A Few Questions for the AMA

The American Medical Association (AMA) just concluded their Annual Meeting of the House of Delegates in Chicago on Wednesday, June 19th. And it seems as if the profession of pharmacy was a topic of conversation.

According to the AMAWire, one of the points of discussion for the delegates this year was pharmacist inquiries with practitioners to verify controlled substances. This is the statement they released in response that you will find on the AMA’s website: The AMA delegates “issued a warning against ‘inappropriate inquiries’ from pharmacies to verify the medical rationale behind prescriptions and diagnoses, calling them unwarranted interference with the practice of medicine.”

Forgive me for being a bit confused about the last part of that statement. I’ve always been under the impression that the duty of a pharmacist was to ensure prescriptions were written for a legitimate medical condition in the course of a practitioner’s normal scope of practice.

If we are being accused of interference, shall we then be relieved of all responsibilities toward ensuring the best interests of our patients? Are we not the drug expert profession that is the last stop in the chain of treatment from provider to the patient?

Pharmacists are reacting to the AMA’s statements with a fair amount of anger. I can definitely understand this sentiment. We aren’t being treated as health care professionals. We are being treated as if we’re some sort of force preventing physicians from effectively treating patients.

In reality, nothing could be further from the truth. Pharmacists exist to work with prescribers, not against them. We are here to help them and to be an insurance policy against drug misadventures.

We look to improve outcomes and strive for ways to utilize medicines properly while minimizing adverse events or other unwanted negative outcomes. This is why the apparent hostility from the AMA confuses me.

There are a couple of problems with the AMA’s assumptions that I will outline below.

• The AMA brought this on themselves. I’m sorry to say, but the reason for all the inquiries from pharmacies is the rampant inappropriate prescribing of controlled substances. Those so called “pain clinics” that are now all too common do raise concerns. Pharmacies are being forced to re-evaluate filling policies. Pharmacists must heighten scrutiny of all controlled prescriptions as a result of loose prescribing habits. Our concerns are a byproduct of the current prescribing tendencies in America.

• The AMA’s hostility is misdirected. I can understand your desire to stand up for your place in the health care system. However, if you look for the real culprits who question your professional judgment, you will find that they aren’t pharmacists. It is the insurance industry and the pharmacy benefit management world. How many times has a pharmacy called a prescriber because of a prior authorization issue? How many times does a prescription insurance claim rejection include suggested alternative therapies? How often does the average doctor change therapy simply because their patient’s insurance plan will not cover a particular drug?

• Pharmacists don’t have a choice. We are the last line of defense against medication-related adverse effects. We have a moral and professional duty to question something if it doesn’t look right. We aren’t calling prescribers to question their judgment. We are calling to protect our patients. We are calling to do our jobs! Learning why a pharmacist inquires about a prescription is very important for the AMA. We should be partners in the patient care process.

• Pharmacists are not robots. We can’t be expected to blindly fill any and all prescriptions without questioning their merit. We are health care professionals. We are responsible for the prescriptions that leave our pharmacies. We are responsible for the safety of the patients we serve. If there is no expectation for the use of professional judgment by pharmacists, then we should not be held legally responsible for the potential negative outcomes.

The only conclusion I can derive as to why pharmacist inquiries were even a topic of discussion at this AMA meeting was the perception that our profession was somehow infringing on the medical profession. And that simply isn’t true.

I ask the AMA to take a good look at the profession of pharmacy. Then I will ask you to do the same with the health insurance and pharmacy benefit management industries. If you do that you will find the source of the true interference to the practice of medicine. And I’ll give you a hint, it isn’t the profession of pharmacy!