Pharmacists as the Center of Prescribing in US Health Care

The US health care system is facing an impending primary care crisis, with 40% of primary care physicians projected to retire or age out within the next 8 years. To address this growing void, clinical leaders are pointing to a highly qualified, yet historically underutilized resource standing behind the pharmacy counter: the pharmacist.

Pharmacists possess, on average, 2 more years of post-undergraduate education than advanced nurse practitioners or physician assistants, yet their clinical prescribing authority remains a patchwork of state-level regulations.

On this week’s episode of the Over the Counter podcast, Drug Topics welcomes back regular contributors from Harps Food Stores, Duane Jones, BS Pharm, and Jennifer Griffin, PharmD, to discuss what they’ve seen in practice regarding pharmacists’ prescribing value.

READ MORE: Pharmacists Can Shift to Provider Status With Medical Billing

The Patchwork of Prescribing Authority

Currently, pharmacist prescribing abilities in the US vary wildly by state, ranging from vaccine administration to test-and-treat protocols for acute illnesses. Fortunately, the clinical momentum is shifting, as 6 states have recently passed legislation.

Organizations like the National Alliance of State Pharmacy Associations provide visual tracking maps to help pharmacists navigate state-specific rules for prescribing oral contraceptives, smoking cessation aids, and naloxone. This localized expansion reflects a broader international movement; a recent global scoping review identified the US as one of only 9 countries where pharmacists are permitted to act as independent prescribers in community settings.¹

However, unlike publicly funded systems in Canada and France, US patients must still typically pay out-of-pocket for these clinical pharmacy services. Government leaders like Mehmet Oz, MD, head of the Centers for Medicare & Medicaid Services, have publicly advocated for broadening this scope, suggesting that allowing pharmacists to prescribe and bill for antihypertensives in rural America would resolve critical access disparities.

Evidence-Based Protocols and Public Safety

A central argument for expanding pharmacist prescribing lies in their strict adherence to evidence-based protocols and clinical safety standards. In the episode, Jones notes that pharmacists operate strictly within predefined guidelines, preventing the inappropriate empirical overprescribing of medications.¹

As he mentions, despite clinical recommendations, 52% of patients receiving antivirals last year were treated empirically without ever being tested, contributing directly to the global threat of antimicrobial resistance. Because pharmacists act as the guardians of medication safety, their intensive focus on medication reconciliation and pharmacological detail reduces adverse events and prevents medication errors.²

This professional reliability is mirrored globally as well.³

In Poland, where pharmacists were granted prescribing authority in 2020, practitioners successfully wrote nearly 3 million electronic prescriptions in under 2 years. At least a fourth of these Polish prescriptions were for cardiovascular diseases, demonstrating how community pharmacists can safely support chronic disease management within a system characterized by high public trust.

The Path to Collaborative Integration

Integrating pharmacists into an authenticated prescribing role requires a systemic shift in pharmacy workflow and physician collaboration. Clinical leaders emphasize that pharmacies must optimize their operations by delegating non-clinical tasks to technicians and implementing synchronization programs to free up time.²

Even in countries like the Netherlands, where formal pharmacist prescribing rights do not yet exist, case studies show that advanced practitioners are already informally writing prescriptions for physician authorization, proving that collaborative prescribing is a natural evolutionary step in modern primary care.⁴

Because community pharmacists see patients an average of 30 times a year, compared with just 3 physician visits, they are uniquely positioned to manage chronic regimens, adjust dosages, and safely deprescribe redundant therapies. Putting the pharmacist at the center of patient care will alleviate physician workloads, lower health care costs, and optimize clinical outcomes.³

Stay tuned for weekly podcast episodes of Over the Counter powered by Drug Topics. Check out our most recent episode with Rick Couldry, MS/HSPA, who discussed the greater health care industry’s push to cloud-based medication management.

REFERENCES

1. Mesbahi Z, Piquer-Martinez C, Benrimoj SI, et al. Pharmacists as independent prescribers in community pharmacy: a scoping review. Res Social Adm Pharm. 2024;21(3):142-153. doi:10.1016/j.sapharm.2024.12.008

2. Who knows more about medication management, pharmacists or physicians? Pharmcon freeCE. March 17, 2026. Accessed August 26, 2026. https://www.freece.com/blog/doctors-pharmacists-medications-who-knows-more/

3. Owczarek A, Marciniak DM, Jezior R, et al. Assessment of the prescribing pharmacist's role in supporting access to prescription-only medicines-metadata analysis in Poland. Healthcare (Basel). 2023 Dec 5;11(24):3106. doi: 10.3390/healthcare11243106

4. Kempen TGH, Benaissa Y, Molema H, et al. Pharmacists’ current and potential prescribing roles in primary care in the Netherlands: a case study. J Interprof Care. 2024;38(5):787-798. doi:10.1080/13561820.2024.2374017