Saying they want to make it easier for elderly Rhode Islanders to get their immunizations, several legislators have proposed a bill to allow pharmacists to administer injectable medications, biological compounds and adult immunizations.
Forty-four states already allow pharmacists to give immunizations, according to Rep. Patricia A. Serpa, D-West Warwick, lead sponsor of the measure. And pharmacists are trained to do so, she said, through a Centers for Disease Control and Prevention course they must take.
“Because most people, particularly the elderly, visit their pharmacies regularly, it would be very convenient for them to receive immunizations there instead of scheduling appointments with doctors or health clinics,” Serpa said in a news release about the bill.
Serpa added that studies have shown that during a pandemic, “there is a 30-percent increase in the number of individuals seeking immunizations.” Her measure, she said, “would ensure that everyone who needs an immunization shot receives one as quickly as possible.”
But both the Rhode Island State Nurses Association and the Rhode Island Medical Society oppose the bill.
“We don’t have a problem with flu vaccinations and emergency situations,” said Donna Policastro, executive director of RISNA. “We have a problem with the broad language of the bill. It doesn’t really protect the public.”
The problem, she said, is that while legislators “keep calling it the immunization bill,” in fact, the language allows pharmacists to administer far more.
The exact wording of the bill says that pharmacists would be allowed “the administration of injectable medications, biologicals, and adult immunizations pursuant to a valid prescription or physician-approved protocol.”
Injectable medications is a broad category; the specialty pharmacy of PharmaCare, the CVS Corp. prescription benefits management subsidiary, lists more than 50.
“I think the problem the nurses association was having was with the injection of biologicals,” Serpa said by phone. After the first round of testimony on the bill, she noted, “they were going to work it out with the Rhode Island Pharmacists Association. And I do believe that [a compromise] can easily be worked out.”
Policastro said that RISNA had alerted the pharmacists’ group to its position, but she hadn’t heard back as of Tuesday.
Policastro also said that states with this type of legislation in place have standardized assessment courses in their colleges’ pharmacy departments, but the University of Rhode Island does not.
She said that without proper training and emergency equipment on site, patients’ lives could be in danger from injectables if they have a reaction, such as anaphylactic shock – the most severe form of allergic reaction. “This is not about a turf issue; it’s a public safety issue,” she stressed.
The R.I. Department of Health and its Board of Pharmacy officially support the bill, said spokeswoman Andrea Bagnall Degos, though she added: “We just want to ensure that there is appropriate training and qualifications.”
Pharmacists’ giving injections is not a new issue in Rhode Island. The Pharmacists Association Web site includes an issue brief on the topic from 2002 that traces the idea back to 1999.
In the 2000 legislative session, the institute and the Pharmacists Association proposed a bill that would update the Pharmacy Practice Act, provide for collaborative practice between pharmacists and other professions, and allow pharmacists to administer adult immunizations.
The Medical Society opposed such a comprehensive measure, the issue brief says, so the pharmacists have worked for passage of their agenda in increments, passing the first two in 2000 and 2001, respectively. They are still working on the third item.
The issue brief notes that in the meantime, “properly trained and certified pharmacists in other states” are giving shots for tetanus and diphtheria, influenza, pneumonia, hepatitis, and more.
Serpa said her bill would benefit pharmacy graduates in Rhode Island, who are now among the few in their profession who can’t give injections, even though they have the CDC training and they must carry malpractice insurance.
“So, they get their Ph.D.’s, but there’s no mechanism in place for them to master the art of administering injections,” she said.
Serpa’s news release also touts another potential benefit of the legislation: By promoting preventive care such as immunizations, it could reduce health care costs, because fewer people would need to be hospitalized.
“Reducing illness and hospitalization indirectly addresses the critical shortage of nurses and the mandatory overtime [for nurses] issue,” Serpa added.
