Proof in the Pudding: More Pharmacists Are Prescribing

Pharmacists have some prescriptive authority in all 50 states, but are they using it? We studied the data on e-prescribing and published the results in the Journal of the American Pharmacists Association (JAPhA). Here’s what we found.

Understanding prescribing trends among pharmacists is important to Surescripts because it can illustrate the impact of technology, policy and payment on pharmacy practice. As a clinical pharmacist, I had a personal curiosity to do this analysis.

During my residency training, I practiced in a family medicine clinic, where I prescribed under a collaborative practice agreement (CPA). Our physicians would diagnose the patient and the pharmacy team would start and adjust the patient’s medications. Everyone on the care team had a job. Ours was to monitor and manage medication—a task that pharmacists are uniquely trained and qualified to do.

After residency, early in my career as a clinical pharmacist, I had a home-based medication therapy management practice. I would visit patients in their homes to review their medications and identify opportunities for optimization. I loved it. My patients needed help coordinating care with their pharmacy and provider teams, and although I didn’t have prescriptive authority, I could see the difference these home visits made. Being in a patient’s home gave me a unique understanding of how medication was impacting the patient’s life, and this patient-centered point of view is the kind of thing that brought me to pharmacy in the first place. Unfortunately, not having prescriptive authority can make medication optimization a bit more challenging.

Certainly, I am not the only pharmacist who has had experiences like these. Prescriptive authority for pharmacists varies across all states, and the volume and characteristics of prescribing among pharmacists aren’t widely available. So, what’s the bigger picture? What are the broader trends?

A Clear Increase in Prescribing Among Pharmacists

With my Surescripts colleagues Mark Hsieh, Joud Roufael, Sharon Kim, Geeta Panwalkar and Max Sow, we set out to identify trends in prescribing among pharmacists as compared to primary care providers. To do this, we analyzed e-prescriptions initiated through our network from electronic health record (EHR) systems from 2019 through 2022.

• What we found: Electronic prescribing among pharmacists increased markedly, owing to state regulation, reimbursement, and access to technology like EHRs.
• By the numbers: The number of e-prescriptions prescribed by pharmacists increased 47% (n=814,726 to n=1,199,601), and the number of pharmacists themselves who were prescribing increased by 122% (1,650 to 3,664).

The number of e-prescriptions by primary care providers, however, increased by only 4%, which suggests that there isn’t as much room for growth among these providers, who are likely prescribing at maximum capacity.

Between the Lines

In our study, we found that pharmacists are increasingly helping patients manage conditions like diabetes and heart disease with prescriptions for warfarin and metformin, for example, and insights like these are critical to gauging the impact of prescriptive authority.

As the results of our study suggest, there is ample opportunity to expand the scope of practice for pharmacists—not to usurp the role of a primary care provider or any other physician, but to work collaboratively as part of the care team.

It’s clear that pharmacists have their own role to play in patient care, a role that goes beyond putting pills in a bottle, and more like the home visits, medication therapy management and prescribing I did as a clinical pharmacist.