INDEPENDENT PRESCRIBING AUTHORITY

To affirm that pharmacists are highly trained medication experts on the interprofessional care team who make evidence-based decisions; further,

To advocate that pharmacists have independent authority to initiate, monitor, modify, and deprescribe all schedules and classes of medications, commensurate with the pharmacist’s training and in accordance with the standard of care; further,

To encourage healthcare delivery organizations to establish credentialing and privileging processes for pharmacists that delineate scope of practice, support pharmacist prescribing, and ensure that pharmacists who prescribe are accountable, competent, and qualified to do so; further,

To advocate that pharmacists be recognized as authorized providers by payers, pharmacies, and industry.

Rationale

Pharmacists are highly trained medication experts skilled in providing comprehensive medication management (CMM) services across the continuum of care. As such, pharmacists are core members of the healthcare team, well-positioned to provide high-quality, cost-effective care that increases patient access and reduces the burden on other healthcare providers. Hundreds of studies published in peer-reviewed literature, conducted throughout a variety of organizations and health systems, have consistently demonstrated the benefits of pharmacist-directed patient care across a variety of clinical practice settings.

Independent, or autonomous, prescribing allows pharmacists to be responsible and accountable and fully execute CMM treatment plans. Independent medication therapy decision-making by pharmacists is already common and accepted by other licensed practitioners (e.g., physicians, physician assistants, and nurse practitioners). Practitioners participating in interprofessional teams that include pharmacists rely on the knowledge, demonstrated competency, and expertise of those pharmacists for CMM. Pharmacists in specialty practice areas such as anticoagulation management, solid organ transplant, and nutrition support have long functioned in roles in which independent prescriptive authority has improved clinical outcomes in the management and monitoring of medication therapy. In settings such as the Indian Health Service and Veterans Health Administration systems, prescriptive authority for pharmacists providing CMM services has been in place for over 40 years and has demonstrated positive clinical impact and increased patient access across the continuum of care.

Enabling state and institutional policy are critical in ensuring that pharmacists can seamlessly provide CMM services as members of the interprofessional team and at the top of their training and education. States authorize pharmacists to independently or collaboratively prescribe or initiate medications at varying degrees. Many health systems authorize pharmacists to manage medication therapy by enacting pharmacy and therapeutics committee policies that require use of medical staff delegation protocols and physician oversight for pharmacist-initiated orders. Pharmacist autonomous prescriptive authority should be the gold standard for practice, especially when appropriate credentialing and privileging is in place and there is a separation of duties to ensure that a prescribing pharmacist is not responsible for the processing and dispensing of that medication order, except during extenuating circumstances.

Credentialing and privileging of individual healthcare providers is essential for determining who is authorized to prescribe and should ensure the appropriate evaluation of the quality of care provided. The credentialing procedures used to establish pharmacists’ competency to prescribe must ensure that patients receive treatment from highly qualified caregivers. In addition to verifying appropriate education, licensure, and certification, the process should include:

• the same transparency and rigor applied to other prescribers,
• criteria used to measure patient care quality, and
• peer review by similar or higher-level peers (i.e., pharmacist prescribers or other licensed practitioners who are authorized to prescribe).

Healthcare organizations should use privileging methods that establish the scope of practice and clinical services that pharmacists are authorized to provide commensurate with their demonstrated competency within an area or areas of clinical expertise. The practice of credentialing and privileging should be consistent between hospitals, health systems, accountable care organizations, and other organizations where pharmacists function as a part of the interprofessional team.

ASHP Policy 2011, Credentialing and Privileging by Regulators, Payers, and Providers of Collaborative Practice, stipulates that pharmacists who prescribe must be recognized by payers and receive equitable payment for performing these advanced practice services. All pharmacist prescribers must possess a National Provider Identifier to monitor the care provided and should be reimbursed for services rendered. Finally, interprofessional education and training programs should incorporate the standard of pharmacist prescribing to ensure consistency and acceptance of pharmacist prescribing in similar practice settings and with similar levels of responsibilities.