Docs want to dispense if pharmacists won't

Voicing concerns that the conscientious objections of some pharmacists are harming patients, the American Medical Association wants physicians to be able to dispense medications when pharmacists refuse to do so.

At the annual AMA meeting last month, the house of delegates voted for a resolution calling for state laws that would permit physicians to dispense medications when there is no willing pharmacist within a 30-mile radius. The resolution is an end run around pharmacists who cite conscientious objections to filling certain prescriptions, such as for emergency contraceptives or birth control pills. However, AMA charged that some pharmacists are refusing to dispense pain medications and psychotropics as well.

The resolution also called on AMA to work with pharmacy associations to guarantee that if a pharmacist conscientiously refuses to dispense a legal script, the patient's right to get the drug will be protected by immediate referral to another dispensing pharmacy. "Patients need access to medications prescribed by their physicians without unnecessary delays or interference," said AMA trustee Peter W. Carmel, M.D. "AMA will work with pharmacist associations and state legislators so that neither patients' health nor the patient-physician relationship is harmed by pharmacists' refusal to fill prescribed medications."

While Gans welcomed dialogue with AMA, he added that just as physicians are not required to provide all medical services, pharmacists should not be required to provide all pharmacy services. "It's unfortunate that the conversation between AMA and APhA did not take place before their house of delegates' action," Gans said. "But physicians and pharmacists collaborate every day to improve medication use and advance patient care, including navigating issues of conscience. We look forward to working with AMA on this issue."

Every state pharmacy board permits physicians to dispense in some fashion. Some pharmacy boards require physicians to get a dispensing permit and others limit dispensing to drug samples. In Idaho, for example, AMA's 30-mile radius rule would not be needed because physicians can already dispense, said Jan Atkinson, senior compliance officer, Idaho board of pharmacy. In Virginia physicians have to get a permit, but they can also dispense when "pharmaceutical services are not available." But what that phrase actually means is not defined in the law, said pharmacy board executive director Scotti Russell.

"The AMA position appears to be a compromise of sorts, a step to support M.D. dispensing, which is already legal but viewed more as a revenue generator than patient service, and weighing in on the whole emergency contraception issue without being too controversial," commented Carmen Catizone, executive director, National Association of Boards of Pharmacy. "Extending the 'dispense-meds-to-help-the-patient-when-the-bad-pharmacist-says-No' scenario to pain medications or psychotropic agents has no relation to the moral objection issue of the emergency contraception-birth control debate. It is another strategy, and a poor one, to open more cash sources for the docs."

View the results of Drug Topics' July, 2005, Instant Poll: Should federal legislation be passed allowing physicians to dispense emergency contraceptives if there is no pharmacist able or willing to fill them in the area?

http://www.drugtopics.com/drugtopics/survey/surveyList.jsp?id=167791