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 (17)
   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

 

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