POLICY SPOTLIGHT: Pharmacy Regulation

In this Policy Spotlight series, Mercatus scholars provide a high-level overview of their positions on key issues facing our nation’s policymakers.

Licensed pharmacists can perform more medical tasks than current regulations allow. For example, pharmacists are generally limited in their ability to address minor medical ailments, despite often having the training to do so. These restrictions can represent significant barriers to the continued advancement of public health, especially during a pandemic. Relaxing restrictions will open an undertapped and, in some cases, untapped medical resource to address Americans’ growing healthcare needs.

As a result of unnecessary barriers, when the coronavirus crisis hit, governments scrambled to suspend restrictions and allow pharmacists and their support staff to do more. These suspensions included granting permission to administer COVID-19 tests and immunizations and to process emergency refills on essential medications. States also expedited licensure for pharmacists licensed in other states. Notably, the experience was somewhat different in Idaho, where prescient, prepandemic reforms had better prepared the state for an emergency.

Expanding Pharmacists’ Roles, Overcoming Opposition

Pharmacists have knowledge of pharmaceutical drugs superior to many other healthcare professionals, and they interact with patients more frequently than physicians do. Yet their prescribing authority remains limited. Reform of pharmacy regulations can take stress off of other parts of the healthcare system. For example, if patients who need only a routine prescription can get it from their pharmacist, they will not incur unnecessary costs to themselves or others at a doctor’s office or in an emergency room.

Opponents of this kind of pharmacy reform cite two principal concerns:

1. Pharmacists may overprescribe or prescribe for conditions outside their medical expertise.
2. Communication may break down between healthcare providers.

In Idaho, a state where pharmacists’ prescribing authority has been significantly expanded, these fears have proven unfounded. Pharmacists are still held to a high standard of care by the State Board of Pharmacy and are aware of the legal liabilities to themselves and their employers for overprescribing medications. Some even say that their greater authority has increased communication with other providers, since pharmacists must notify primary care physicians of new prescriptions and satisfy other reporting requirements.

Leveraging the Capabilities of Pharmacy Technicians

Licensed pharmacists call on pharmacy technicians to assist them in a variety of roles, including performing administrative duties and providing basic medical care for patients. However, in more than half of the states, the number of technicians that pharmacists may supervise at any given time is limited by state regulations.

• These ratio requirements presumably seek to protect the public and ensure patient safety and quality of care. But if pharmacists are forced to perform routine tasks that do not require their expertise, the overall quality of service could be lower.
• Since the start of the pandemic, at least eight states have relaxed or removed their ratio requirements altogether as part of their emergency response. There do not appear to be notable negative effects to doing so.
• States such as Idaho, Rhode Island, and Utah have allowed technicians to administer vaccines in recent years, and the evidence suggests that this can improve workflow and morale within the pharmacy. Improving the division of labor in this way should help more customers be able to access pharmacy services more quickly.

More Telepharmacy, More Access

Telehealth is transforming healthcare delivery across the country, including through telepharmacy.

• Easing telepharmacy restrictions in Idaho enabled multiple pharmacies to open in rural communities, some of which had been without a pharmacy for decades.
• When pharmacists can manage a dispensing pharmacy from off site, they can oversee multiple pharmacies at once, providing patient consultations via video conferencing.
• Telepharmacy thus reduces the costs of operating pharmacies in remote parts of the country.

Further Reading

James Broughel and Yuliya Yatsyshina, “Pharmacy Technician Ratio Requirements” (Mercatus Research, Mercatus Center at George Mason University, Arlington, VA, March 2021).

James Broughel, Phil Haunschild, and Yuliya Yatsyshina, “Reforming the Practice of Pharmacy: Observations from Idaho” (Mercatus Research, Mercatus Center at George Mason University, Arlington, VA, April 2020).

James Broughel and Yuliya Yatsyshina, “Putting the President’s Pharmacy Vaccine Plan into Action” The Hill, April 8, 2021.

James Broughel and Yuliya Yatsyshina, “Relax Pharmacy Regulations to Help with COVID-19 Testing and Treatment” (Mercatus Policy Brief, Mercatus Center at George Mason University, Arlington, VA, March 2020).

James Broughel and Phil Haunschild, “How Idaho’s Prescient Pharmacy Reforms Prepared It for the Coronavirus” National Interest, May 28, 2020.