patients if medicine and pharmacy work together to address the issues brought up in the House.”

The AMA House of Delegates includes 521 delegates representing 180 state and medical specialty societies. It meets twice a year.

APhA learned of the two resolutions just a few days before the AMA House meeting. Burns, Senior Director of Government Affairs Marcie Bough, PharmD, and other staff quickly evaluated the language in Resolutions 219 (originally titled, Evaluation of the Expanding Scope of Pharmacists’ Practice and Interference of Pharmacy Benefit Managers in the Practice of Medicine, and introduced by the Ohio delegation) and 228 (Medication Therapy Management, introduced by the Michigan delegation). Staff members contacted APhA leaders, formulated a response, asked other pharmacy organizations for ideas and support, and made plans for Bough to travel to Chicago and speak at the meeting of a Reference Committee that would make recommendations to the full House. Margaret H. Tomecki, PharmD, FAPhA, Senior Manager of Practice Development and Research with APhA, joined Bough at the meeting.

In comments filed in writing with the Reference Committee and reiterated by Bough in Chicago, APhA said the resolutions “were inconsistent with the existing scope of pharmacy practice recognized in all 50 states and could undermine efforts that foster the kind of coordination of care among individual and institutional providers that will improve the quality and delivery of care.”

The pharmacy groups added that the resolutions were in conflict with “recommendations and policy pronouncements of the Institute of Medicine” and that “involvement of pharmacists in interprofessional care or team-based care” is a “hallmark of IOM’s recommendations for improving the U.S. health care system.”

Joining APhA in opposing the resolutions were the Accreditation Council for Pharmacy Education, American Association of Colleges of Pharmacy, American College of Clinical Pharmacy, American Society of Consultant Pharmacists, American Society of Health-System Pharmacists, College of Psychiatric and Neurologic Pharmacists, Food Marketing Institute, National Alliance of State Pharmacy Associations, and National Community Pharmacists Association.

The Reference Committee responded by making key changes to Resolution 219 and recommending its adoption in lieu of the more inflammatory Resolution 228. The edits are shown below with underlines representing added language and strikethroughs showing deletions.

In the full House, the amended language was adopted without further change.

“We plan to work with AMA as they implement this policy and work on principles relevant to the scope of pharmacy practice,” Bough said. “We have long had a good working relationship with AMA, and we are certain that these policies will provide an opportunity to network with our colleagues in medicine and serve as a resource for them on the evolving role of pharmacists in team-based approaches to patient care.”

Text of resolutions with preliminary (not official) changes by Reference Committee B

219: Evaluation of the Expanding Scope of Pharmacists’ Practice and Interference of Pharmacy Benefit Managers in the Practice of Medicine

That our American Medical Association evaluate and develop policy to prevent pharmacy benefit managers from interfering with or limiting the physician’s right to practice medicine (Directive to Take Action);

That our AMA re-evaluate the expanding scope of practice of pharmacists in America and develop additional policy to address the proposed new services provided by pharmacists that may constitute the practice of medicine (Directive to Take Action & Modify Current HOD Policy);

That our AMA continue to collect and disseminate state specific information in collaboration with state medical societies regarding the current scope of practice for pharmacists in each state; studying if and how each state is addressing these expansions of practice (Directive to Take Action);

That our AMA develop model state legislation to address the expansion of pharmacist scope of practice that is found to be inappropriate or constitutes the practice of medicine, including but not limited to the issue of interpretations or usage of independent practice arrangements without appropriate physician supervision and work with interested states and specialties to advance such legislation (Directive to Take Action).

228: Medication Therapy Management

That our American Medical Association strongly petition or advocate to regulators and/or legislators the AMA’s opposition to interpretations or usage of Medication Therapy Management which result in an expansion of the scope of practice of pharmacists (Directive to Take Action).