Florida: Overpopulated, overburdened
Home to the Mayo Clinic and other top hospitals (Newsweek, “World’s Top Hospitals,” 2021), Florida does not seem like a healthcare desert. However with almost 22 million people, it is the third most populous state and one of the fastest growing. Over 10 years, the population increased 14.6% (U.S. Census Bureau). Twenty percent of residents are immigrants, with 18% of them undocumented (American Immigration Council). Florida also attracts 200,000 seasonal farm workers. And it draws scores of retirees, snowbirds and tourists. Many require accessible, affordable health care in a system that has become overburdened.
“A quarter million people move here annually,” said Michael Jackson, executive vice president and CEO of the Florida Pharmacy Association, Tallahassee. “It’s very international and is a destination for theme parks and other recreation. There’s more than 1 million annual visitors. Many seek medical assistance. There probably aren’t enough primary care physicians for everyone.”
The Commonwealth Fund’s 2020 Scorecard on State Health System Performance ranked Florida 41st among the 50 states in healthcare quality. It studied access, affordability, avoidable use, consistent pediatric care and overall costs, particularly for the privately insured.
COVID-19 pushed Florida’s system to the brink, forcing state legislators to acknowledge pharmacists’ capabilities. Implemented in July 2020, House Bill 389 allows pharmacists who have completed board-approved course work and other requirements to initiate, modify or discontinue drug therapy in collaboration with a physician for more than a half dozen chronic conditions, including asthma and diabetes.
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HB 389 also lets qualified pharmacists (also under a supervising physician) test, screen for and provide drug therapy for minor, nonchronic conditions, including influenza and minor infections.
In July 2021, qualified pharmacists (and pharmacist-supervised interns) gained authorization to administer immunizations/vaccines listed by the Centers for Disease Control and Prevention and those authorized for emergency use by the FDA.
“The pandemic opened policy makers’ eyes,” Jackson said. “They realized the nation was shutting down. They made significant changes to deploy pharmacists in additional care areas. This saves patients’ time, frees up physicians and lets pharmacists do what they were trained to.” Changes also keep people out of emergency rooms.
[Read more: Oregon: A pioneer in advancing pharmacy scope]
Unfortunately, Medicaid, Medicare and insurance coverage is spotty. And pharmacists do not have as much freedom as in some other states. “Florida is rather restrictive,” said Belawoe Akwakoku, state government affairs manager at the National Community Pharmacists Association. “Services must be under a collaborative practice agreement. It’s hard to expand the scope. It’s a large Medicare state where doctors have much authority.”
New legislation’s wording could eventually change this. “There’s a statement that says, ‘other pharmaceutical services,’” Jackson said. “That could open many doors for pharmacists to use their training.”
Scope of practice
- Begin, modify or terminate drug treatment for arthritis, asthma, chronic obstructive pulmonary diseases, Type 2 diabetes, HIV/AIDS, obesity and other chronic conditions. Services must be provided in collaboration with a doctor. Pharmacists must also complete board-approved course work and meet other criteria (House Bill 389, July 2020);
- Under a physician’s auspices, qualified pharmacists may test, screen for and prescribe prescription medications for minor, nonchronic conditions like influenza, streptococcus, lice, skin conditions (e.g., ringworm, athlete’s foot) and minor infections (House Bill 389, July 2020);
- Qualified pharmacists and pharmacist-supervised interns can provide immunizations/vaccines listed by the CDC and those approved for emergency use by the FDA (July 2021);
- Order and dispense opioid antagonists that utilize an autoinjection or intranasal delivery system for patients or caregivers (Senate Bill 544, July 2022); and
- Board-certified, registered pharmacy technicians who have undergone required training can administer vaccines/immunizations to adults under a certified pharmacist’s supervision (House Bill 1209, July 2022).