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Arizona optometrists authorized to prescribe oral medications
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PHOENIX — With an amplification of the state’s therapeutic pharmaceutical agent (TPA) law on July 30, optometrists here may now prescribe all topical medications and several oral prescription pharmaceuticals, according to Marc R. Bloomenstein, OD, FAAO, Arizona Optometric Association (AZOA) president.
“The passage of an examination, after taking a course approved by the state board of Arizona, will enable all ODs to practice with this new amplification and allow them to obtain a DEA [Drug Enforcement Administration] license,” Dr. Bloomenstein said.
Optometrists in Arizona are now permitted to prescribe oral antibiotics classified as tetracycline and its derivatives, penicillin and its derivatives, erythromycin, azithromycin and clarithromycin. However, an oral antibiotic cannot be prescribed, dispensed or administered to a patient younger than 6 years old. The bill also sets a 72-hour time limit for the use of antibiotics if the condition does not improve, with the exception of blepharitis, for which the time limit may be extended to 10 days.
Antihistamines, such as cetirizine, loratadine and fexofenadine, may be prescribed for not more than 7 days for any patient. After such time limits have been reached, the optometrist must consult with a primary care physician about a referral. Over-the-counter nonsteroidal anti-inflammatory agents (NSAIDs) may be prescribed, administered and dispensed in dosages that exceed over-the-counter dosages but do not exceed maximum dosages of counterpart prescription NSAIDs. In addition, schedule III controlled substances, classified as analgesics, may be prescribed, dispensed and administered by a certified licensee.
The following restrictions are still in place: optometrists may not prescribe, dispense or administer oral steroids; oral antifungals or antivirals; oral carbonic anhydrase inhibitors; oral antimetabolites or immunosuppressives; anything administered intravenously; substances administered by injection, except to counter an anaphylactic reaction; schedule I, II, IV or V controlled substances; oral agents for the treatment of closed-angle glaucoma attacks; and an oral NSAID (except for over-the-counter oral NSAIDs, which can be prescribed in prescription dosage.)
Of the practicing licensed optom etrists in the state of Arizona, 382 are TPA licensed. “I feel the number of TPA doctors is very high for the percentage of licensees using this privilege to prescribe,” Dr. Bloomenstein said. Eighty percent of the licensed ODs are TPA certified, he said, adding, “With the continual growth of our state, this number will undoubtedly grow very quickly.”
OD/MD relationship varies
Dr. Bloomenstein said that the TPA law has affected the optometrist/ophthalmologist relationship in many ways, both positively as well as negatively. “The ability to be better comanagers and work more closely with MDs in the practice setting is a benefit allowed by the TPAs,” he noted. “However, it has some ophthalmologists feeling that we are trying to take over their profession without going to medical school. This has opened some wounds thought to be closed.”
Until the passage of the TPA law in 1993, Dr. Bloomenstein, who works in a cataract and refractive surgery center with seven ophthalmologists and eight optometrists, said that he previously witnessed ODs referring a lot of pathology because they were not permitted to treat it. Since the TPA legislation was passed, however, “the referrals have been reduced to a very small number of cases outside our scope of practice,” he noted. “Since I have been residency trained with prescribing pharmaceuticals, the TPA licensure has not changed my prescribing habits. Instead, it has given me an ability to treat as taught.”
Future battles
Optometrists in the state of Arizona are constantly fighting with managed care, Dr. Bloomenstein said. “There are many plans that exclude ODs, and we do not have a lot of direct access for primary eye care,” he said. “We are constantly battling with plans to accept optometry’s role in health care. I am confident that the big plans will start to recognize us and the smaller plans will follow suit.”
As for the future, he said, the top goal of the AZOA will be to implement the new amplification law. “It will also be the association’s goal to maintain the advances we have so strongly fought to obtain,” Dr. Bloomenstein said. “The association wants to reach out to all of our members, no matter what scope they choose to practice in, to ensure they will have the right to practice as taught.”
For Your Information:
- Marc R. Bloomenstein, OD, FAAO, is the Arizona Optometric Association president and director of refractive services at the Barnet Dulaney Eye Center. He may be reached at 4800 N. 22nd Street, Phoenix, AZ 85016; (602) 955-1000; fax: (602) 508-4700; e-mail: bloomenm@prgeye.com.