Iowa: Practicing far afield
Iowa produces more corn than any other state, yielding 2,552.2 million bushels in 2021 alone (U.S.D.A. National Agricultural Statistics Service). Hence, 36% of Iowans live in small rural communities (NationalPopularVote.com) that often lack doctors or pharmacies. The Bureau of Labor Statistics cited just 1.85 pharmacists per 1,000 population. Iowa has 7,056 active physicians (Becker’s Hospital Review), putting it in 44th place compared with other states.
Following decades of work, healthcare options have expanded in rural and other communities. Iowa tested the first telepharmacy in September 2012; in July 2016, the Telepharmacy Practice Bill became law. In May 2021, the Test and Treat/Collaborative Practice bill passed, as did legislation that broadened responsibilities pharmacists can delegate to properly trained technicians.
“The goal is to get pharmacists unchained from the dispensing counter,” said Brett Barker, vice president, government affairs at the Des Moines-based Iowa Pharmacy Association. “There’s primary care shortages in rural areas; the pharmacist may be the most highly trained medical professional around.”
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With telepharmacy, pharmacy techs with additional training dispense drugs in remote locations under the auspices of a pharmacist located elsewhere. “This lets us operate in rural communities,” Barker said.
Pharmacy techs also can perform product verifications and administer vaccines. Pharmacists can delegate other tasks “using their professional judgment,” the new ruling said.
The Test and Treat/Collaborative practice law lets pharmacists test for strep, flu and COVID-19, and prescribe necessary treatment. “Pharmacists can see any patient who wants a test as long as they qualify for testing under the statewide protocols,” said Emmeline Paintsil, director of professional affairs at the Iowa Pharmacy Association in Des Moines. If the test is positive, the pharmacist can prescribe treatment and follow up with the person’s primary care provider. “One rural pharmacy has provided 857 test-and-treat services for strep and COVID-19 alone,” she said.
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In July 2021, pharmacists became eligible for provider reimbursement under Iowa Medicaid for vaccines. “People can access services faster at pharmacies,” Paintsil said. “But charging cash is a barrier. This paves the way for other service reimbursements.”
Added Barker, “Medicare and Medicaid are another piece. Many private payers will follow their lead.”
Scope of practice
- The Iowa Prescription Monitoring Program (March 2009) provides information to authorized prescribers and pharmacies regarding patients’ controlled substance use. This helps determine appropriate prescribing and treatment without contributing to abuse, dependence or diversion of drugs for illicit use;
- The first telepharmacy was launched in Victor, Iowa, in September 2012, followed by several pilots. The Telepharmacy Practice Bill (SF 453) was signed into law in July 2016;
- 2016 legislation lets pharmacists dispense naloxone under a statewide standing order. In 2018, additional legislation passed that allows pharmacists to dispense naloxone under a statewide protocol;
- In 2018, pharmacists became eligible to provide nicotine replacement therapy;
- The Test and Treat/Collaborative practice law (SF 296/HF 794, July 2021) allows pharmacists to test for and prescribe treatment for strep, flu and COVID-19. It also establishes “broad, collaborative practice authority,” letting them enter into collaborative practice agreements with any physician, dentist, podiatric physician, veterinarian, opto-metrist or advanced registered nurse practitioner with an active Iowa license to treat any patient in the state; and
- A May 2021 rule broadened pharmacists’ authority to delegate responsibilities to pharmacy technicians “using their professional judgment.” This includes administering vaccines, which pharmacists also provide.