Should Pharmacists Give Medicine Without a Prescription? State Lawmakers Aren’t Sure.

Joint Commission weighs options as medical groups make their case.

RICHMOND- Should pharmacists offer treatment at times without a prescription? That’s a change multiple medical organizations want to see. State lawmakers, on the other hand, are divided.

Virginia’s Joint Commission on Healthcare heard from representatives of 14 medical organizations Wednesday. Physicians and pharmacists alike made their case. Some supported statewide protocols. That means if a person comes to a pharmacy with certain symptoms, a pharmacist could give them medicine without any note from a doctor. They argued this would give patients a more affordable way to get treatment.

“A statewide protocol authorizes pharmacists to dispense certain medications or vaccines without a doctor’s prescription,” said Jeffery Lunardi, Executive Director of the JCHC. “If the individual presents with specific clinical symptoms.” 

If a person is experiencing anaphylaxis, for example, under the protocols a pharmacist could give them epinephrine. Lunardi explained these changes could bring down the cost of things like vaccines and insulin syringes, by eliminating the need to go to a doctor’s office.

“There’s no better time than now,” said Christina Barrille with the Virginia Pharmacist Association. “Especially during the current pandemic, it’s important that we modernize Virginia law and leverage nearly 1,500 pharmacies and over 4100 pharmacists who’re standing ready to help and deliver this type of care.” 

However, while there was agreement on several items, the workgroup did not agree on more than half the suggestions. So lawmakers came to a compromise. They agreed to go ahead with the parts that had majority support. The rest would be revisited at a later date.

Pharmacists Provide More Access

The entire workgroup was in unanimous agreement on three major suggestions:

• Letting pharmacists handle tuberculosis testing
• Letting pharmacists give out HIV prophylactics
• Allowing pharmacists to prescribe medical devices, like epi-pens and insulin syringes to patients

“A patient was prescribed insulin by a doctor, but not the syringes. So technically, a person can come to the pharmacy and fill the prescription for insulin, but they’d have to pay full over-the-counter costs for the syringes,” said Lunardi.  “If they’re prescribed the syringes, then they’re covered by insurance and it would lower their out-of-pocket cost.” 

The workgroup also suggested that pharmacists to give out CDC-approved vaccines, smoking cessation materials and treatments for the flu, strep throat and urinary tract infections. However, the Joint Committee didn’t agree on these terms.

RELATED: We Need Transparent Drug Prices, Virginia Lawmakers Say

Cons of the Situation

Now, the Joint Committee did put some limitations in place. Under these plans, pharmacists could give out vaccines, but only those on the CDC’s approved list. But, some doctors argued that wasn’t enough.

For example, under these new recommendations, someone who’s showing symptoms of strep throat could go to their local pharmacist, tell them their symptoms and receive a CLIA waived strep test.

If the test comes back positive, the pharmacist could give them the appropriate treatment without a doctor’s prescription. But, the opposition argued that pharmacists could accidentally overlook other more serious illnesses if they don’t go to a doctor’s office.

“Our line in the sand is that testing is not diagnosis,” said Clark Barrineau from the Medical Society of Virginia. “Notably, our objections to the strep, flu and UTI testing are based on that principle. Diagnosing requires potentially a physical exam, knowing the patient’s history and doing additional labs to make sure there isn’t any heart or renal failure.” 

According to Barrineau, illnesses like strep throat and the flu can present just like many other more serious conditions. In order to diagnose it properly, a physician would have to run other tests.

“The flu test is not a plus or minus test. It is not a pregnancy test. It needs to be interpreted and there are so many things that can go wrong,” said Barrineau.

How Does COVID-19 Factor Into This?

With healthcare workers receiving COVID-19 vaccines already, other Virginians are waiting patiently for the vaccine to become available for everyone else. But, if this proposal gets passed by the General Assembly, where does the COVID vaccine fit in? Unfortunately, that answer isn’t clear just yet.

When the workgroup was making their plans, they didn’t discuss how to include COVID-19 vaccine. Mainly that’s because while the vaccine’s been approved for emergency use, the Centers for Disease Control and Prevention haven’t added it to their approved list of vaccines.

“No, the COVID-19 vaccine was not discussed,” said O’Halloran. “This was the authorization to order and administer vaccines on an immunization schedule included by the CDC for persons 18 years or older. Since it’s likely not on there yet, it’s not included.”  

However, lawmakers are hopeful that the CDC will add it soon.

“I do believe that the CDC is going to update their immunization schedule to include COVID,” said Sen. Barbara Favola (D-Arlington). “I expect that we’re going to need herd immunity very quickly if we’re going to control this continued spread.” 

Earlier this week, the company, Pfizer, delivered over 72,000 vaccines to 18 healthcare systems across the state. According to a statement from Gov. Ralph Northam, Pfizer and Moderna will give 480,000 doses of the vaccine to the rest of Virginia by the end of the month. 

Arianna Coghill is a content producer with Dogwood. You can reach her at [email protected]