editor'sNOTE: The Prescribing Pharmacist

Mr. Eckel is professor and director ofthe Office of Practice Developmentand Education at the School ofPharmacy, University of North Carolinaat Chapel Hill.

A few years ago, a commissionrepresenting the diversebranches of our professioncame up with a vision of pharmacistpractice for 2015 forecasting that pharmacistswill be the health care professionalsresponsible for providing patientcare for optimal medication therapy.

This deceptively simple statement setsa challenging goal of a much broader,patient-centered role for the profession.We are taking the first steps toward thisfuture with the gradual yet widespreadadoption of medication therapy management(MTM); establishment of a behind-the-counter category of drugs would beanother step forward. Here is anotherintriguing possibility that would helpmake this vision a reality: independentprescribing by pharmacists.

Many states already allow collaborativepractice between physicians andpharmacists that includes prescribingand ordering lab tests. Independent prescribing—already a reality in some othercountries—could be a significant nextstep.

Support for this idea comes from areport released late last year by KaloramaInformation predicting that as many as 6states may allow pharmacists to prescribeindependently within 5 years. Whymight this happen? The study lists severalreasons, including the increasing educationlevel of pharmacists; surgingdemand for prescriptions that strains theexisting medical system; and the potentialfor independent prescribing toreduce the cost of routine medical visitsfor both patients and insurers.

This growing responsibility will driveincreasing pharmacist influence overdrug purchasing, and the report suggeststhat pharmaceutical manufacturersadjust their marketing strategies accordingly.It is estimated that pharmacistscurrently influence about 29% of drugpurchases worth $77 billion annually; by2012, that could increase to 37% of drugpurchases worth $145 billion.

The transition to independent prescribingwill bring challenges, of course.Many of us have been hesitant to moveinto disease managment and MTM, andthat is partly because it is difficult toswitch back and forth between the mindsetsrequired for dispensing and advisoryroles. Moving into prescribing will requirean even bigger jump, and we might seethe pharmacy profession divide intothose who prescribe and those who dispense.We also can expect oppositionfrom medical professionals who feelthreatened by the emergence of pharmacistprescribers.

Nevertheless, changes to the currenthealth care environment are inevitable,and our extensive pharmacist trainingand capabilities make us well positionedto take on new and expanded roles.