Measure to expand role and responsibility of pharmacists expected to pass Knesset vote

A portion of a 2010 law giving pharmacists more involvement in prescriptions and advice to patients is expected to be implemented soon, after a Knesset committee voiced majority support last week.

By JUDY SIEGEL-ITZKOVICH
Pills medicine medication treatment (photo credit: Srdjan Zivulovic / Reuters)
Pills medicine medication treatment
(photo credit: Srdjan Zivulovic / Reuters)
A portion of a 2010 law giving pharmacists more involvement in prescriptions and advice to patients is expected to be implemented soon, after a Knesset committee voiced majority support last week.
Most members of the Knesset Labor, Social Affairs and Health Committee offered support for the measure, and it is expected to hold a vote on it soon, which would lead to implementation. The Israel Medical Association, which fears physicians will be consulted less and pharmacists will take over some of their traditional roles, has voiced concern over the measure. The IMA is lobbying against it, the Health and Finance ministries favor it and the pharmacists are divided because they will not get special pay for their extra work.
The IMA claims that the law, which was part of the Treasury’s Arrangements Law of 2010, will “harm public health, create a situation endangering safety and efficacy in medical care and unreasonably risk the privacy of patients.”
According to the law and regulations, a patient with a chronic condition may go to a licensed pharmacist and ask for a repeat prescription without going to a physician.
This, of course, will reduce visits to doctors and save health funds’ quarterly, per patient doctors’ fees.
In addition, any patient can receive a prescription for a one-time medication for a skin infection or other acute problem. This, says the IMA, will lead to primary or continued care without the doctor seeing the patient. The pharmacist will be able to give a prescription for up to six months after the doctor’s original prescription expired.
Only pharmacists with at least five years of experience will be able to prescribe drugs on their own.
The IMA, which represents most physicians working in the public medical system, charged that patients coming into pharmacies will not have privacy and that customers will be privy to their personal medical situation.
Dr. Eyal Schwartzberg, an experienced clinical pharmacist who worked at Emek Medical Center before moving to the Health Ministry to head its pharmaceutical branch, told The Jerusalem Post that many health fund pharmacies, if not private ones, have already set up consultation rooms for patients. Thus he denied that patients’ privacy would be compromised.
Schwartzberg, who favors the Health Ministry initiative, insisted that the arrangement would not be compulsory for either the doctor or patient and that it would be carried out voluntarily, without payment being made to the pharmacist or his organization.
They will do this to provide better care for the patient as a public service, he said, adding that pharmacists will not sell more expensive medications, as for chronic conditions, the medication given will be the same one the patient had, and for acute conditions, there is a limited number of products.
“It will make life easier for patients, especially in the periphery, where there are fewer pharmacies,” he said.
He doesn’t envision private pharmacies joining the arrangement unless the public health funds sign contracts with them on giving counseling on medications.
The ministry “honors doctors as primary prescribers. We are thinking of giving other medical professionals room to expand their responsibilities as well, given the fact that in 10 years there won’t be enough family physicians and the population is aging,” Schwartzberg said.
Howard Rice, a veteran but retired pharmacist who used to head the Israel Pharmacists Association (of private pharmacists), said he favors the reform in principle but insists that it won’t work unless pharmacists are paid for this extra work.
“It would take an average of 20 minutes for each consultation. I believe that the doctors have brought this on themselves. since so many have their secretaries write the repeated prescriptions anyway.”
Rice, who owned a private pharmacy in a prime Tel Aviv neighborhood, closed it down a few years ago because he “sold only medications and not cosmetics. There was no way to earn a decent living, so I closed it and rented out the premises. Now I am involved in research and consultancy,” he said. “Many others have followed suit.”
There are some 850 private pharmacists and 700 health fund pharmacies.
He noted that the IMA’s claims that pharmacists lack the training to advise patients are wrong. Many pharmacists have more clinical pharmacology training than physicians.
But “the true name of this governmental move is how the heath funds can save more money to waste on services and treatments that they could and should have avoided in the first place. Most physicians in Israel receive poor payment for the enormous responsibility and time they provide to patients. Pharmacists are in the same position, as indeed are most health care professionals in Israel,” he said.
Rice added that “the doctor is not always available, and the patient [usually on Fridays or the eve of festivals] finds himself without medication. What should he do? Go to any doctor? Go to the emergency room at a hospital? To do his job properly the pharmacist must know the medical profile of the patient, even the foods he eats and nonprescription things he takes.”
Rice concluded: “It is high time that the Health Ministry took the bull by the horns and insisted on what is called in the more advanced countries ‘Western collaborative care’: The physicians work hand in hand with the pharmacist and both work hand in hand with all healthcare professionals for the benefit of the patient.
“In England and Scotland, for example, this already occurs, and in the latter, when one patronizes a new pharmacy, one has to formally register with it and the file goes with him.”