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Medication Prescribing Authority for VA Pharmacists to Continue for 2 Years

Cheryl A. Thompson

ASHP’s Government Affairs Division recently learned that Department of Veterans Affairs (VA) clinical pharmacy specialists with medication prescribing authority may continue to practice as they have been doing.

The following information is provided by ASHP's Government Affairs Division.

There is good news for pharmacists practicing in the Department of Veterans Affairs (VA). Many members have asked us about the status of the "Medication Prescribing Authority" proposal that is anticipated from the Department of Veterans Affairs (VA). The last Unified Regulatory Agenda, published in the Federal Register on December 3, 2001, indicated that the VA hoped to issue an Advance Notice of Proposed Rulemaking (ANPR) by the end of last year. That did not happen.

The good news is that, on March 18, VA Secretary Anthony J. Principi issued a memorandum stating that he had decided to postpone the deadline for application of the scope of practice provisions in VA Directive 2001-082 for two years, until June 30, 2004. During this period, the VA will "develop a uniform national policy for prescription authority" that will be incorporated into VA regulations. Secretary Principi’s memorandum states that, meanwhile, there will be no change in the prescribing authority for advanced nurse practitioners (ANPs), clinical pharmacy specialists (CPSs), and physician assistants (PAs) that was described in VA Directive 10-95-019. The Secretary’s rationale for this decision is that changes to the prescribing authority for nonphysician prescribers "would have an adverse effect on VA’s ability to provide accessible healthcare to veterans. It will result in variability in the scope of practice within the same professional groups. This variability will make privileging problematic for VA facilities and make supervision of VA providers more complex. It may make it even more difficult for VA to provide care to veterans in rural and other underserved areas."

ASHP had been informed by VA staff that the long-anticipated ANPR on "Medication Prescribing Authority" has been reviewed by the Office of Management and Budget (OMB), and that OMB has asked the VA to clarify some issues in the proposal. Secretary Principi’s March 18 decision memorandum will have considerable effect on the wording of the ANPR, as he has instructed the VA’s general counsel "to ensure directives and regulations issued to implement the uniform national policy developed pursuant to this decision apply the Federal supremacy doctrine to as to protect both the Department and individual providers from any adverse action by the States as a result of the exercise of the policy."


Instead of issuing an ANPR, as it had planned to do for almost two years, the VA issued a directive (2001-082 – "Medication Prescribing Authority for Clinical Nurse Specialists, Nurse Practitioners, Clinical Pharmacy Specialists and Physician Assistants") stating that, as of December 31, 2001, a previous directive issued in 1995 (10-95-019 – "General Guidelines for Establishing Medication Prescribing Authority for Clinical Nurse Specialists, Nurse Practitioners, Clinical Pharmacy Specialists and Physician Assistants") that established medication prescribing authority for ANPs, CPSs, and PAs would expire. Within six months—that is, by June 30, 2002—these practitioners must comply with the new VA policy "that prescribing authority for non-physician clinicians is based on the individual’s State licensure, registration or certification"—that is, the practitioner’s state of licensure, registration, or certification, not necessarily the state in which the VA facility is located. Early in March, our contacts at the VA indicated that the advice that VA headquarters had been giving to the field was for practitioners not to make any change in what they were doing that could negatively impact patient care.

The 1995 VA directive (10-95-019) gave ANPs, CPS, and PAs medication prescribing authority so that the "VA can provide high quality care through the proper utilization of a variety of well qualified and appropriately credentialed health care providers." Under this directive, local VA facilities would develop a scope of practice to "identify the individual’s prescriptive authority as well as a description of routine and non-routine professional duties and the general areas of responsibility to be performed." The directive also stated that "because States cannot regulate the activities of the Federal Government, or its employees when acting within the scope of their Federal employment, except by congressional consent, State laws and regulations relating to medication orders and prescriptions do not affect scope of practice statements under this Directive."

This issue is extremely important to ASHP, as we have long pointed to the authority that VA pharmacists have under Directive 10-95-019 for drug therapy management as a model for the private sector and as an example of collaborative practice to encourage the states to enact collaborative drug therapy management legislation.

One way that VA pharmacists can keep up-to-date on the issue is through a monthly teleconference with VA headquarters relating to VA pharmacy, which is held the third Wednesday of every month, beginning at 2:00. The chief pharmacist at VA facilities can be contacted for an invitation to sit in on the teleconference.

For further information, please contact Gary C. Stein, Ph.D., ASHP’s Director of Federal Regulatory Affairs at 301-657-3000, ext. 1316, or