A brewing battle between Florida doctors and pharmacists may have been resolved for now.
Some medical groups had been worried about a rule being drawn up by a state regulatory board after the Legislature and Gov. Ron DeSantis this year approved a law to expand the kinds of health services that pharmacists can provide.
But on Wednesday, members of Florida’s pharmacy licensing board agreed to alter the rule, which centered on regulations for the treatment of chronic medical conditions. The changes will likely avoid a legal tussle with doctors and nurses, and put the new regulations on a track to potentially be in effect by October.
The Board of Pharmacy Rules Committee decided to remove a provision that would have authorized pharmacists working in collaboration with physicians to “treat any disease that is expected to last greater than one year or more.”
The provision drew the ire of groups such as the Florida Medical Association, the state’s largest physicians’ organization, which argued that the inclusion of a “catch-all” phrase in the proposed rule would run afoul of the law.
Also eliminated from the proposed rule was a provision that would have authorized pharmacists to treat osteoporosis and osteoarthritis. While the inclusion of osteoarthritis was meant to expand the types of chronic conditions that could be treated, Board of Pharmacy general counsel David Flynn warned that it would restrict the law, which authorizes pharmacists who enter into collaborative arrangements with physicians to treat arthritis.
The proposed rule, though, would add five chronic health conditions that pharmacists are authorized to treat under the new law.
The DeSantis administration made clear that it wanted the rule fast-tracked so pharmacists could be available to treat patients during the COVID-19 pandemic.
“Kudos to the members of this committee and the board and the counsel who are moving to get it done as quickly as possible and as non-controversial as possible and leaving the real controversial stuff to a later date,” said Jacksonville health care attorney and lobbyist Christopher Nuland, who represents physician groups.
The Board of Pharmacy Rules Committee held two joint meetings with members of the Board of Medicine and Board of Osteopathic Medicine to discuss the proposed regulations, as required by law. The rule still must be approved by the full Board of Pharmacy, which meets in August.
Nuland, who represents organizations such as the Florida Chapter of the American College of Physicians Services, said his clients wouldn’t challenge the current iteration of the rule.
But he made no promises if the Board of Pharmacy decides to alter the rule before adopting it.
Nuland said if the rule isn’t challenged or slowed down with requests for additional meetings, it could be in effect by Oct. 1.
The expansion of authority for pharmacists has been spearheaded by House Speaker Jose Oliva, a Miami Lakes Republican who used his considerable legislative power to revamp parts of the health care system during the 2019 and 2020 legislative sessions.
In an attempt to make health care more affordable, Oliva persuaded lawmakers this year to pass a bill (HB 389) that allows pharmacists to enter into collaborative arrangements with physicians to treat patients for chronic medical conditions. Those conditions include arthritis; asthma; chronic obstructive pulmonary diseases; Type 2 diabetes; human immunodeficiency virus or acquired immune deficiency syndrome; and obesity.
The law allowed the Board of Pharmacy to expand the list of chronic medical conditions to include “any other chronic condition adopted in consultation with the Board of Medicine and Board of Osteopathic Medicine.”
Ultimately, the proposed rule that the Board of Pharmacy Rules Committee approved would expand the chronic conditions that pharmacists could treat to include opioid abuse disorder; hypertension; hyperlipidemia; smoking cessation; and anticoagulation management.
But it didn’t go as far as some members of the Board of Pharmacy Rules Committee wanted. For instance, some members wanted pharmacists to also have the ability to treat heart disease and mental illness.
The panel, however, agreed that those conditions should be considered later.
“Whether you say osteoarthritis, osteoporosis, congenital heart defect, there is still a physician who designed that protocol and a pharmacist is still following it based on that prescription or that protocol in place,” said Mark Mikhael, an Orlando pharmacist and member of the Rules Committee. “There’s the reality of the situation of moving the rule forward and the practicality of what this really entails.”
Joel Rose, chairman of the Board of Osteopathic Medicine and one of the physicians who consulted with the Board of Pharmacy Rules Committee, said the current iteration of rule was a good first step to implement the law.
“It’s like a fine machine. It will get oiled up and move more smoothly as time goes along. It’s new to physicians and pharmacists in the state of Florida, new to the patients in the state of Florida,” he said. “So it’s kind of like growing pains, I guess.”
