Now that state laws allow pharmacists to administer immunizations in all 50 states, legislators and pharmacy organizations are looking to expand pharmacy medication-administration services (MAS) to include a wider range of drugs. For many patients, pharmacies could provide far easier access to critical medications than clinics or doctors’ offices. As a result of poor flexibility, lack of dexterity, or fear of needles, other patients may struggle to inject themselves with drugs designed to be self-administered and could benefit from pharmacist support or assistance.
Forty states permit pharmacists to administer injectables beyond vaccines, with 28 granting broad authority to pharmacists for administration of injectable medications, according to a report on state policy recommendations for MAS issued by the National Alliance of State Pharmacy Associations (NASPA) and the College of Psychiatric and Neurologic Pharmacists (CPNP). Currently, just Florida, Kansas, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, Rhode Island, South Dakota, and Texas do not allow pharmacist administration of nonvaccine medications. The laws vary substantially among the states that do permit medication administration, with eight requiring a collaborative practice agreement (Alaska, Connecticut, Maine, Michigan, Montana, Nevada, Ohio, and Wisconsin). Arkansas, Illinois, Maryland, and Minnesota have other restrictions.
Drugs appropriate for pharmacist administration include antipsychotics, anticoagulants, immunological agents, erythropoietics/hematopoietics, androgen, calcium regulators, vitamin B12, naltrexone, and certain antineoplastic agents, according to the American Pharmacists Association (APhA).
The National Community Pharmacists Association encourages pharmacies to consider becoming a recognized injection center specifically for antipsychotics to help patients initiate and maintain long-acting therapy.
“Patients who receive their long-acting antipsychotic medications at an alternative injection center, typically a pharmacy, and remained in the program for more than 6 months were 4.5-fold more likely to be adherent to their medication than those within the program who did not select the medication administration offering,” according to the authors of the report of the APhA Stakeholder Conference on Improving Patient Access to Injectable Medications, issued earlier this year.
NASPA notes several other benefits to pharmacy administration of long-acting injectable antipsychotic medications, including reducing stigma associated with the medications or visits to behavioral health clinics. “In the community pharmacy setting, patients are receiving their important medications in the same way that others receive their flu shot, which includes policies and procedures for communicating care delivery back to the patient’s health care provider and other care coordination services,” the NASPA/CPNP report said.
To prepare to deliver these medications, NASPA and CPNP recommended receiving training appropriate to the medications and the patient population from an accredited program and learning proper administration techniques. While their report did not recommend a specific number of required hours of continuing education, it did advise pharmacists to maintain “continued competency regarding the populations they serve, medications they administer, and current guidelines.”
In addition, the NASPA/CPNP report noted that states might require collaborative agreements, medical orders, or a standing order or protocol for administration of medications. In those states that do not have specific requirements, the organizations recommended that pharmacists develop policies to ensure care coordination and communication with healthcare providers.
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