In February, Governor Gavin Newsom signed a bill authored by Sen. Scott Wiener that makes it easier for Californians to obtain PrEP and PEP, medications that prevent HIV infection, without a doctor’s prescription.
California already allowed pharmacists to prescribe these drugs but limited patients to a 30-day supply. The new law expands it to 90 days, which makes it easier for Californians to avoid infection from this dangerous virus.
Yet lawmakers can do much more to expand access to other important treatments by broadening the scope of pharmacist prescribing. More than half of all pharmacists today have doctorate degrees (PharmD), for which they receive as much classroom and nearly as much clinical instruction as medical doctors. They often know more about drug interactions and side effects than physicians, and physicians often consult pharmacists before deciding on what medication to prescribe.
As our new policy brief explains, Canada’s most populous province and a prominent Australian state show what is possible when pharmacists can use their training to serve patients fully. In Ontario, pharmacists prescribe medications for nineteen common conditions, including urinary tract infections (UTI), menstrual cramps, and hay fever. In the first six months of 2023 alone, Ontario pharmacists wrote over 250,000 prescriptions, reducing the pressure on overbooked physician’s offices and enabling patients to obtain relief more quickly and conveniently.
Queensland, Australia, a state with over 5 million people, pioneered the practice of pharmacists prescribing UTI treatments and has recently added wound care and shingles to the conditions that pharmacists can address. A Queensland University study found that the reforms will allow many women to access UTI treatment two or more days faster than they could if a physician’s appointment was still required.
Expanding pharmacist prescribing authority is also being pioneered closer to home. In Colorado, which passed a pharmacist prescribing law in 2021, patients can access UTI treatments, EpiPens, diabetes supplies, and several other prescription treatments without a physician’s involvement. This contrasts with California, where the only prescription treatments pharmacists can unilaterally dispense involve HIV prevention, smoking cessation, and birth control — all of which are also available from Colorado pharmacists.
The Colorado pharmacist prescribing law follows a model initially implemented in Idaho and recently enacted in Montana. The law permits a pharmacist to prescribe if at least one of four conditions are met: A new diagnosis is not required, the condition to be treated is minor and generally self-limiting, the condition has a test waived under the federal Clinical Laboratory Improvement Amendments to guide diagnosis, or there is an emergency in which the patient’s health or safety is threatened without immediate access to a prescription.
California previously attempted a more wide-ranging pharmacist prescribing reform, but it didn’t work. In 2013, Gov. Jerry Brown signed legislation creating a new category of Advanced Practice Pharmacists with prescribing authority. Unfortunately, the law’s steep requirements for becoming certified deterred all but a handful of pharmacists from pursuing the certification. Instead, California should empower all pharmacists to prescribe, requiring specific training when necessary.
Pharmacies are much more numerous than doctors’ offices; many are open 24 hours a day. With California’s worsening shortage of primary care practitioners, lawmakers can help relieve the bottleneck that many patients encounter trying to get routine doctor appointments if they implement a law similar to Colorado’s. Pharmacists could be treating millions of patients for routine medical problems annually, reduce unnecessary physician visits, add convenience, and accelerate patient relief and recovery.
Marc Joffe is a federalism and state policy analyst at the Cato Institute. Dr. Jeffrey Singer is a senior fellow in health policy studies.