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Pharmacist-Physician Proposal Draws Renewed Debate

After the state Legislature approved a law that expanded the types of health care that pharmacists can provide, a deal between physicians and pharmacists to fast-track collaborative practice arrangements might be unraveling.

The Florida Board of Pharmacy announced this week that it was revisiting a proposed rule to include “heart/cardiovascular disease” and “mental health” on a list of chronic medical conditions that pharmacists would be authorized to treat. A meeting of the Board of Pharmacy Rules Committee has been scheduled for Aug. 24.

Florida Board of Osteopathic Medicine Chairman Dr. Joel Rose said adding the conditions to the proposal will cause delays in the rule adoption. Rose was one of a handful of physicians who consulted with the Board of Pharmacy Rules Committee over the summer on developing the proposed rule meant to carry out the law passed during this year’s legislative session.

“My position was, move with what we agreed upon and get it started. Get things in place and then come back and look at other areas,” Rose, a Tampa physician, told The News Service of Florida on Wednesday. “Now we are going to have to go back and meet and consider these other areas.”

The new law (HB 389) allows certain pharmacists to enter into collaborative arrangements with physicians to treat patients for chronic medical conditions. Those conditions include arthritis; asthma; chronic obstructive pulmonary diseases; Type 2 diabetes; human immunodeficiency virus or acquired immune deficiency syndrome; and obesity. 

The law allowed the Board of Pharmacy to expand the list of chronic medical conditions to include “any other chronic condition adopted in consultation with the Board of Medicine and Board of Osteopathic Medicine.”  

The Board of Pharmacy Rules Committee held two meetings with representatives of state physician boards on the proposed rule. An early version would have authorized pharmacists working in collaboration with physicians to “treat any disease that is expected to last greater than one year or more.” 

But the provision drew the ire of groups such as the Florida Medical Association, the state’s largest physicians organization, which argued that the inclusion of a “catch-all” phrase ran afoul of the law.  

Ultimately members of the Board of Pharmacy Rules Committee agreed to eliminate the broad phrase. 

Also eliminated from an early iteration of the rule was a provision that would have authorized pharmacists to treat osteoporosis and osteoarthritis.  And while there was sentiment among some members of the Rules Committee to include heart disease and mental illness in the proposed rule, they agreed at the time to only add opioid abuse disorder; hypertension; hyperlipidemia; smoking cessation; and anticoagulation management in the proposed rule.

Board of Pharmacy Rules Chairman Jeffery J. Mesaros didn’t immediately respond to request for comment.

“The  big issue …  is whether to add cardiovascular disease and behavioral health and whether those terms need to be narrowed,” said Chris Nuland, a Jacksonville health care attorney who lobbies for physician groups and closely tracks the state’s medical licensure boards.

The full Board of Pharmacy is scheduled to meet Aug. 25. Mesaros is  scheduled to provide an update to the full board on the proposal.