March 15, 2019
TPA applauds Tennessee Board of Pharmacy President Debra Wilson and members of the Tennessee Board of Pharmacy for adopting a Policy Statement on Preventive Care during their meeting in Nashville earlier this week. This Policy Statement provides pharmacists with greater clarity regarding pharmacists’ provision of preventive care pursuant to Tennessee Board Rule 1140-03-.17 governing Collaborative Pharmacy Practice. Through the adoption of this policy statement, the Board has provided pharmacists with much-needed guidance regarding their role in preventive care and helped to ensure that patients in Tennessee have access to pharmacist-provided preventive care.
Current Board rules state that pharmacists are permitted to provide preventive care pursuant to collaborative pharmacy practice agreements which do not require a diagnosis. This policy statement identifies preventive care services that may be provided by pharmacists in this manner, such as screening and identification, performing CLIA-waived laboratory tests, ordering laboratory tests, treatment, clinical interventions, medication optimization services (including the prescribing, administration, and therapeutic optimization of medications and non-medication therapies), and initiation of patient referrals to physicians, advanced practice nurses, and physician assistants.
This policy does not authorize pharmacists to independently prescribe medications for preventive care. The Tennessee Board of Pharmacy will continue to review collaborative pharmacy practice agreements to ensure that agreements meet the Board’s existing rules.
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Tennessee Board of Pharmacy Policy Statement on Preventive Care
This Tennessee Board of Pharmacy policy is intended to provide guidance to pharmacists regarding collaborative pharmacy practice agreements with prescribers authorizing the provision of preventive care which promotes patient health and does not require diagnosis appropriately made and documented by the physician, advanced practice nurse or physician assistant, as identified in Tennessee Board of Pharmacy Rule 1140-03-.17 (5)(b). Under this Board rule “all care and services provided, except immunizations, opioid antagonists, and preventive care, must be pursuant to a diagnosis appropriately made and documented by the physician, advanced practice nurse or physician assistant.” In addition to immunizations, opioid antagonists, and preventive care identified in this Board rule, Tennessee Board of Pharmacy Rule 1140-15 authorizes pharmacists to prescribe and dispense hormonal contraceptives through non-patient specific collaborative pharmacy practice agreements, which does not require a diagnosis, with prescribers.
Preventive care maintains patients’ health to avoid or delay the onset or progression of certain preventable diseases, conditions, and other illnesses. Specific to this Board rule, pharmacists are authorized to provide preventive care, including the identification of potentially serious health conditions and provision of early treatment of those conditions, pursuant to collaborative pharmacy practice agreements with prescribers which do not require a diagnosis. Pharmacist-provided preventive care under this rule may include screening and identification, performing CLIA-waived laboratory tests, ordering laboratory tests, treatment, clinical interventions, medication optimization services (including the prescribing, administration, and therapeutic optimization of medications and non-medication therapies), and initiation of patient referrals to physicians, advanced practice nurses, and physician assistants.
Under this Board policy, the Tennessee Board of Pharmacy provides the following policy statement regarding preventive care in Board Rule 1140-03-.17. Preventive care may include, but is not limited to:
- Emergency allergic reactions
- Seasonal and chronic allergic rhinitis
- Travel health
- Smoking cessation
- Screening, prevention, and treatment of influenza and streptococcal infections
- Herpes and herpes-related conditions
- Dermatologic conditions
- Reduction in therapeutic gaps in care for chronic conditions (such as diabetes, hypertension, hyperlipidemia, chronic heart failure, chronic lung disease)
- Alcohol and drug abuse
- Lifestyle modifications and weight loss management
- Mental health and depression
- Prevention of falls
- Osteoporosis and bone health
- Medication-related clinical guideline optimization (such as BEERS and STOPP/START criteria, reduction of duplicate meds, discontinuation of unnecessary or potentially inappropriate medication therapies)
- Acid reflux, gastroesophageal reflux disease, and heartburn
- Lice and scabies
- Vitamins and supplements (such as folic acid, prenatal vitamins for fetal health, vitamin B12, Vitamin D)
- Penicillin skin testing
- Prophylaxis of cytomegalovirus, pneumocystis jiroveci pneumonia, and other common infections in immunocompromised patients
- Prophylaxis of urinary tract infections
- Prophylaxis of meningitis
- Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP)
This policy is not intended to change or conflict with pharmacist-provided care and services currently authorized under a pharmacist’s scope of practice in Tennessee Code Annotated 63-10-204(39)(a) and (b).
This policy does not supersede or replace any requirement or obligation listed in statutes or rules pertaining to collaborative pharmacy practice. This policy defines preventative care as excluding the requirement for a patient-specific diagnosis. All other requirements of collaborative pharmacy practice remain in place.
ADOPTED BY THE TENNESSEE BOARD OF PHARMACY ON MARCH 12, 2019.
To download the policy, as well as background and rationale, please CLICK HERE.