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4/13/2004

New Jersey Modernizes Pharmacy Practice Act

Kate Traynor

The state of New Jersey is poised to implement a new pharmacy practice act, which declares pharmacists to be health care providers and sets the stage for pharmacists' involvement in collaborative drug therapy management (CDTM).

The new pharmacy practice act was signed into law Jan. 14 to replace the state's previous act, portions of which date from the early 1900s. There is a 180-day delay before the statute goes into effect—a delay that allows regulations to be adopted to give form to the new law.

Edward G. McGinley, president of the New Jersey Board of Pharmacy, said that the old practice act "didn't have a definition for the practice of pharmacy."

Instead, he said, the previous act dealt with governance and did not "enable or empower pharmacists to use their training," he said.

McGinley said that the new act gives the pharmacy board the authority to oversee the practice of pharmacy. "But," he added, "the actual implementation of these new changes will occur through the writing of new regulations."

Many of the changes that expand the scope of pharmacy practice in the state require the state board of pharmacy to collaborate with the state's medical licensing board.

"The act provides that regulations for collaborative drug therapy management, medication administration, and immunizations must be jointly promulgated by the pharmacy board and the state board of medical examiners," McGinley said. He added that representatives of the two regulatory groups plan to meet in late May to work on the CDTM regulations.

New Jersey is the 40th state to legislate CDTM provisions for pharmacists. Hospital pharmacies that operate under the guidance of a pharmacy and therapeutics committee are exempt from the CDTM provisions of the new law.

Specific features of the new act include:

  • A provision that allows qualified pharmacists to administer immunizations and drugs in "programs sponsored by governmental agencies that are not patient specific,"
  • A provision that pharmacists may dispense a different dosage form of a drug than was prescribed if the prescribing physician is notified within 48 hours after the prescription is filled,
  • A list of definitions for terms related to the practice of pharmacy,
  • Language that defines the role of pharmacy technicians and places them under the authority of the board of pharmacy, and
  • Language defining the responsibilities and authority of the state board of pharmacy to regulate the practice of pharmacy in the state.

McGinley said that the pharmacy act is based mostly on the National Association of Boards of Pharmacy's model practice act.

Robert Adamson, director of legal and public affairs and president-elect of the New Jersey Society of Health-System Pharmacists (NJSHP), said that the support of pharmacists in the state was critical to getting the practice-act legislation passed.

"Our pharmacy society, as well as other pharmacy societies in New Jersey, as well as the pharmacy community, were all rallying around to try to get the bill changed, updated to current practice standards, and then also to try to expand our role with collaborative drug therapy management," he said.

Adamson said that controversy about the CDTM provisions held up enactment of the bill, which the state legislature eventually passed after about eight years. He speculated that without the CDTM provisions—which he described as a "hot topic"—the act "would have sailed right through years ago."

Adamson and McGinley said that physicians and nursing groups in the state initially opposed the updated act and that it took time to overcome that opposition.

"Ultimately," McGinley said, "all parties involved ended up giving and taking a little bit" to produce an acceptable final product.

Adamson said that NJSHP lobbied hard to get the state legislature to pass the practice act.

"The first dialogue that we had [noted] that, generally speaking, most of the diseases that we wind up treating will have some of medication component tied to them," he said. "If we take a look at who really has been trained almost exclusively to worry about medication management, it would be a pharmacist."

Adamson said that NJSHP emphasized to lawmakers the role pharmacists could play in managing medication use, improving patient safety, and lowering medication costs.

He said that publicity about the 1999 Institute of Medicine report "To Err Is Human: Building a Safer Health System" and, later, the addition of an outpatient prescription drug benefit to Medicare put a favorable spotlight on pharmacy.

"It was perfect timing for us," Adamson said. "We were fortunate to be focused on these things at a time when everybody was receptive to the message." Legislators, he added, "wanted to get our feedback on where things were heading, just as much as we wanted them to help us move forward" with modernizing the practice act.

Adamson said that working with the legislature was new territory for NJSHP. At first, he said, "we really didn't know how to do this."

Eventually, he said, "we began going to the fundraisers, we began writing the letter campaign, visiting our state senators. We went to see our New Jersey congressman in Washington during [ASHP's] Legislative Day."

At first, Adamson said, he was intimidated by the idea of getting his legislators to listen to him, but that soon changed.

"You have to remember that the state senators, your U.S. congressman—they have to listen to you," he said. "If you make an appointment with them, they will eventually see you, because everybody wants to get elected," he explained.

Adamson said NJSHP now believes that staying politically active is "the only way" to advance its agenda.

"We're actually going to really take legal and public affairs very seriously," he said. "We're just going to keep doing letter campaigns, still call our state senators, go to Legislative Day—all of the these things are very, very important, and we really didn't realize that until very recently."