Increasing access to care through prescriber-driven pharmacist protocols


Rippetoe Freeman

By: Cindy Stowe, PharmD, and Patricia Rippetoe Freeman, PharmD

Standing orders and clinical protocols allow the delivery of prescribed care based on an agreed upon set of criteria. Pharmacists practicing in health system settings have had broad authority to provide protocol-driven care for many years.

In contrast, community pharmacists’ authority to provide protocol-driven care has been limited to the provision of immunization services, and, more recently, to the provision of the opioid antagonist naloxone.

Evidence shows that pharmacists providing protocol driven direct patient care can improve both patient and public health . Many organizations including the Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services and the National Governor’s Association have recognized the value that pharmacists provided care can bring to our nation’s health.

As a result of recent statutory and regulatory changes, Kentucky pharmacists, regardless of their practice setting, can now utilize prescriber-approved protocols to deliver additional healthcare services, resulting in increased access to care across the Commonwealth.

Given the opportunity to provide additional patient care services through evidence-based, prescriber-driven, Board of Pharmacy authorized protocols, pharmacists can improve the health of Kentucky’s citizens by providing needed access to healthcare.

The Kentucky pharmacy practice act was amended in 2016 with HB 527, adding to the definition of a “prescription drug order” to include prescriptions issued under protocols authorized by the
Board of Pharmacy.

The process of Board Authorized Protocols is outlined in 201 KAR 2:380. This new regulation establishes the framework by which pharmacists, acting under the direction of a prescriber, can provide mutually agreed upon patient care services as outlined in a specific care protocol.

This regulation only authorizes pharmacists to provide the care that is explicitly laid out in the protocol and signed by the collaborating prescriber. Thus, all care provided under a Board of Pharmacy authorized protocol as a result of this regulation is done so under the direction of prescribers and all prescriptions dispensed under the protocol are done so under the prescriber’s name.

Under these protocols a pharmacist may initiate the dispensing of non-controlled medications, overthe- counter medications, or other professional services (e.g., Clinical Laboratory Improvement Amendments (CLIA) waived tests) as directed under the terms of the protocol.

Prescribers and pharmacists will work together to formulate protocols that contain the criteria to identify eligible patients to receive pharmacist-delivered care, a list of medications that can be dispensed, procedures for how the medications are to be selected for initiation and monitored (care plan), patient education to be provided and documentation of dispensing.

Pharmacists are highly trained healthcare providers who stand ready and willing to help improve public health by serving as care extenders. Given the opportunity to provide additional patient care services through evidence-based, prescriber-driven, Board of Pharmacy authorized protocols, pharmacists can improve the health of Kentucky’s citizens by providing needed access to healthcare.

— Cindy Stowe, PharmD, is dean of Sullivan University College of Pharmacy and Patricia Rippetoe Freeman, PharmD, is associate professor at College of Pharmacy at the University of Kentucky.


Related posts