“The one major difference between pharmacy and a lot of the other health professions is that we’ve been operating under what we call a bright-line-rules enforcement strategy,” says Deeb D. Eid, director of government relations for Empower Pharmacy, a Houston-based compounding and mail-order pharmacy. “So, you know, there are rules out there that tell you the square footage that your pharmacy countertop needs to be.”

Eid, a former pharmacy professor at Ferris State University, believes pharmacy regulation is limiting patients’ access to necessary treatment, and he joins the Overton Window Podcast to discuss how states are rethinking prescription-drug rules by expanding pharmacist authority and simplifying licensing laws.

“Idaho was really the flagship state that went down the pathway of looking at things from an evidence-based perspective,” says Eid. “Do more rules equal safer? Is it plausible to say that the more regulations, the more legislation we have, the safer it is for our pharmacists, but also really for the public in that state? The main thing that these agencies are tasked with is protecting the public.

“[Idaho] went down a pathway of standard of care. So, looking really deeply at what is in their rules. Is there precedent to that rule? Does it actually have evidence? What’s the burden of proof that comes with the regulation or the legislation that’s in place? And they went down the pathway. It’s been a long journey, and other states have followed since.”

State-by-state reform is a heavy task, according to Eid.

“We looked at the laws and rules on administering immunizations in all 50 states,” Eid says. “We wanted to get a word count across the entire country of one piece of practice that is shared among medicine, nursing, and pharmacy. The act of administering a vaccine is the same, regardless of whether you’re a nurse, a doctor, or a pharmacist. It's the same act. It doesn’t take anything different to be able to administer that vaccine. So we tried to level the playing field.

“We found that pharmacy had 57,000-plus words compared to medicine, which had 15,000, and nursing which had 4,000 words. And that's across the entire country. So why does it take pharmacy that many more words in their rules and laws to be able to do the exact same function? It just just does not make sense when you really think about it from a logical perspective.”

He points to the need for reforms in how state laws govern standard of care and full practice authority.

“I look at standard of care and full practice authority as a lock and key,” says Eid. “People sometimes get mixed up. They think that standard of care means full practice authority. They’re really two separate things and and it’s important to keep them separate. Standard of care is the enforcement philosophy that you know what decision a prudent pharmacist or healthcare professional would make with the same education, training, knowledge, and following the same standards. Full practice authority is what you are legally allowed to do within the laws and rules of your state.

“But they’re really related in a way, and they're required, I think, to unlock the full scope of what you're asking over restrictions on things like can you go into a pharmacy, can you walk into a clinic and see a pharmacist and have them be able to sit down with you or evaluate what's going on. Maybe you’ve got a scratch in your throat. You’re thinking you have the flu or your strep, or maybe your kids or some loved one out there needs access to that care after hours when clinics aren’t open. And so we’ve seen an expansion, I’ll call it, of what authority pharmacists have in various states.”

He points to the unique position of the pharmacy industry in the individuaL medical experiences of Michiganders.

“Pharmacists are the most accessible healthcare professionals around,” Eid says. “Drive around anywhere and you're probably gonna see two or three pharmacies at almost every corner, maybe not as many in rural areas like we have here in Michigan. But there are pharmacists behind the scenes often in your hospitals and clinics, and in many other places, able to offer those types of services. These are things like prescribing, deprescribing, can we offer point of care testing for things like strep and flu and COVID? Are we able to administer medications and vaccines? And so when you when you look at full scope, what we really mean by that is the the ability to offer the full scope within that person's education, training and knowledge, and that goes right back to the standard of care.”

Listen to the full conversation on the Overton Window Podcast.

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