More States Allowing Providers Other Than Doctors To Prescribe Medicines

The Wall Street Journal on Tuesday examined the "rapid spread of prescribing power" to health care providers who are not medical doctors, a practice being employed in some states looking to cut health care costs and expand access to prescription drugs. While some non-doctors with extended medical training -- such as nurse practitioners and physician assistants -- have traditionally been able to prescribe medications in most states, an increasing number of professions are now looking to generate new income and expand their businesses by prescribing drugs. The "loosening rules" reflect "a broader shift in the health care system, as more non-physicians ... play a larger role in providing care," the Journal reports. Six states now allow pharmacists to prescribe emergency contraception to patients who have not visited doctors. Other state governments have recently enacted laws allowing a broad range of health care professionals -- including naturopaths, certified midwives, optometrists and psychologists -- to prescribe a limited range or specific category of drugs. According to the Journal, the trend has led to a "wide variation between professions and states" in the nation's prescribing laws. However, many states have similar safeguards in place that require non-physicians to work with some level of supervision from doctors.

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While the federal government has traditionally welcomed expansion of prescription powers, doctors' groups have raised "fierce opposition" to the new prescribing laws, saying they allow underqualified professionals to "tread on their ... turf" and "undermine the standards of the U.S. health care system," the Journal reports. Jack Lewin, CEO of the California Medical Association, said, "To have people with less training prescribing very complicated medicines creates a quality problem." Some pharmacists said they worry about rising malpractice insurance costs for non-doctors resulting from the increased potential for errors in their new prescribing powers. "You can get into huge trouble when you've got the dentist, the optometrist, and the nurse practitioner all prescribing different drugs," Ernest Boyd, executive director of the Ohio Pharmacists Association, said. The pharmaceutical industry is "divided on the issue," while insurers support non-doctor prescribing because of the potential savings from fewer doctors' visits, the Journal reports. Barr Laboratories, which manufactures EC drug Plan B, has lobbied states to allow pharmacists to prescribe their drug. However, other drug companies have remained neutral on the debate because of concerns that expanded prescribing powers could raise new liability risks and that pharmacists would be allowed to switch patients from brand-name drugs to generics without a doctor's approval (Spencer, Wall Street Journal, 6/1).