Throughout 2024, NCPA has been asking state legislatures to pass bills giving pharmacists independent authority to prescribe and administer vaccinations and test-and-treat services for minor illnesses. Over 100 bills were introduced expanding pharmacists' scope of practice in those areas, as well as contraception, HIV PEP and PrEP, and tobacco cessation. This is the 2024 Year in Review for state-level scope of practice and payment for service legislation.
Community pharmacies are delighted to see policy catching up with what pharmacists have always been capable of, but there must be an understanding that scope cannot be expanded without an adequate way to reimburse pharmacists and ensure access to patients. Our latest State Wins documents shows impressive victories in expanding vaccination and testing services, with closer alignment with emergency permissions granted through the PREP Act:
In Minnesota, H.F. 5247 allows authorized licensed pharmacists to administer COVID-19 and influenza vaccines to patients 3 years and older and all other FDA-approved vaccines to patients 6 years and older without a prescription. It also includes permissions for pharmacists to order and administer CLIA-waived tests for COVID-19 and other minor illnesses.
Washington, D.C.'s B. 25-02545 authorizes pharmacists to order, perform and interpret results of CLIA-waived tests. Similar bills were passed aligning with the PREP Act protections but with higher age thresholds: Pennsylvania's H.B. 1993 authorizes pharmacists to administer the same vaccines for those five and older and all other ACIP-recommended vaccines to patients eight years and older. Kentucky's H.B. 274 and Ohio's S.B. 144 both authorize pharmacists to administer all vaccinations to patients as young as five.
Advocates have faced opposition from other health professional associations mostly based on not believing pharmacists have the adequate training to treat reactions to vaccines or certain treatment. However, the trust among the public and stakeholders that pharmacists can do so will continue to grow thanks to work by NCPA and other advocates to convince the U.S. Department of Health and Human Services to extend protections for pharmacists' vaccine and testing authority through 2029.
In addition to expanding the PREP Act we have seen great interest in prescriptive authority for HIV PEP and PrEP. In Louisiana, H.B. 579 authorizes pharmacists to order and perform rapid HIV tests to administer up to a 30-day supply of PrEP and/or 28-day supply of PEP. Delaware's H.B. 194 allows pharmacists to initiate HIV PrEP/PEP via a statewide protocol approved by the state's health department.
Florida and Maryland are two states that passed more limited legislation on treating HIV with both states permitting pharmacists to dispense PEP on a limited basis: Florida pharmacists can only administer PEP under a collaborative practice agreement, and in Maryland pharmacists can only be pursuant to a standing order.
The most comprehensive legislation we have seen that embraced a standard of care model has been Tennessee's S.B. 869, which grants broad prescriptive authority for not only vaccines and testing but for administering epinephrine, hormonal contraception, naloxone, and fluoride.
As popular as the scope expansion is, a lot of bills have not included pathways for reimbursement. The uptake of these services has not been as quick with pharmacists in these states since there has not been a payment model to sustain these services. Delaware and Minnesota have both passed legislation mandating insurance coverage for pharmacists' services and NCPA will be closely monitoring their implementation.
NCPA looks forward to the hundreds of more bills that will be introduced in 2025 as more states understand the benefits of pharmacists' care and their access to services.
