When it comes to comprehensive service rosters, Idaho tops the list, providing more leeway for pharmacists than any other state. Among other things, Idaho pharmacists can prescribe myriad types of medications, including oral contraceptives. They can dispense naloxone and emergency supplies for diabetes and other conditions. And both pharmacists and technicians can administer vaccines, giving pharmacists more time flexibility.
“Idaho is the most advanced and progressive state in terms of what pharmacists can do, so long as it’s not expressly prohibited by state or federal law and it’s in their educational training and experience,” said Nicki Chopski, executive officer of the Idaho State Board of Pharmacy and bureau chief of the Idaho Division of Occupational and Professional Licenses Health Professions Bureau in Boise. “This is exactly how nursing and medicine are governed. You don’t need to write out every little step pharmacists can take. Pharmacists can perform at the top of their education rather than top of their license.”
In 2018, the Idaho Board of Pharmacy literally rewrote the rule book, repealing all old rules and issuing new ones. The goal was to eradicate outdated regulations and ones impeding use of beneficial new technologies and practice models. New rules cut total word count by 55%, removed 62% of restrictions and eliminated six licensure categories.
[Read more: Washington: 43 years of comprehensive services]
Today, Idaho is the “least regulated state with the most pharmacist services,” said Mike Ayotte, NACDS’ senior vice president of pharmacy, transformation and advocacy. “They didn’t go after specificity. They said, ‘This is what you can do, not what you can’t.’”
Changes came out of sheer need. Idaho’s population is nearing 1.8 million. There are just 3,504 active physicians — or 196.1 per 100,000 population (Becker’s Hospital Review). This is the smallest ratio nationwide. Twenty-nine percent of residents reside in rural communities, often miles from doctor-staffed health facilities (NationalPopulationVote.com). Pharmacists are their most accessible option.
[Read more: Rhode Island: Pharmacists address social issues]
“Pharmacies provide access and less treatment delay,” Chopski said. “There are communities where the doctor is an hour away. But most people have a pharmacy fairly close by. They’re open when doctors’ offices are closed. With the provider shortage, pharmacists’ services have relieved some of the burden.”
Independent pharmacies have been most aggressive about expanding services. Among large chains, Albertson’s has taken the lead. Services are supported by Medicaid reimbursement.
Scope of practice
- Since July 2018, Idaho pharmacists have been able to prescribe a wide range of medications. Prescribing falls under four pillars: medication for minor and self-limited conditions; emergency drugs (e.g., nitroglycerine); medications for conditions that do not require a new diagnosis; and tests for pregnancy, flu, COVID-19 and other conditions;
- Since before 2018, pharmacists have been able to prescribe immunizations (starting in 2011), tobacco cessation aids, epinephrine and naloxone;
- Based on service needs, pharmacists can decide how many technicians they require; most states have a ratio;
- Pharmacists can prescribe oral contraceptives after evaluating patients’ risk factors;
- In March 2017, Idaho became the first state to allow pharmacy technicians to administer vaccines under the auspices of an immunizing pharmacist. They must also complete certain training; and
- Medicaid has recognized Idaho pharmacists as providers since April 2020.