Grassroots Efforts Advance the Pharmacy Profession


How California pharmacists mobilized support to pass landmark pharmacist scope-of-practice legislation

Legislative decisions made at the local, state and national level can determine much of the way you run your pharmacy business. And, you can impact how those decisions are made. However, your elected officials can only represent you when they understand that filling pill bottles is only a small part of your job. They need to recognize the essential care you provide that optimizes patient medication therapy and promotes wellness and disease prevention.

The passage of California Senate Bill (SB) 493 — legislation introduced in February 2013 to enable pharmacists to practice to the full extent of their training and education — provides an example of how getting involved can make a difference.

Activism Matters

California pharmacists understood the importance of educating government officials and the public on the essential role they play on a patient’s collaborative healthcare team. They also highlighted the critical function pharmacists can have in reducing strain on the already strapped California primary care workforce as it prepares for the 2014 implementation of the Affordable Care Act (ACA) and the influx of millions of patients with a pent-up demand for services.

Pharmacists engaged in several activities to get their message heard:

  • Getting more involved in California state pharmacy organizations. Collaborative efforts by the California Pharmacists Association and the California Society of Health Systems Pharmacists were critical. Members utilized the SB 493 fact sheets, talking points, online grassroots advocacy action center, and other advocacy tools to concisely and quickly ground themselves and those they were educating on the facts. Members volunteered for committees and events. They made financial donations to the affiliated Political Action Committee (PAC) and Pharmacy Legislative Impact Fund. Plus, many pharmacists joined these organizations for the first time, recognizing that numbers speak loudly to elected officials.
  • Direct outreach to government officials. Pharmacists and pharmacy students sent hundreds of simple, well-crafted emails and letters to lawmakers clearly stating their concerns around the provider shortage and how giving pharmacists a greater scope of practice could ameliorate the situation. Owners invited local and state officials to take short tours of their independent pharmacies. Other pharmacists hosted meetings at their homes or community centers so that representatives could hear from patients and providers speaking directly to the important role that pharmacists play in providing care. Rallies are also an impactful way to make a statement. On April 16, 2013, a sea of over 600 white coats descended on the State Capitol in Sacramento for California Pharmacy Legislative Day.
  • Engaging the public. Pharmacists wrote editorials for their local papers, posted social media posts, and created blogs to engage as many people on the issue as possible. They signed petitions to recognize pharmacists as health providers. And, they took advantage of other social events (e.g., dinner parties, book clubs, etc.) to educate on the issues (since you never know who can become a useful ally).

Getting Involved Gets Results

On October 1, 2013, the same day the state’s health insurance exchange (Covered California) launched initial open enrollment, Governor Brown signed California SB 493.1 The bill establishes recognition for Advanced Practice Pharmacists who will be able to do the following beginning January 1, 2014:

  • Perform patient assessments
  • Order and interpret drug therapy-related laboratory tests
  • Refer patients to other healthcare providers
  • Initiate, adjust and discontinue drug therapy under physician protocol
  • Work with other healthcare providers to evaluate and manage a patient’s health issues

Additionally, California SB 493 authorizes all licensed pharmacists to:

  • Administer drugs and biologics by injection when ordered by a prescriber
  • Provide consultation, training and education about drug therapy, disease management and disease prevention
  • Participate in multidisciplinary review of patient progress, including appropriate access to medical records
  • Furnish self-administered hormonal contraceptives pursuant to a statewide protocol (similar to existing emergency contraception authority)
  • Furnish travel medications not requiring a diagnosis
  • Furnish prescription-level nicotine replacement drugs for smoking cessation pursuant to a statewide protocol and after certain training and certification requirements are met
  • Administer immunizations to patients three years of age and older without a physician protocol if certain training and certification requirements are met and certain procedures are followed
  • Order and interpret tests for the purpose of monitoring and managing the efficacy and toxicity of drug therapies, in coordination with the patient’s prescriber

The bottom line is that as states are wrestling with how best to deal with the impending physician shortage, you can make a difference in how state legislators think about potential solutions. California’s pharmacy provider status legislation is an example of how your voice matters. The key is taking action to make sure your voice is heard. Equally as important to making your voice heard is showing results! Take advantage of current opportunities to provide clinical services such as MTM, vaccinations and education programs to show that pharmacists can deliver better health to our communities

ACA Could Present Additional Opportunities to Effect Change

A physician shortage was projected even before passage of the Affordable Care Act. In fact, from 2003 through 2009, reports from 26 states were published projecting physician shortages.2

With 32 million more Americans expected to enter the healthcare system in the next few years due to healthcare reform,3 we should also expect even more pressure on the healthcare system. The Association of American Medical Colleges estimates a physician shortage of 90,000 by 2020 and 130,000 by 2025. The shortage is likely to increase as America’s aging population needs more care and 250,000 physicians are expected to retire in the next decade.4


Source: Association of American Medical Colleges

Source: Association of American Medical Colleges

States are aware of this looming physician shortage, and debates are taking place regarding what to do about it. Some states are increasing medical school classes and residency programs; some are focused on expanding the scope of practice of nurse practitioners; and some are looking to expand the scope of practice of non-physician health providers, including pharmacists. The Scope of Practice Legislative Database maintained by the National Conference on State Legislatures shows that from 2011 to 2013 there have been 178 scope-of-practice-related bills introduced in 38 states pertaining to pharmacotherapy.5

Expanding scope-of-practice laws to broaden the services that pharmacists can provide is an important step in addressing the country’s looming physician shortage.

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The information provided here is for reference only and does not constitute legal advice. We make no representations with regard to the content’s comprehensiveness. You are solely responsible for investigating and complying with all applicable laws that govern the operation of your business.

1 Governor Brown Signs SB 493, Business Wire, California Pharmacists Association, October 1, 2013.
2 Recent Studies and Reports on Physician Shortages in the U.S., Center for Workforce Studies, Association of American Medical Colleges, October 2012.
3 CBO’s Analysis of the Major Health Care Legislation Enacted in March 2010, Congressional Budget Office, March 30, 2011.
4 Projected Supply and Demand, Physicians, 2008-2020, Association of American Medical Colleges.
5 Scope of Practice Legislative Database, 2011-2013, National Conference of State Legislatures, Online Data updated April 1, 2013.