Legal Authority for a Pharmacist's order for prescription drugs

Background and Evolution...     by Thomas A. Savino, RPh

The most common initial reaction many people have when visiting WebRx Pharmacy Palace is that it must be illegal for a pharmacist to prescribe prescription drugs.  This reaction is understandable because the most visible function that pharmacists perform for the public is the dispensing of prescription drugs.  In most cases, the patient obtains a prescription from a physician, dentist, advanced nurse practitioner, or other prescriber and brings the prescription to a community pharmacy to be "filled" or dispensed.

Unbeknownst to the majority of the public are the many other functions or services that are performed by pharmacists every single day.  Pharmacists today are involved in a much greater role in delivering health care services than perhaps at any other time in the history of the profession.  The evolution of pharmacy services at this expanded level has happened over the last few decades.  Some of the expanded services pharmacists provide today are things like drug utilization review, administration of vaccinations, patient counseling on individual drug therapy, drug-level lab test monitoring and consultation, issue of emergency contraceptive medicine, equivalent drug selection, and direct prescribing of medication to patients.  Pharmacy services and corresponding regulations are under the jurisdiction of individual state board of pharmacies and vary from state to state.  The national trend is headed in the direction of even more expanded roles for pharmacists.

In 1986, the Florida legislature passed what was commonly known in pharmacy circles as "The pharmacist prescribing law".  The media focused quite a bit of attention at the time to the subject and it was an exciting time for pharmacists who were provided with a better way to help their patients or customers.  Along with all the attention to the new service came a lot of confusion from the public and some "scrambling" by many of the giant pharmacy chains as they tried to decide quickly how to react to the new legislation.  According to the law, pharmacists were granted permission to charge fees for these services and even bill insurance companies for those fees.  The chains had to make decisions about how to go about providing their customers with the new services, yet deal with the issue of employee-pharmacists charging fees for those services.  Their fear was that pharmacists might charge different fees leading to confusion among the public.  Also, to stay competitive with other chains they wanted to have control over what was being charged in their stores in comparison to competing chain pharmacies so as not to appear as "high priced" and losing their customer base.

Not all prescription drugs could be prescribed by pharmacists.  Only a select formulary of drugs that were approved by a commission appointed by the governor could be prescribed.  The selection in the beginning was very limited.  Many of the drugs on the list were already available without a prescription as a similar formulation or lower potency.  Associated with prescribing under the law was a pile of paperwork and records that were required.  There was also an added liability perceived by many pharmacists for performing this new service.

The chains made the decision to create policies by which there would be no extra fees beyond the cost of the prescription for the new service.  If a pharmacist was employed by a chain, he/she had to follow the company's policies.  With the combination of the perceived liability, limited selection of drugs that could be prescribed, and lack of remuneration for the individual pharmacist who provided those services, the practice of pharmacist prescribing drugs to patients died a gradual, quiet death.

Until recently, the "pharmacist prescribing law" has remained in a somewhat dormant state.  What has changed since the original law has been an expansion of the formulary of drugs that can be prescribed, and the explosion of the internet as a widely available means of access to connect patients with health-care providers.  In mid 1998, the WebRx Pharmacy Palace was born as a means for people to chat live with a pharmacist.  About a year later, WebRx Pharmacy Palace became the nation's first site to offer pharmacist-prescribed medications by way of the internet.

To view the specific Florida statutes which provide the authority for pharmacist prescribing please visit the links below.  The areas of the law that specifically relate to pharmacist prescribing are 465.186, 64B 16-27.210, and 64B16-27.220. (PDF/Adobe Acrobat file - You must scroll to the appropriate section of the chapter.)

Other relevant statutes & rules:

Chapter 465, Florida Statutes: Pharmacy (link current as of 12/2003)
Chapter 893, Florida Statutes: Drug Abuse Prevention and Control (link updated 12/2003)
Rules: Chapter 64B15-18, Florida Administrative Code. (Note: This link is a large Adobe Acrobat file (PDF) that requires the Acrobat Reader to view.  The link is to the entire chapter.  Once open, search for section 64B15-18.  The link is current as of 12/2003). 

Click here to read an article in its entirety which first appeared in the Drug Topics Newsmagazine, April 20, 1987 which probed pharmacist's opinions on the issue of prescribing.

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