Highly publicized cases in recent years of tainted products, including Avastin and trypan blue as well other compounds not related to ophthalmic use, culminated in federal legislation last fall designed to tighten controls on compounding. So far the impact, apparently, has been underwhelming. The message that emerges from the experts we spoke to is clear: If you’re using a compounding pharmacy, you better get to know your pharmacist and his processes real well.
That turns out not to be bad advice even for those who don’t use compounders. The pharmacist, thanks to a host of converging influences, is poised to take a far bigger part in patient care than his traditional role of dispensing pills.
The Affordable Care Act, for one, is expected to bring a huge influx of new patients, straining the capacity of already-overloaded primary-care practices. Beyond the emergence of minute-clinic models in pharmacies and other retail locations, legislation is being considered and in some cases has already been enacted that allows appropriately licensed pharmacists to provide immunizations and in some cases even write prescriptions after a physician’s diagnosis. A California law that took effect in January enables licensed pharmacists to independently furnish routine vaccinations, hormonal contraception, nicotine replacement medications and certain prescription drugs for travelers. The law also creates a new designation of “advanced practice pharmacist,” which would enable designated pharmacists (after receiving additional training and experience) to assess and refer patients; start, stop and adjust drug therapies; order and interpret drug therapy-related tests; and “participate in the evaluation and management of diseases and health conditions.” The law states that “pharmacists are health care providers who have the authority to provide health care services.” Such provider status legislation could allow more pharmacists to practice “at the top of their license,” that is, to the full extent of their training and education.
While the immediate impact of such changes is more likely to be felt in primary care, ophthalmologists need to be aware that the pharmacist is emerging as a potentially valuable and increasingly involved member of the health-care team.