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Prescribing Authority for VA Pharmacists to Continue as is, for Now

Donna Young

The Department of Veterans Affairs (VA) has temporarily postponed changing its policy that defines the medication prescribing authority of clinical pharmacy specialists, nurse specialists, nurse practitioners, and physicians assistants.

Under the policy created in 1995, licensed clinical pharmacists who have an M.S. or Pharm.D. degree, are specialty board certified or have two years of clinical experience, and have completed a residency accredited by the American Society of Health-System Pharmacists may prescribe drugs to VA inpatients and outpatients. VA clinical pharmacy specialists may, in accordance with an established formulary or protocol, initiate, continue, discontinue, and alter a patient’s medication therapy. This authority preempts the standards of the state of the VA provider’s licensure and the state in which the clinical pharmacy specialist practices.

The 1995 policy was scheduled for replacement in June by a directive that would define VA providers’ prescribing authority as that set forth by the standards of the state in which the practitioner holds a license.

But the VA recently decided to postpone the policy change until June 2004.

In a March 18 memorandum, VA Secretary Anthony J. Principi said the proposed policy change would have an "adverse effect on VA’s ability to provide accessible" health care 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," Principi stated.

Principi has directed the Veterans Health Administration to "develop a uniform national policy that reflects the doctrine of federal supremacy as it relates to medication-prescribing authority" before June 2004, according to a VA official.