Montana pharmacists may get more power to prescribe

Mark Buck, a physician and pharmacist in Helena, Montana, said he's been seeing more patients turn to urgent care clinics when they run out of medication. Their doctors have retired, moved away, or left the field because they burned out during the covid-19 pandemic, leaving the patients with few options to renew their prescriptions, he said.

"Access is where we're really hurting in this state," Buck said.

Senate Bill 112, sponsored by Republican Sen. Tom McGillvray, would address that need by expanding the limited authority Montana already gives pharmacists to prescribe medications and devices. Supporters said the measure could help fill health care gaps in rural areas in particular, while opponents worried it would give pharmacists physician-like authority without the same education.

Eleven states, including Montana, give pharmacists prescribing authority to some degree for medications such as birth control, naloxone, tobacco cessation products, preventive HIV drugs, and travel-related medications. The FDA has allowed pharmacists nationwide to prescribe the covid drug Paxlovid during the public health emergency.

According to a 2021 report by George Mason University's Mercatus Center, there were about 228,000 primary care physicians nationwide in 2019 and more than 315,000 pharmacists in 2020. The report found that patients using Medicare visit a pharmacist twice as often as a primary care provider, and the difference is even larger in rural areas.

Pharmacists, who often work in grocery stores, "are open longer hours than most doctors' offices, and no appointment is needed," the authors of the Mercatus Center study wrote.

Under the bill, pharmacists could prescribe for patients who do not require a new diagnosis, for minor conditions, or in emergencies. They could not prescribe controlled substances.

During a Jan. 18 committee hearing on the bill, supporters said pharmacists also would be able to provide strep and flu tests, along with diabetic supplies.

Buck, the Helena doctor-pharmacist, said the bill wouldn't solve the provider shortage, but it would "put a thumb in the dike that's leaking."

According to data from the University of Wisconsin Population Health Institute, Montana had one primary care physician per 1,210 people in 2019. Some counties have no primary care providers, but they usually have a pharmacy, said Kendall Cotton, executive director of the Frontier Institute, a public policy think tank in Montana. For example, Powder River County has no physician, he said, but a grocery store in the county seat, Broadus, has a pharmacy.

As a clinical pharmacist practitioner for 15 years, Travis Schule of Kalispell wouldn't be much affected by the passage of SB 112. In Montana, providers like him with additional education and training already have authority to prescribe under Montana's existing rules.

But he sees the bill's potential to expand access to treatment in Montana. In some cases, people might have to drive three hours to see a physician, and SB 112 would allow a pharmacist to serve as a "first triage" before they travel that long distance, Schule said.

"This bill is a patient-centric bill," Schule said. "It's not for pharmacists. It's for patients."

SB 112 is modeled after a bill passed in Idaho. Tim Flynn, a pharmacist at an Albertsons grocery store in Meridian, Idaho, said the legislation lets patients be treated for minor conditions, such as urinary tract infections, when they can't schedule a doctor's appointment or get to an urgent care clinic.

The Montana Medical Association and the Montana chapter of the American Academy of Pediatrics oppose SB 112. They say SB 112 would fragment care, risk patient safety, and substitute pharmacists for emergency care physicians.

But Montana Medical Association CEO Jean Branscum said there was an opportunity to build on the Idaho model, by bringing pharmacists and physicians together while making sure patients get the same standard of care.

"Let’s come up with a model of care that will allow pharmacists to do more than they do now, be a part of that team, practice at the highest level, and also appreciate the value of the physicians as part of that team too," Branscum told lawmakers at the Jan. 18 hearing.

Keely Larson is the KHN fellow for the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and Kaiser Health News. Larson is a graduate student in environmental and natural resources journalism at the University of Montana.