If you liked the premiere, you are going to love the sequel. In a huge move on August 19, the Secretary of the U.S. Department of Health & Human Services (HHS) has further amended his declaration of the Public Readiness and Emergency Preparedness (PREP) Act. In doing so, he has allowed pharmacists and pharmacy interns the ability to provide any Advisory Committee on Immunization Practices (ACIP) recommended vaccine to all children ages 3 to 18 during the public health emergency (PHE), regardless of state scope of practice. If you’re sitting there scratching your head thinking, “But…what about state scope of practice?” we will refer you to our previous post where we explained the power the Secretary of HHS gets during PHE to supersede state scope of practice law.
There is plenty to break down here on how this health policy impacts you and your practice. So, let’s get to it!
Let’s break down this amendment
The original declaration of the PREP Act by the Secretary was declared back in March. In May, he filed an amendment to allow pharmacists the ability to provide COVID-19 tests regardless of state scope. And now, with this Amendment, we see the government anticipating what is expected to be a rough flu season. Any pharmacist or pharmacy intern that meets the specific criteria outlined in the amendment (APhA put together a good overview of requirements here) can provide any ACIP recommended vaccine to children age 3-18 years old during the PHE, regardless of state scope of practice. This covers current vaccines and, when approved, the COVID-19 vaccine.
So why is this necessary? Well, in the first few months of the pandemic, 98% of primary care offices saw a decrease in revenue, meaning that patients weren’t receiving their normal preventative healthcare, including vaccines. According to the background information of the amendment, over 40% of pediatrician offices surveyed reported that either they were not planning to resume immunization services for all patients, or they were unsure of their future plans. This leaves a potential for a huge gap in patient care which could result in long-term negative health outcomes and economic consequences. This will not affect pharmacists in every state, but in those states that have age restrictions on some or all vaccinations, it opens the door for pharmacists to ensure children are receiving the care they need from an accessible and highly trained professional. We have included a map above of the states that are affected based on data from APhA / National Alliance of State Pharmacy Associations (NASPA) Survey of State Laws/Rules which was last updated in June 2020.
Further clarification was also brought to the PREP Act declaration to expand the definition of COVID-19 to cover other diseases that may be caused by the virus, or mutation of the virus, in the future.
Instead of a cherry on top of this sundae, let’s add some future-casting!
So, what does this mean for the future? This continued overruling of state scope of practice by HHS during the PHE is making at least a few pharmacists see state scope of practice laws in a different light. From those opposing scope of practice expansion of non-physician practitioners, it is a frequent talking point that expansion should be limited in order to ensure quality of care is maintained. However, at some time in hopefully the near future, we will face the lifting of the PHE, and on one day pharmacists will have the training in order to provide quality care through vaccinations to any child age 3-18 years old, and on the next day that training is no longer relevant. This calls in to question the purpose of scope of practice laws to be different from state to state. Is this truly a method to ensure quality of care is being provided? If so, why should a patient in Arkansas not be afforded the same quality of healthcare as someone in Florida? And is this quality really only different because of the PHE?
We have seen many of the rules and laws that have gone into effect only during the PHE begin to transition into permanent changes if they increase efficiency of care delivery without jeopardizing quality. There is the potential for a slew of legislative introductions to come following the lifting of the PHE to allow similar ability for pharmacists to provide vaccinations to children age 3-18 years old. However, this may not be the limit of the potential for change. With the overruling of state scope of practice, it calls into question why the service a healthcare professional can provide is dependent on where they practice. Maybe this will be the start of the conversation in the US for campaigns for standardized scope of practice for our healthcare team members? Only time will tell.
Final thought…Kudos to the advocacy work of our national pharmacy organizations for championing this win! If you have not already, give them some praise!
The Grassroots Pharmacist 