Florida physician and pharmacist associations have been fighting for months over a proposed state Board of Pharmacy rule change that would give pharmacists the authority to change patients' prescriptions to match their health plan formularies.
Pharmacists say the proposal will increase patient convenience and decrease the time busy doctors spend on the telephone rehashing prescription orders. But physicians argue that such a move increases their liability risk and is unsafe for patients.
"We've been challenging it every step of the way," said attorney Francie Plendl, director of the Florida Medical Association's division of governmental affairs. "I'll say it's been contentious."
Plendl says patient safety should trump patient convenience every time. She also argued that the Board of Pharmacy does not have the authority to change prescribing regulations and that legislative action is required to do so.
Earlier this summer, the presidents of the FMA, the Florida Academy of Family Physicians and the Florida Osteopathic Medical Association co-wrote a letter to Board of Pharmacy chair Gail Merrell expressing their organizations' opposition to the rule change.
"The physicians feel strongly that patients will be endangered if changes are made to their medications without a prior discussion with the physician that is documented in the patient's record," the letter stated.
The letter also stated that the groups "understand that pharmacists are frustrated with the current situation." And the three leaders offered to educate physicians on the need to improve communication with pharmacists about prescription changes, educate physicians on the need to review formularies before writing a prescription, and encourage managed-care organizations to make formularies readily available to doctors.
According to Florida Department of Health spokesman Doc Kokol, the board's executive director, Rebecca Poston, will be drafting a letter next week officially requesting Florida Attorney General Charlie Crist's legal opinion on whether the board has the authority to change prescribing regulations. A decision against the board could end the controversy. But, if Crist rules in the board's favor, the controversy could just be heating up.
"If they do move forward with the rule, we would file a challenge and we will also be seeking attorneys' fees," Plendl said.
Florida Pharmacy Association Executive Vice President Michael Jackson said his organization requested the rule change in anticipation of the Jan. 1 launch of the Medicare Part D drug benefit program. He predicted there will be massive and unexpected changes in patients' prescription drug regimens as they discover the brand-name medications they were receiving under Medicaid will not be included in their new Medicare coverage, which will increase the number of pharmacist calls to physicians.
Tad Fisher, executive direction of the Florida Academy of Family Physicians, said the state's medical liability climate dictates that physicians must be consulted for every decision made regarding their patients' healthcare.
"If something goes wrong, they're not going to bring the pharmacist up," he said. "They're going to bring the physician up and say, 'Why did you allow this to happen?'"
Jackson, however, said the reason doctors oppose the rule change is because they don't understand it.
"There is a perception that this is giving pharmacists undo authority to make a therapeutic change," Jackson said. "It's being presented as a turf battle, but we see it as a need. We have patients frustrated with wait times because we can't get immediate approval. We're stuck in the middle."
Under current rules, patients either have to wait for the pharmacist to get authorization from the physician to change a prescription or the patient can buy the prescribed drug with their own money. Many patients choose to just go home without their medication, Jackson said, and this delays the start of their medication therapies.
Under the proposed rule, pharmacists would have authority to change a prescription from one drug to the "therapeutic equivalent" of that drug if it's the preferred product designated on the patient's health plan formulary. But this could only be done if the prescribing physicians gives prior authorization either in their own writing or by checking a preprinted box marked "formulary compliance approval" on the prescription slip.
"The prescriber has full control over this," Jackson said.