Pharmacists are now recognized as prescribers to some degree in almost all states. Legislation in most states reflects the provider role, and in some cases even allows pharmacists to bill for services. In some regions, pharmacists may initiate or modify therapy for common conditions such as diabetes, asthma, COPD, or conditions requiring anticoagulant or cardiac drugs.
But this new long-sought status brings new frustrations: liability issues, physician resistance, and lack of payment for value-added services.
“It’s a big step for a pharmacist to be out front with the new expanded responsibilities.” said David Brushwood, RPh, JD, Professor of Pharmaceutical Outcomes and Policy at the University of Florida College of Pharmacy. Because of that, added Brushwood, some practitioners prefer to remain in the traditional role.
APhA spokesperson Mohamed A. Jalloh, PharmD, said that this should come as no surprise.
“With greater responsibilities there is a higher risk of liability,” said Jalloh. While he is unfamiliar with the specifics regarding pharmacist’s insurance rate characteristics, he suspects that the cost of malpractice insurance for pharmacists will rise as they take on these expanded roles.
To limit liability concerns, it’s important that pharmacists not practice beyond the scope of authority granted by law, explained Brushwood. He pointed out that pharmacists have “limited prescribing authority” based on an individual state’s regulations. At the same time, he noted that health institutions often misunderstand the expanded role of the pharmacist, so the pharmacist may be misrepresented under a health-system’s malpractice coverage.
“The health-system pharmacist should purchase individual malpractice insurance as a supplement to an institution’s coverage, to make sure everything you do is covered,” said Brushwood.
Speaking for the community pharmacy arena, Linda Garrelts MacLean, RPh, FACA, Clinical Professor, College of Pharmacy at Washington State University, said: “In Washington, when I sign a collaborative drug therapy agreement, I assume the liability to care for my patients.” She added that it’s important to let insurance carriers know that [pharmacists] are practicing within the scope of practice allowed in their state.
Kevin Day, Associate Director of Strategic Initiative, NCPA, said that the purchase of additional liability insurance usually isn’t required in the community setting when pharmacists work under collaborative practice agreements. Premiums should remain relatively stable as long as pharmacists operate within their scopes of practice.
NACDS declined to comment on pharmacist liability.
Technical mistakes, such as those that involve dispensing, are the most common liability claims pharmacists face, said Brushwood. Issues that arise as pharmacists initiate or modify therapy are “more difficult to quantify and are therefore more protected.”
NCPA’s Day said to date, he is not aware of any situations where a pharmacist was the subject of a litigious claim for initiating or modifying therapy or administering a medical test.
But pharmacists cannot rest on their laurels, countered Brushwood. There is a lag time between an event and a case appearing in litigation, so it’s possible there are cases currently working their way through litigation channels. “Pharmacists who are initiating or modifying therapy need to be vigilant and take steps to ensure they are protected,” said Brushwood.
In dealing with patients, Brushwood cautioned, you don’t want any surprises. “Identify yourself to the patient as a pharmacist right from the beginning,” he said. And in the hospital setting, Brushwood said that it’s a good idea to establish an effective line of communication with risk management. “Make sure that that department understands the expanding scope of pharmacy practice. And as a means to avoid errors, don’t be afraid to use computer algorithms to help you figure out the right drug and the right way to use it,” said Brushwood.
Lastly, he asserted, don’t replace old arrogance with new arrogance. Doctors, for example, sometimes get defensive when questioned by a pharmacist about a drug order. “Don’t do the same thing. Don’t let arrogance get in the way of a legitimate question another member of the health-care team may have about a drug order you initiated or modified,” said Brushwood.
Up next: Physician resistance