So the big debate at work this morning was over this section of the Indiana Code (IC 25-26-13-25(c)):
Except as provided in subsection (d), a prescription for any drug, the label of which bears either the legend, “Caution: Federal law prohibits dispensing without prescription” or “Rx Only”, may not be refilled without written, electronically transmitted, or oral authorization of a licensed practitioner.
According to my law prof, this means that pharmacists can authorize refills on OTC meds without authorization from the original prescriber. And the man would know, because he literally WROTE a lot of Indiana’s law as it pertains to pharmacy.
The reason why this is an issue at all is because AB called me on Monday asking for a refill on her daughter’s MiraLax, a newly over-the-counter laxative. I informed her that her physician had called us and specifically voided the 5 refills on this medication. She did not believe that her doctor would ever do such a thing, and didn’t appreciate being told what she could and could not pick up. She ended up so furious that she called the pharmacy supervisor Tomi (I didn’t even have to give her his number because she already had it — it sounds like she’s a routine critic). Tomi later called me to talk about this, and I suggested we invoke the law cited above. He said that was a great idea, but the pharmacists on duty weren’t about to authorize a refill without a doctor’s authority, even though the law specifically says they can! So we had to call the doctor’s office Tuesday morning for authorization.
I brought in a copy of this law this morning, and the two pharmacists had a less than enthusiastic idea about this authority the law has granted them. One said that she only knew of “older” pharmacists who did this, but only because they had little care for the law (sic) and would have done it just to get the customer out of the store. The other called this one of the “gray areas” of pharmacy.
I was kind of surprised by these responses. I would have thought that pharmacists on the whole would be more receptive to more autonomy than they’re used to. Instead, it’s sort of frustrating to me to see pharmacists shuffling back into their familiar corner of just rubber stamping whatever physicians tell them. We have the education enough to decide whether a patient needs a laxative or not, and we should be able to bill it through Medicaid without fear of the dreaded audit.
I fear that the only noisemakers in the advancement of prescriptive rights for pharmacists are the vibrant young pharmacists and those in the university setting. Even our biggest professional organization, the American Pharmacist’s Association (APhA), is not in favor of HR 5780, a bill proposed in the House which would allow for the billing of Medicare Part B by clinical pharmacists for practitioner services. But I have hope that I’ll see significant and exciting advances in this area during my career, and it starts with pharmacists taking charge of the law which is already written for them!
