Washington: 43 years of comprehensive services
In 1979, the United States was shaken by several tumultuous events. But Washington state had some bright spots: The Seattle SuperSonics won the NBA Championship against the Washington Bullets, and pharmacists became highly essential healthcare providers, with far more authority than out-of-state colleagues.
Pharmacy practice was redefined, making the Evergreen State the first to let pharmacists prescribe oral contraceptives and other narcotic and non-narcotic drugs under collaborative drug therapy, or CDTA, physician agreements. This revised Practice Act also permits direct administration of drugs, drug use monitoring/management and ordering, and reviewing and using lab tests to adjust medication levels.
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Another first came in 1994, when Washington pharmacists became authorized to provide vaccinations. Prior to COVID-19, it was one of just three states allowing pharmacy technicians to perform this function, which frees up pharmacists’ time.
“Pharmacists in many states do similar things,” said Jennifer L. Bacci, a Washington State Pharmacy Association board member and associate professor at the University of Washington School of Pharmacy. “What’s unique is the length of time our pharmacists have been able to perform these functions.”
Additional training is not required. “It’s up to pharmacists and their abilities and experience to determine the scope,” Bacci said. “Our political environment acknowledges pharmacists and laws give us broad authority.”
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Another milestone was the May 2015 passing of ESSB 5557, putting pharmacists’ services on par with those of other healthcare providers and mandating reimbursement by health insurance networks. Elsewhere, this has been a barrier to pharmacies augmenting services.
“Pharmacists are passionate about serving patients,” said Belawoe Akwakoku, state government affairs manager at NACDS. “Some independents closed because revenue and payment weren’t there. There were 20,000 U.S. community pharmacies two years ago; now there’s 19,000.”
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Independent pharmacies have been most aggressive about broadening services. “They tend to be nimble and responsive to local need,” Bacci said. At the Yakima Valley Farm Workers Clinic’s 40 Washington and Oregon locations, on-site pharmacists provide many services. Patients include some of Washington’s estimated 187,000 seasonal agricultural workers, according to the Washington State Department of Commerce. Kroger’s Fred Meyer and QFC banners have broadened offerings, too.
Pharmacists also practice in the sparsely populated Cascade Mountain area where there are few doctors, Bacci said. Pharmacists also serve immigrants, which comprise 14% of Washington’s population of 6.9 million, according to NationalPopularVote.com. Among immigrants, 23% are undocumented.
Scope of practice
- Under a revised Practice Act (1979), Washington became the first state in which pharmacists could prescribe oral contraceptives and other narcotic and non-narcotic drugs under collaborative drug therapy agreements with doctors. This ruling also lets pharmacists directly administer and manage medication regimens, and use lab tests to adjust drug therapies;
- Washington became the first state in which pharmacists could provide vaccinations (1994) under collaborative agreements with doctors. Prior to COVID-19, it was also one of just three states that also allowed pharmacy technicians to do this. (The other two were Rhode Island and Idaho.);
- In April 2020, the Washington State Pharmacy Quality Assurance Commission adopted Chapter 246-945 of the Washington Administrative Code, thus rewriting the rules for pharmacists. Practice standards spanning 30 chapters now comprise one. New rules modernize outdated practices, eliminate redundancies and allow for professional judgment while prioritizing outcomes, patient safety and access to quality care;
- Passing of ESSB 5557 (May 2015) mandated that pharmacists be reimbursed by health insurance networks, putting them on even keel with other healthcare providers; and
- Pharmacists can dispense naloxone without a prescription.