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Mass. TPA legislation transformed optometry into a prescribing profession
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The attainment of therapeutic pharmaceutical agent (TPA) legislation has been a driving force in optometry’s evolution from its optical roots to its current status as primary eye care provider.
“It is clear that future historians will undoubtedly credit prescriptive authority as one of the major milestones in the evolution of the profession,” said Sherry L. Cooper, manager of State Government Relations for the American Optometric Association, in an interview.
In October 1997, Primary Care Optometry News reported on the passage of TPA legislation in Massachusetts, the last of the 50 states to gain this privilege.
Today, PCON discusses this milestone with the Massachusetts Society of Optometrists (MSO) as well as Ms. Cooper. This month’s installment of our 10-year Retrospective Series also addresses Massachusetts’ remaining hurdle – obtaining glaucoma privileges.
Political forces a hindrance
According to Richard T. Lawless, MSO executive director, politics was a major hindrance to the 1997 passage of TPA legislation in the state.
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“We are in the same situation right now with glaucoma,” he told Primary Care Optometry News. “We’re the last state, and we don’t have our bill yet. We tend to have a very strong medical lobby in Massachusetts, and they argue their point very well. So they are a formidable opponent.”
Mr. Lawless said the passage of the TPA legislation has had a significant impact on patient care in Massachusetts. “I think it has allowed optometrists in this state to provide more services and more care to their current patient base,” he said. “So patients have more access to more services at the optometry office now than they did before.”
The attainment of prescribing authority has significantly advanced the position of optometrists in Massachusetts as well, Mr. Lawless said. “Certainly for the optometrist, they have improved their position as practitioners by being able to provide those additional services and also get paid for them,” he said. “But even more so, it has allowed optometrists to provide more medical services, which I think was a major stride in the whole therapeutics movement: to go from being a vision care doctor to being an eye care doctor.”
Mr. Lawless said, currently, the overwhelming majority of optometrists in Massachusetts are therapeutically certified. “It took a while for some docs to feel comfortable with it,” he said. “For the recent graduates and the young doctors, it’s second nature, but the ODs who had been out in the field for a number of years had to go back for retraining as required in the legislation.”
He said, to this end, the MSO offered five therapeutic training programs, the last of which was held in 2001. “We are also working with Connecticut to do more, just to make sure that anybody who is still in need of therapeutic certification can get it,” Mr. Lawless said.
He said in his state, ODs most commonly use their TPA privileges to prescribe topical medications for ocular conditions such as conjunctivitis. “In Massachusetts, we can only prescribe topical medications, not orals,” he said. “Being able to prescribe oral medications is in our current bill. So it’s both a prescriptive authority bill and a practice scope expansion bill.”
Struggles for further privileges
Regarding the ongoing battle to gain glaucoma treatment privileges, Mr. Lawless said, “We continually do our homework in order to respond to the medical lobby’s questions raised before the legislature, and we’ve done fairly well. Last legislative session, we got through the Senate and almost through the House before the session ended. So the bill moved last year. We’re hoping that in this session, the stars will line up for us.”
A national perspective
According to Ms. Cooper, the advent of TPA legislation has marked a milestone in optometry’s advancement at a national level. “Prescriptive authority belongs in a list with other important milestones in the evolution of optometry, including licensure, accreditation of educational programs, requirement to pass a test prior to licensure, requirement to diagnose disease [for referral] and finally – treatment of disease,” she said.
Ms. Cooper said prescriptive authority has transformed the role of optometry across the country. “I believe prescriptive authority privileges have solidified optometry as a prescribing profession and, as a result, have established optometry as the primary eye care profession,” she said.
While she has no specific data about therapeutic certification, Ms. Cooper estimated that between 85% and 90% of licensees across the country hold prescriptive authority. “The percentage may be a bit less than this average in states with more recent laws and markedly higher in states with older laws,” she told Primary Care Optometry News.
Ms. Cooper said five states still have no oral prescribing authority: Alaska, Florida, Massachusetts, New York and Rhode Island. However, she added that the oral authority in three states is limited to only one drug or class of drugs, and many more have incomplete oral authority.
“All of this must be expanded in order to bring every state up to a uniform level,” she said.
Licensure by endorsement?
While it might appear that the solidification of TPA privileges in all 50 states might promote licensure by endorsement, Ms. Cooper maintains that the issue of mobility among jurisdictions remains a huge problem.
“While the history of disparate prescriptive authority laws over the past 3 decades would be an obvious ‘culprit’ to blame in the problems competent optometrists have long faced in moving from one jurisdiction to the other, I can tell you now that every state optometry act authorizes licensees to prescribe drugs,” she said. “And now that many of these laws are approaching greater and greater uniformity, the amelioration of this culprit has not served to facilitate mobility at all.”
She said the AOA continues to work industriously toward bringing about mobility for optometrists. “Mobility is a topic of great interest to our members and an issue on which the State Government Relations Center works diligently as a high-priority,” she said. “But establishing uniform prescriptive authority laws in every state has simply not turned out to be the cure for this problem.”
For Your Information:
- Sherry L. Cooper is manager of State Government Relations for the American Optometric Association. She can be reached at 243 N. Lindbergh Blvd., St. Louis, MO 63141; (314) 991-4100; fax: (314) 991-4101; e-mail: SLCooper@AOA.org.
- Richard T. Lawless is executive director of the Massachusetts Society of Optometric Physicians. He can be reached at 1071 Worcester Rd., Framingham, MA 01701; (508) 875-7900; fax: (508) 875-0010.