The roles of pharmacists and pharmacy technicians must evolve alongside the rapidly changing healthcare landscape, according to Donald Klepser, PhD, MBA, professor and interim dean at the University of Nebraska Medical Center. During the session “Collaborative Practise, Statewide Protocols, and Self-reliant Prescriptive Authority: How Pharmacy is Expanding Services to Increase Access to Patients,” Klepser emphasized the importance of moving beyond dispensing to provide higher-level services, such as immunizations and medication therapy management.

The discussion focused on community pharmacy, as opposed to hospital settings, where there is a “clearer path” for delegation of authority, according to Klepser. He suggested pharmacists should shift away from solely dispensing medications to address other services, such as administering immunizations, conducting point-of-care testing, and providing medication therapy management.

“Somebody mentioned health policy and pharmacoeconomics… and that’s where I think pharmacy has an opportunity to continue to be the most successful health care provider location.[Also,] prescriptive authority, what role pharmacy technicians play, as [these are] crucial.It is indeed absolutely crucial to know how we might get to a point where this is actually a business model. We’re here for the patient,” Klepser said.

These ideas are especially critically important as pharmacy deserts become more prevalent. Klepser stated that there are 150 US counties that do not have a pharmacy or pharmacist. The absence of a pharmacy often means the absence of a prescriber, primary care physician, nurse practitioner, or physician assistant, forcing patients to travel miles to access healthcare.

Klepser suggests that these issues can be addressed in both urban and rural areas by shifting resources. In some states, pharmacists can work in specific “categories” of care (e.g., hormonal contraceptives, pre-exposure prophylaxis, smoking cessation) if they have the proper education, training, and adhere to particular protocols. In more “restrictive” states,pharmacists can act if a patient has a pre-existing relationship with a provider. Though, in areas with only one pharmacy and no existing primary care providers, patients may not be able to receive care for certain illnesses (e.g., influenza, strep throat).

Collaborative Practice Agreements (CPAs)

“We’re here for the patient.”

This is where collaborative practice agreements (cpas) come in. According to Klepser, CPAs are formal agreements with well-defined scopes that allow for collaboration and interaction among healthcare professionals in areas lacking aspects of healthcare.

“That’s where we move into population CPAs, where a patient who has the signs and symptoms of [a] disease and comes into the pharmacy, the pharmacy will do an evaluation, and if they meet the criteria specified in the CPA, they are able to provide care to dispense a medication, regardless of whether or not that patient has ever gone to [a physician’s] office or even knows who [that physician] is,” explained Klepser.”That does allow the pharmacist to provide care to the community, but you have to find a physician willing to countersign that, willing to delegate that authority, and therein lies the barrier.”

Klepser noted that patient care and outcomes improve when a pharmacy or pharmacist is involved, which generally signals better cost control because peopel are not relocating or getting sicker, and are more frequently accessing care. CPAs in areas lacking certain pillars of healthcare can improve the efficiency and quality of patient care.

Klepser emphasized that, despite challenges regarding restrictive state laws and the need for physician collaboration, the expansion of cpas and the recognition of pharmacists’ capabilities offer a promising path forward. Empowering pharmacists to practice at the top of their education and license benefits patients by offering more accessible and efficient care and contributes to better overall cost control within the healthcare system.