September 19, 2019 at 01:00AM by CWC

If you’re anything like me, you use your pharmacy mainly for filling prescriptions, buying supplements, and impulse purchasing drugstore beauty products. But I’ve never considered talking to the actual pharmacist for…anything, really. I’m missing out, apparently, because pharmacists are medical professionals  who can play a helpful role in anyone’s overall health care network, particularly given their accessibility.

This is something I realized while researching a piece on over-the-counter birth control, when I learned that pharmacists in my state (California) can actually prescribe oral contraceptives. I had no idea this was the case, which led me to wonder what else they’re capable of doing which, it turns out, is a lot. “Pharmacists are truly under-utilized in our healthcare system—they’re very highly educated and trained [for five to eight years!] and skilled,” says Edith Mirzaian, Pharm.D., BCACP, an associate professor of clinical pharmacy at the University of Southern California.

However, there is some variance in what pharmacists are able to do for you, depending on where you live. “All 50 states are variable in terms of the scope of the pharmacist’s practice,” Mirzaian explains. “If you have a cardiologist, the cardiologists in New York that’s the same thing as a cardiologists in California and a layperson will be able to tell you what a cardiologist does but a pharmacist in New York absolutely does not do the same thing as a pharmacist in California because our state laws are very different.”

Yet by taking the time to know the full range of what your pharmacist can do, Mirzaian says, you may be able to reduce the amount of time you spend in your doctor’s office, urgent care lines, and even emergency rooms. Sign me up!

What is it that pharmacists do, exactly?

1. THEY FILL PRESCRIPTIONS

You probably know that your pharmacist is first and foremost tasked with verifying your prescription’s legitimacy. They ensure it’s the right dose for you based on your height, weight, other prescriptions, medical history, and allergies, and also often optimize for brand versus generic when possible to save you money.

They might also, says Birth Control Pharmacist founder Sally Rafie, PharmD, BCPS, APh, NCMP, provide you with specialized packaging to make it clear when and how you’re supposed to take a medicine, particularly if you are elderly or otherwise disabled. If you have many prescriptions, they can also work with your insurance company to synchronize them so you only have to go into the pharmacy once to pick them all up in one fell swoop.

2. THEY CAN PROVIDE MEDICATION AND SUPPLEMENT COUNSELING

Given how much training they go through, a pharmacist is a better IRL expert on your prescriptions and supplements than, say, Dr. Google. Everyone should utilize their pharmacist for this, Mirzaian says. “The simplest things to ask are, ‘What is this medication and how am I supposed to use it?’” she suggests. “If you’re taking any non-prescription medicines like herbal meds, vitamins, or supplements, be sure to tell the pharmacists so they can gauge whether or not there’s an interaction or problem.” This is essential, as many natural supplements and herbs have known interactions with prescription meds, including St. John’s Wort, saw palmetto, and gingko.

You can also, Mirzaian says, talk to your pharmacist about any side effects you might be experiencing. “A lot of  times, people stop taking their meds because they don’t like the effect that they have on them or they’re not sure if it’s something they should be feeling,” she says. “A pharmacist can help determine if it is a severe adverse effect or is there could be something that you could use or do to help manage that side effect,” she explains.

Speaking of supplements, these are the three that every woman should consider taking:

3. THEY CAN ADMINISTER ROUTINE IMMUNIZATIONS 

If you don’t want to wait a million years for your doctor to have an appointment for a flu shot, consider seeking out your pharmacist. Depending on where you live, they’re able to administer certain routine vaccines, a category of vaccines regulated by the Advisory Committee on Immunization Practices (ACIP), a branch of the CDC. In some states, says Mirzaian, pharmacists are only allowed to administer Influencza (flu) and Pneumococcal (strep throat) vaccines, whereas in others they’re able to offer a more full range of shots, including the HPV vaccine. Other variations in care include limitations on the age of patients to whom pharmacists can administer immunizations and, in some states, prescription requirements. You can locate your state on this immunization map for more info on which vaccines are available to you via the pharmacy. Plus, pharmacy vaccines are usually covered by insurance in the same manner they would be at the doctor’s, and if you don’t have coverage, you can save money by shopping around from pharmacy to pharmacy.

4. SOME CAN HELP YOU STAY WELL WHEN YOU TRAVEL 

A percentage of pharmacists will choose to go through additional training in order to provide travel medicine. “You can then go to the pharmacy and say, “Hey, I’m going to X,Y,Z country,’ and they can give you just about everything that you need,” Mirzaian explains. This includes relevant vaccines as well as, for example, anti-malaria medication, antibiotics for traveler’s diarrhea, medications for motion sickness, altitude sickness, etc. Technically, the CDC links to a directory of travel medicine providers, but the links sends you through a variety of local portals and isn’t all that helpful; instead, your best bet is to just call your local pharmacy to see what’s offered.

5. SOME CAN PRESCRIBE MEDICATIONS TO SAVE YOU A VISIT TO THE DOC 

Many states allow for very specific medications to be prescribed by pharmacists, including the birth control pill (California, Oregon, etc.), naloxone for opioid overdoses (all, with caveats), and tobacco cessation medications (New Mexico, Arizona, and more).

Other medications may be prescribed by individual pharmacists who have entered into what’s known as a collaborative practice agreement with a physician or nurse practitioner. So, if your doctor is friendly with your pharmacist, it’s possible you could get your UTI prescriptions—as in, the actual script and not just fulfillment of the script—from the latter instead of the former. In some cases, pharmacists can even swab test you for things like the flu or strep throat and prescribe medication accordingly. This type of service is offered in 48 states and the District of Columbia.

“The pharmacy profession is moving forward together with other health professions in a collaborative way, because our entire health system is focusing so heavily on interdisciplinary care,” Mirzaian says. She says the goal is to address all gaps in care for a patient rather than for various professionals to work with the same patient in isolation. These prescription visits usually incur a fee, which may or may not be covered by insurance (more on that to follow).

What these collaborative care agreements look like—and the ways in which they empower pharmacists as prescribers—vary state to state and pharmacy to pharmacy. “It’s really individualized,” says Mirzaian. “I know a pharmacist in a suburban neighborhood who has a collaborative practice agreement with a couple of different physicians nearby—she sees her patients bring in prescriptions from these physicians a lot, so she’s over the years built a relationship with them and talked with them about what needs they have for their patients that the pharmacy can help with.”

Unfortunately, there’s no easy way to find out who has a collaborative agreement and with whom—so if I want to find a pharmacist who could prescribe me UTI medication, I have to ask pharmacists individually which collaborative agreements they have, if any, and then go see the doctor with whom they have that agreement. In other words, it’s not currently a super easy perk to utilize but, says Mirzaian, this is direction in which the pharmacy industry wants to go.

6. SOME CAN HELP MANAGE CHRONIC DISEASE 

In some states, pharmacists are also authorized to manage medications for chronic diseases such as high blood pressure, heart failure, diabetes, etc. “Pharmacists might see the patient to check in on their meds and check in on their disease state more often than a physician, potentially, and [so the two are] kind of working collaboratively to optimize that patient response to their medications and their health overall,” Rafie says. Such pharmacists can order lab tests to monitor disease progress, track how the medications are working, and adjust them accordingly. “In some cases they do this straight out of the pharmacy and in some cases they do this in collaborative practice relationships with a particular physician or a group of physicians,” Mirzaian explains. Some pharmacies might even run certain blood tests on-site.

Is your pharmacist unable to do most of the above? Here’s what you can do about it.

If you’re feeling frustrated by the caveats in this piece, you’re not alone. My pharmacist sources tell me they want to do more for patients. There are a few barriers to making this happen, however. The first is regulations, and both Rafie and Mirzaian tell me that if you want your pharmacists to have more power, you need to lobby for them to get it. Rafie suggests reaching out to the pharmacists’ association in your state to either spark or join activity in that direction, and also raising awareness in your community around the possibilities of what pharmacists can do.

You’ll also need to either get used to paying a fee for certain services or advocate for insurance companies to cover care offered by pharmacists. In most states, they currently don’t, since pharmacists aren’t identified as health care providers, Rafie says—even when chiropractors and acupuncturists are. This cost question is a huge barrier to expanding pharmacy-based health care because many pharmacists opt out simply because they aren’t compensated for their time. “If you go to your physician’s office, you’re seen, evaluated, either given a prescription or not, and maybe a test is ordered,” she says, and your insurance is billed for the service and your doctor gets paid through insurance. However, that compensation infrastructure doesn’t exist for pharmacists. “Right now, in a physical pharmacy, the only thing [pharmacists are] being paid for is the medication that you’re dispensing and a lot of times, they’re paying you less than what you invested into dispensing that medication,” Mirzaian explains.

Giving pharmacists more power to help patients is crucial, says Mirzaian, because pharmacists can help close the “massive gaps” in primary health care which exist in the U.S.  “Your physician can tell you a bit about the drugs, but your pharmacist is the one who’s looking at you more globally in terms of everything else that you’re taking, because you might go to three different physicians for three different things and they would each prescribe something and none of them would know what the other’s prescribing,” says Mirzaian. “We are the medication experts, and that’s intentional—there’s a reason why they’re two different professions.” Besides, the doctor’s office doesn’t sell cheap sheet masks… yet.

Pharmacists aren’t the only workaround for getting health care sans a trek to the doctor—comprehensive STI tests and birth control can now be ordered online. You can do a professional gut check at-home these days, too.

Continue Reading…

Author Erin Bunch | Well and Good
Selected by CWC

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