Docs vs. R.Ph.s: A clash of wills


There are many new sources of friction between physicians and pharmacists these days, and muchvigilance is required to ensure that your rights are protected.

To begin with, pharmacy leaders are upset over a commentary published by Wall and Brown in the May issue of Obstetrics & Gynecology. Putting aside the fact that the authors maintained that allowing pharmacists to refuse to dispense emergency contraception based on their personal values is "inimical to the public welfare and should not be permitted," the article made several other statements about pharmacists that are causing quite a stir. Consider the following: pharmacists "have more in common with corporate managers, retailers, and the general business community than they do with members of the traditional learned professions." Yikes!

Then, too, the authors claimed that pharmacists can only dispense and not prescribe and that they do not take comprehensive medical histories, perform physical examinations, or evaluate laboratory results when they fill prescriptions. Clearly the authors have an antiquated notion of the role of pharmacists and are not aware that more than 40 states now allow pharmacists to prescribe and perform expanded duties.

Another area of conflict between docs and pharmacists involves compounding. At the just-completed AMA meeting, the house of delegates considered a resolution to ask the FDA to take enforcement action against pharmacies that compound drugs and to ask CMS to reconsider its policy of reimbursing for these medications. Driving this measure is the concern by allergists and respiratory practitioners that some pharmacies are taking advantage of lax state standards and are mass-manufacturing nebulizer medications under the guise of compounding.

Fortunately, AMA recognized that the resolution, as written, could also place in jeopardy legitimate compounding practices. So the measure was not passed but recommended for referral.

At the same AMA meeting, delegates took up the issue of retail clinics, which are springing up in chains, such as CVS, across the country. Alarmed that these walk-in clinics are projected to increase to several hundred by the end of this year, AMA adopted a series of principles that store-based clinics should meet. The goal is to keep the clinics, staffed by nonphysician providers, at a limited scope of clinical practice.

Finally, docs don't want their prescribing data to fall into the hands of drug reps. So they've pushed for state legislation to ban pharmacies, PBMs, and data-mining companies from selling their physician-specific prescribing information. New Hampshire is set to pass the first law in the country that prohibits the licensing or sale of such data for any commercial use, except for the limited purposes of pharmacy reimbursement, formulary compliance, care management, utilization review, and health research. Opposing the bill are drug chains, data-mining companies, and drugmakers. They contend that foreclosing access to prescribing data could result in the unintended consequence of hurting patient care. Similar legislation is now being considered in other states, such as Arizona and West Virginia.

As you can see, there are many new sources of friction between physicians and pharmacists these days, and much vigilance is required to ensure that your rights are protected. If you disagree with the position physicians have taken, you better speak up or you may find yourself on the losing end.

Now on to another subject. Carol Ukens, our senior editor, retired on July 7, after 15 years of service. She has contributed so many great articles and story ideas over the years that we feel bereft and disconsolate over her departure. We wish her the best. Luckily, she has agreed to freelance for us, so you will continue to see her byline in our pages from time to time. If you wish to send her your good wishes, please e-mail them to
and we will pass them along to her.

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