State-run pharmacy boards around the country are mirroring federal efforts to relax restrictions for health-care workers by easing local rules on licensing and drug distribution as the nation battles a pandemic.
At least thirteen states have offered some kind of reprieve for pharmacy professionals. Some of the biggest changes are green-lighting remote work, giving pharmacists more autonomy to handle certain prescriptions, and allowing out-of-state pharmacists and pharmacy technicians to practice locally if they’re licensed elsewhere. Some states, such as Arizona and California, are also letting out-of-state drug distributors sell products to local pharmacies, which could ease bottlenecks in local supply chains.
More states will likely ease burdens on local pharmacists and distributors to promote a broader network of care as cases of Covid-19 increase, regulatory lawyers predict. Georgia, Ohio, Missouri, Virginia, and Texas have already loosened restrictions on out-of-state pharmacists working in their communities.
“That’ll be helpful if one state is particularly heavy hit, so they can get out-of-state help,” Rachel Yount, a health-care regulatory attorney at Mintz, said.
Ohio Leading the Charge
Ohio has been especially proactive in altering its local rules to ease burdens for pharmacy professionals, Antonio Ciaccia, government affairs director at the Ohio Pharmacists Association, said.
The group keeps an extensive list of the changes Ohio’s pharmacy board has made amid the pandemic. They range from changes found in many states, like remote work approvals, to rarer guidance, like “curbing the stockpiling and inappropriate prescribing of chloroquine and hydroxychloroquine.” That’s the malaria drug President Trump had touted as a promising treatment for Covid-19, the disease caused by the new coronavirus.
A couple weeks ago, Ohio pharmacists were inundated with patient requests for the malaria drug. Clinical trials are underway to test it as a treatment, but evidence showing it works is slim at this point.
Pharmacists across the state saw huge surges in demand “the second it became popular in the news,” Ciaccia said. The drug also treats lupus and rheumatoid arthritis, and patients with those conditions were having trouble getting it.
Ciacca would know. It happened to his own mother. The Food and Drug Administration officially added the drug to its shortage list this week.
Now, Ohio patients that want the drug to treat Covid-19 have to meet multiple criteria before getting it, including a documented positive test result. Using it to prevent the virus is “strictly prohibited” unless it’s approved by leaders of the state pharmacy board. Nevada has similar restrictions, which are in effect until the end of June.
In many cases, though, new state rules are designed to expand access to medication during the pandemic.
Patients are able to refill their prescriptions early or get a bigger supply of their medication even if refills weren’t originally authorized by their doctors in states including Virginia, Maryland, Florida, and Arizona. States outline their own criteria for refills, while also encouraging pharmacists to use their “professional judgment” when deciding when to give a patient more of their medication.
Most of the waivers are tied to the governor’s declaration of a state emergency, which means they’ll sunset after the emergency is lifted.
Some of the temporary changes could be made permanent after the pandemic ends if they make pharmacies operate more efficiently, according to Kalie Richardson, a lawyer at Hyman Phelps & McNamara, who advises clients on pharmacy regulatory requirements.
“I wonder if things like adjusting staff supervision ratios or allowing pharmacists to perform certain services remotely, if there will be any consideration to incorporating things like that into the pharmacy regulations,” she said. They could be particularly helpful in remote areas where patients traditionally don’t have access to extensive health-care options.
Richardson was referring to laws that typically require certain ratios of pharmacists to supervise intern pharmacists within a facility. Some states, such as California, have relaxed those rules under emergency orders.
“There will be several buckets of trends,” she said, predicting that looser staff requirements and more remote work at pharmacies will be things that “just about every state will do.”