Few prescribing restrictions for ODs in Idaho, Utah
Click Here to Manage Email Alerts
HAILEY, Idaho — Most of the optometrists in Idaho — about 90% of the state’s 190 ODs — are certified to use therapeutic pharmaceutical agents (TPAs), said Steve Snapp, OD, president of the Idaho Optometric Association.
Idaho optometrists “can prescribe any drug that we need without restriction, as long as it pertains to taking care of the eyes,” he reported. The original TPA law was passed in 1987 and then amplified in 1993 to add oral drugs and remove restrictions against beta blockers.
“We really don’t have any limits on the medications we can use,” he said. “We can use all topicals, orals and injectables.”
All but 5% of TPA-certified optometrists use their therapeutic privileges, Dr. Snapp estimated. Certification for TPAs is standard for new graduates, and established practitioners are required to take 100 hours of courses to receive certification.
In his own experience, Dr. Snapp said that therapeutics constitutes a major part of his practice. “It would be a mistake for optometry to abandon the vision care side of things, but [therapeutics] has made a big difference in our practice,” he said. “The reason is that you can take care of more problems. You don’t have to send somebody out; basically, all we refer out now is surgery. We take care of almost everything else.”
Dr. Snapp added that in a rural state such as Idaho direct access is particularly important. “We have a few populated centers, but a large part of Idaho is rural and not served by ophthalmology,” he said. “Those people want to come in and have their eyes taken care of just like in a big city, so it really improves the access for people to have eye health care locally.”
Because the TPA law has been in place for so many years, Dr. Snapp said, most patients have come to expect the current level of service from their optometrists. “I think that patients assume that they’re going to get taken care of just like if they went to anybody else, which is kind of nice,” he said. “I can remember the days when we couldn’t write prescriptions for pain medication, and people would come in and say, ‘Doc, can you give me something for this pain?’ It was really a problem, because you couldn’t. Now you can.”
While Dr. Snapp said that there are still roadblocks standing in the way of hospital access, he hopes that the situation will soon change. “Managed care in Idaho has just hit in the last year, mainly in the more populated areas such as Boise,” he said. “But when it hit, it came really hard. A lot of plans are excluding ODs, so it’s something that we’re going to have to start working on right away. It is definitely cutting the access of people to their normal eye care practitioners — and cutting out some of the MDs, too.”
Dr. Snapp recognizes Idaho’s good fortune to have a full scope practice, and except for a select few restrictions, optometrists here have a great deal of freedom.
“We do have a good law, and I think that certainly has been a big benefit for us as optometrists,” he noted. “This allows us to take much better care of patients.”
Managed care concerns in Utah
With their scope of practice expanded in February 1997, optometrists in Utah now hope this will translate into increased acceptance from managed care organizations.
“Some of the larger insurance companies in Utah do not use optometrists. We’re in the process of educating them about how they should,” said Terry H. Berner, OD, president-elect of the Utah Optometric Association (UOA).
Despite the rural nature of much of the state, managed care has become an important factor for optometrists here, said Dr. Berner. “You’re seeing more patients and making less money.”
The association also is concerned with optometrists receiving staff privileges at hospitals. Currently, most of the ODs who have received hospital privileges practice in rural areas, Dr. Berner said. The UOA has not pushed for this privilege statewide, but will become involved on behalf of individual doctors, he added.
Optometrists in Utah have taken advantage of the amplification legislation passed in February 1997 that expanded the list of drugs ODs can prescribe and removed some of the supervisory restrictions on scope of practice. About 75% to 80% of practicing optometrists in the state are prescribing, Dr. Berner said.
The amplification removed an ophthalmologist and a pharmacologist from the optometric board and eliminated the requirement that optometrists who were treating eye disease had to be supervised by an ophthalmologist. Optometrists also gained prescribing privileges for all oral medications except Schedule II or III narcotics, and ODs can use oral antibiotics only for lid-related disease.
“The law is acting as we expected it to. Rules are in place, and there seems to be no problem with scope of practice for optometry in the state of Utah. We have everything we need at the moment,” said Dr. Berner, who was chairman of the legislative committee when the amplification law was passed.
Passage of this law is an indication of the positive relationship between ophthalmology and optometry in Utah, Dr. Berner said. The legislative committee negotiated the privileges outlined in the law with organized ophthalmology, who then helped secure passage of the legislation, he said. This cooperation continues in the form of a joint committee made up of optometrists and ophthalmologists that tracks legislative issues and other areas of concern to the eye care industry.
For Your Information:
- Steve Snapp, OD, can be contacted at P.O. Box 1360, Hailey, ID 83333; (208) 788-4120; fax: (208) 788-3571.
- The Idaho Optometric Association can be contacted at 9077 Maple Hill Dr., Boise, ID 83501; (208) 378-7700; fax: (208) 376-5812.
- Terry H. Berner, OD, can be reached at 8210 Top of the Word Dr., Salt Lake City, UT 84121-6060; (801) 322-0467; fax: (801) 363-6053.
- The Utah Optometric Association can be contacted at 230 West 200 South, Ste. 2110, Salt Lake City, UT 84101-3409; (801) 364-9103; fax: (801) 364-9613.