Pharmacist Prescribing: “Test and Treat”

There is growing policy interest in pharmacist prescribing based on the results of a rapid diagnostic test.

Current Landscape:

• Direct Prescribing Authority:

1. 1. Arkansas (2021): can treat, via statewide protocol, health conditions that can be screened utilizing CLIA-waived tests
   2. Colorado (2021): can prescribe drugs for conditions that have a test used to guide diagnosis or clinical decision-making and is CLIA-waived
   3. Delaware (2022): can order, test, screen, and treat, pursuant to a statewide protocol, health conditions including flu, strep, COVID, other respiratory diseases, lice, certain skin conditions, and other existing or emerging public health threats when identified and permitted.
   4. Idaho (2018): can prescribe drugs for conditions that have a test used to guide diagnosis or clinical decision-making and is CLIA-waived
   5. Iowa (2021): can prescribe, via statewide protocol, tests and treatment for flu, strep, and COVID
   6. Kansas (2022): can initiate treatment, via statewide protocol, for flu, strep, and UTI

• Delegated Prescribing Authority/Collaborative Practice Agreements:

1. 1. Beyond direct statewide prescribing authority, many states have CPA authority broad enough to allow pharmacists to prescribe pursuant to a rapid diagnostic test. Based on NASPA’s research, these states include:
      • Florida*, Idaho, Illinois, Kentucky*, Michigan, Minnesota, Montana, Nebraska, New Mexico, North Dakota, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, Wisconsin, Wyoming (18)
   2. Florida (2020) allows pharmacists test and treat for minor, nonchronic conditions (including strep and flu) under a protocol with a physician. Because the protocol requires a physician’s signature, it functions more as a CPA than a statewide protocol.
   3. Kentucky allows pharmacists to use board approved protocols to test and treat for flu, strep, UTI, and other conditions. Because all of the protocols require a physician’s signature, they function more like CPAs than statewide protocols.

NASPA Pharmacy-based Point-of-Care Test & Treat National Certificate Program

Research Articles:

• Utilization of influenza and streptococcal pharyngitis point-of-care testing in the community pharmacy setting
• A community pharmacy-based influenza screening and management program shortens time to treatment versus pharmacy screening with referral to standard of care
• Time and motion study of influenza diagnostic testing in a community pharmacy
• Effectiveness of a pharmacist-physician collaborative program to manage influenza-like illness
• Community pharmacist-physician collaborative streptococcal pharyngitis management program
• A feasibility service evaluation of screening and treatment of group A streptococcal pharyngitis in community pharmacies
•  Pharmacy-based management of influenza: lessons learned from research

Other Resources:

• Implementation guide from the Community Pharmacy Foundation and Washington State University

 

Click Here to Go to the Pharmacist Prescribing Resource Page