Idaho’s Broad Practice Laws Allow Pharmacists, Techs to More Quickly Respond to COVID-19

As the coronavirus disease 2019 (COVID-19) pandemic demonstrates the vital roles pharmacists play in public health, experts in Idaho are hoping that the state’s broad practice laws for pharmacists and technicians will provide a blueprint for other states looking to expand pharmacists’ capabilities.

The Idaho Board of Pharmacy has worked on expanding pharmacists’ scope of practice for several years now and have achieved significant success. Independent prescriptive authority is a major piece of the broad practice and has been particularly important during the COVID-19 pandemic, according to Nicki Chopski, PharmD, executive director of the Idaho State Board of Pharmacy.

Patients still have basic health needs, Chopski said, but going to an urgent care facility or primary care office is not possible for some at-risk patients. Pharmacists can step in to prescribe a medication for conditions such as a basic cold or urinary tract infection, thereby relieving a major burden on the stressed health care system.

The board has also worked to expand practice for pharmacy technicians, which Chopski said is vital in order for pharmacists to take on larger roles. Technicians in Idaho can administer vaccines, perform remote data entry, and can take new orders. Technicians can also run nearly the entire filling process, Chopski said, with the exception of drug utilization reviews and patient counseling.

As with pharmacists’ practice over recent years, Chopski said technicians in Idaho are accustomed to these broad activities, which saved time when the pandemic began.

“Our techs are not scared to do that,” Chopski said. “They know what to do, they’ve had training.”

Jennifer Adams, PharmD, associate dean for academic affairs at the Idaho State University College of Pharmacy, echoed similar sentiments.

“I think one of the benefits that has been really fantastic during COVID is that what [Idaho’s] practice is like day-to-day is what other states are moving toward,” she said.

Even after the pandemic is over, Chopski said she hopes other states will recognize the benefits of expanding pharmacists’ practices. The process will vary in every state, some aspects will remain the same, according to Chopski. In Idaho, the Board of Pharmacy begins working on proposals and language in the spring. They typically submit the final language in October, before the legislature reviews the proposals when they meet in January. If approved, the changes then move onto the governor’s desk for his final signature.

Because they have accomplished so much in recent years, Adams said people from other states frequently assume that it must be an easier process in Idaho, which she said is untrue. The process in Idaho is actually more difficult, she noted, with even more checks and balances.

Chopski agreed, saying the board’s relationships with legislators and the governor have been important. Not only do the legislators recognize pharmacists as key health care providers, Chopski said, but they also recognize that pharmacists have the training and education to make the right medical judgments for their patients.

For example, Chopski said when the board was proposing independent prescriptive authority, legislators originally requested a list of specific drugs that pharmacists would be able to prescribe. Eventually, however, the list was deemed unnecessary and the legislators said pharmacists could make prescriptive decisions themselves.

“That’s been our governor’s approach to COVID as well,” Chopski said. “Yellow Pine, Idaho, is not the same as Boise, Idaho, so we have a very county-by-county approach to COVID. We try to allow our pharmacists to do the same in their pharmacies.”

The broad practice laws are not without limitations, of course. For example, Chopski said there are 4 categories for prescriptive authority, of which patients must fall into at least 1. Prescriptions must be for an emergency situation, a minor and self-limiting ailment, or for something that can be diagnosed with a Clinical Laboratory Improvement Amendments-waived test. Finally, the prescription cannot be for a new diagnosis.

In addition, Chopski said pharmacists must outline the procedures for prescribing, perform an assessment, notify primary care, and document the entire process. So far, Chopski said there have been no complaints from physicians regarding pharmacists’ prescriptions.

“Are we performing brain surgery?” Chopski asked. “No, we’re not going down that route as pharmacists. We’re doing what we’re trained to do.”

Not all pharmacists have implemented every single aspect of the broad practice laws, Adams said. She noted that some dove in headfirst and began trying everything that they could safely do, but others may not have the time and latitude to train the staff and ensure safety.

Even for the pharmacists who are more cautious, knowing that they have greater leeway to find creative solutions during COVID-19 has led to some unique solutions, according to Chopski. One pharmacist worked with a nearby distillery to compound hand sanitizer, and only briefly needed to check with the state Board of Pharmacy to ensure there were no problems.

For her part, Chopski said she hopes some pharmacists will become more adventurous when implementing their broad new capabilities, but she understands their hesitation. Pharmacists are trained to work from a checklist model, Chopski said, but this is more of a “build your own adventure.”

Other states are beginning to follow suit, she added. Many states have some of the individual capabilities implemented in Idaho, she said, but they were just the first to combine all the practices at once.

“I think there’s interest,” Chopski concluded. “Somebody’s always got to be first, right?”