The NCSL Blog

03

By Kelsie George

Rural communities tend to have older and sicker residents compared to urban and suburban communities.

Credit: Centers for Disease ControlThe increased need for medical care and prescription drugs, coupled with scarcity of primary care physicians in rural areas, exacerbates many barriers to accessing necessary health care. Maximizing the use of pharmacists as part of the health care delivery system is among several state strategies to meet the unique health care needs of rural and underserved communities.

With nearly 9 in 10 Americans living within five miles of a community pharmacy, pharmacists are some of the most accessible healthcare professionals. Pharmacists are trained to test, treat and immunize for many infectious diseases, including influenza, and by practicing their full scope of practice within their training and license could alleviate pressure on the health care system created by the COVID-19 pandemic.

Along with dispensing prescription medications and offering expertise in the safe use of prescriptions to patients, pharmacists play an important role in enhancing public health and increasing access to care in rural and underserved areas in coordination with other health care providers.

As of May 2019, more than 311,000 licensed pharmacists work in drug, general merchandise and grocery stores as well as hospitals and other health care facilities. To practice, pharmacists must hold, at minimum, a bachelor’s degree, though most states require a doctor of pharmacy (PharmD) degree and pass the appropriate licensure exams. Each state has a board of pharmacy which regulates pharmacists, pharmacy interns and pharmacies within their state, as well as licensing applications, renewals and transfers.

Pharmacists are often the first line of contact for patients in rural communities and provide important advice on the safe use of prescription and over-the-counter medications to remedy symptoms until patients can schedule an appointment with their physician. 

In recent years, some states expanded pharmacists’ scope of practice to include prescribing certain medications (e.g., hormonal contraceptives, tobacco cessation aids) and modifying prescriptions under specific circumstances, either independently or in collaboration with the original prescriber. This allows patients to receive medications in a timelier manner.

Ten states allow pharmacists to prescribe hormonal contraceptives while 12 states allow pharmacists to prescribe tobacco cessation aids. In West Virginia, pharmacists are allowed to dispense self-administered hormonal contraceptives to patients 18 years or older if the pharmacist has completed a board-approved training program and have notified the patient’s primary care provider. Iowa allows pharmacists to prescribe nicotine replacement tobacco cessation products. 

Three states allow pharmacists to modify original prescriptions written by a physician. For example, Idaho allows a pharmacist to modify a prescription quantity, dosage form or complete missing information.

As health workforce shortages continue to grow, states will look for ways to increase access to health care, especially in areas facing primary care provider shortages like rural communities. Using pharmacists to help patients manage medications and address chronic illness is one strategy states may examine.

Please visit NCSL’s website ScopeofPracticePolicy.org for more information.

Kelsie George is an intern in NCSL’s Health Program.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.