This article is more than 5 years old. Information may no longer be current.
Alaska seeks oral prescribing privileges
Click Here to Manage Email Alerts
ANCHORAGE, Alaska — Since June 11, 1992, optometrists in Alaska have been authorized to diagnose, treat and manage any conditions of the eye — including glaucoma — and its appendages as long as the medication is topical. Currently, the state has a bill on the floor of the Senate that would allow practitioners here to use any drug related to the eye, including controlled substances, excluding Schedule I and II.
Expanding the current therapeutic pharmaceutical agent (TPA) law to allow oral medications would further improve eye care in the state, especially in the more rural areas, said Jeffrey Gonnason, OD, Alaska Optometric Association immediate past president. “The TPA law greatly opened up better access to eye care, because our state has areas where there are no ophthalmologists for 1,000 miles, but there is an optometrist there,” he said. “We have the most rural areas of all the states; we call them the ‘bush.’ In the past, the bush communities have had eye care assistants where people with just a few weeks of training at the public health hospital were handing out drugs. That was a big supporting point for TPA [legislation]. In these communities, the quality of care has greatly increased with optometrists having treatment privileges. The state has a budget audit committee, and they pointed out that there was better access of care available, and there were no complaints to the state board.”
Dr. Gonnason said that the legislature is in recess until January 2000.
TPA privileges improved OD/MD relations
Since optometrists have taken a more active role in the comanagement process, Dr. Gonnason said, the relationship between optometrists and ophthalmologists has taken a positive turn in the past several years. “We had very little communication with them before; we would refer our patients to them and occasionally they’d send them back to us,” he said. “We don’t refer patients for treatment of garden-variety conditions anymore, but by the same token, we’re comanaging laser and cataract surgery. The TPA law didn’t make that much of a difference at all, except for improved communication with some of the ophthalmologists because of comanagement issues.”
While the relationship has strengthened, Dr. Gonnason said that conditions are still far from flawless. He said that MDs are still opposing the amplification law in light of the state’s optometrists applying for systemic drugs and laser and limited surgery 2 years ago. “They opposed that vigorously,” he said. “Even the American Academy of Ophthalmology sent materials to legislators, opposing us. So my feeling is that they’re drawing the line at laser and surgery.”
By requesting only orals, Dr. Gonnason said, any opposition should be kept to a minimum. “The word was that if we didn’t ask for lasers and surgery, they weren’t going to waste their time fighting it, as 37 other states have orals,” he said. “But the ophthalmologists have enlisted the Alaska State Medical Association to oppose us. So there was a little bit of opposition, but the bill is still moving.”
Hospital access
Dr. Gonnason said that he is not aware of any optometrists in the state who are permitted hospital privileges. “We don’t know of anyone who has hospital access at this point, although two of our ODs are on the boards of the hospitals in their town,” he stated. “These are rural areas where they call the OD in for consultation, but I don’t know if they have official privileges or not.”
He added that direct access, however, is not really an issue, because managed care is so scarce in Alaska. “We really have no HMOs,” he said. “Basically, the managed care we have is Medicare, Medicaid and Vision Service Plan; the rest is private. We have a freedom of choice law for private insurance where people can choose their own doctors, so there are no barriers to access at this point.”
Of the approximately 80 licensed optometrists in the state, Dr. Gonnason said that most take advantage of prescribing privileges. “We have only about three ODs who are not TPA certified,” he said.
For Your Information:
- Jeffrey Gonnason, OD, is the immediate past president and legislative chair of the Alaska Optometric Association. In solo private practice since 1977, Dr. Gonnason may be reached at 2211 E. Northern Lights, Ste. 202, Anchorage, AK 99508; (907) 276-2080; fax: (907) 276-2081.