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Oral prescribing legislation: an attainable and ongoing goal
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In the majority of states, optometrists have acquired oral prescribing privileges, whether antibiotic, antiviral, anti-allergy, anti-inflammatory, analgesic or all of the above.
“Seven states don’t have any orals and two more states can only prescribe analgesics,” said Sherry Cooper, manager of the State Government Relations Center for the American Optometric Association.
The following states currently are unable to prescribe any orals: Florida, Alaska, Massachusetts, Mississippi, New Jersey, New York and Rhode Island.
Georgia and Illinois are able to prescribe oral analgesics only. In addition, several jurisdictions are unable to prescribe oral antivirals, including Arizona, Delaware, District of Columbia, Maryland, New Hampshire and Texas.
New Jersey: credentialing stipulation
In New Jersey, oral prescribing privileges are imminent, with legislation currently on the governor’s desk for signature. Assembly bill 2825 will amend the optometric scope of practice to include a credentialing process that will allow for the prescription of orals.
Once accredited, practitioners will be certified to “use and prescribe pharmaceutical agents for treatment purposes.”
Essentially, this would include all oral medications, according to Bryan Markowitz, executive director of the New Jersey Society of Optometric Physicians.
“This bill would allow optometric physicians all orals, including all antibiotics, antivirals and all controlled dangerous substances, except schedules 1 and 2,” Mr. Markowitz told Primary Care Optometry News.
Georgia bill ready to go
In Georgia, repeated efforts to gain oral prescribing privileges have been defeated or stalled by opposition from the Georgia Society of Ophthalmology and the Medical Association of Georgia.
“Also, MDs hold key positions in our State Senate, which prevents our bills from passing certain committees,” said John B. Whitlow, OD, secretary and legislative chairman of the Georgia Optometric Association (GOA).
Dr. Whitlow said the GOA has introduced several bills that would have allowed for the use of orals. “The closest we came to passage was in 2001, when we lost in the Senate by one vote,” Dr. Whitlow said in an interview. “Since that time, Republicans have gained control of the Senate, where several members are medical doctors, thus enabling them to use their influence.”
According to Ted McElroy, OD, president of the GOA, Georgia had been a one-party state controlled by the Democratic Party for more than 150 years. He told Primary Care Optometry News that the change to a two-party state, which occurred 2 years ago, has presented new challenges for optometric legislation.
“When Georgians elected their first Republican governor in 2002, we knew change was coming, but we had no idea how dramatic it would be,” he said. “Then when four prominent Democrats in the State Senate switched to the Republican Party, everyone involved in legislation, including legislators, was just trying to figure out what to do next.”
Dr. McElroy said that as a consequence of that change, the president of the Senate, a Democrat lieutenant governor, was stripped of his power to appoint committees and committee chairmen in the now Republican-dominated Senate. “As a result, to all non-MD health care providers’ dismay, a Republican MD was appointed chairman of the Senate Health and Human Services Committee,” he said. “Though optometry still has friends on the committee, there was no way to go around the committee chair.
“When at the request of the Senate Licensing Board GOA introduced legislation making it a felony to practice optometry without a license,” Dr. McElroy continued, “we had to call on the Secretary of State to assure the chairman that this was not a scope issue. So right now we are waiting to see how the elections go in November. You might say we are in a state of limbo, ready to go. We’re just testing the direction of the legislative wind.”
Alaska bill misrepresented
A legislative attempt by optometrists in Alaska to secure privileges for prescribing oral medications was defeated after companion House and Senate bills failed to be brought up for a vote.
“We are disappointed that the legislation did not pass,” said Sheryl Lentfer, OD, legislative keyperson and president of the Alaska Optometric Association in a previous interview. “Everyone is just tired of this bill being held up. They are ready for it to move.”
Although Senate Bill 197 and House Bill 306 were aimed at acquiring prescriptive authority for orals, opposition groups have issued statements exaggerating the scope of the privileges sought. According to a press release disseminated by the American Academy of Ophthalmology (AAO), the AAO and Alaska ophthalmologists defeated optometry’s “efforts to legislate surgical privileges.”
However, the legislation does not in any way make reference to surgical privileges, Dr. Lentfer said. “That just isn’t true,” she told Primary Care Optometry News. “We asked for prescriptive authority for orals and then injectables only for anaphylaxis. We didn’t limit the class. We asked for class 2 through 5 schedule drugs. [The legislation] never made any references to laser or any type of surgery.
Dr. Lentfer said the Alaska Optometric Association fully intends to revisit the legislation in the future. “Forty-three states now have these privileges, and we intend to keep trying until we get them, too,” she said.
Dr. Lentfer said that with oral prescribing privileges, the approximately 100 optometrists in Alaska will be better able to help patients in rural areas. “We have a lot of remote areas in our state, and the ophthalmologists are mostly in the big cities, so we’re really needed there,” she said. “I think almost everyone is ready to have this legislation move, because it is clearly needed.”
Illinois legislation stalled
In Illinois, legislation allowing for the prescription of orals is being considered, but so far has been stalled due to other concerns, according to Michael G. Horstman, executive director of the Illinois Optometric Association.
“We have not attempted to obtain oral antiviral or anti-infective privileges,” Mr. Horstman said in an interview. “Other issues have delayed an effort of expanded orals. We are considering an orals effort, but the timing is unknown.”
For Your Information:
- Sherry Cooper can be reached at 243 N. Lindbergh Blvd., St. Louis, MO 63141; (314) 991-4100; fax: (314) 991-4101; e-mail: SLCooper@aoa.org.
- Bryan Markowitz can be reached at 20 Texas Ave., Lawrenceville, NJ 08648; (609) 671-0900; fax: (609) 671-1820; e-mail: bmarkowitz@comcast.net.
- John B. Whitlow, OD, can be reached at 407 South Greenwood St., Lagrange, GA 30240-3123; (706) 882-0616; fax: (706) 882-8515; e-mail: 2docs4eyes@bellsouth.net.
- Ted McElroy, OD, can be reached at 2012 Pineview Ave., Tifton, GA 31794; (229) 382-4765; fax: (229) 382-4819; e-mail: TMcElroy@friendlycity.net.
- Sheryl Lentfer, OD, can be reached at 1345 W. 9th Ave., Anchorage, AK 99501; (907) 272-2557; fax: (907) 274-4932.
- Michael G. Horstman can be reached at 304 W. Washington Street, Springfield, IL 62701; (217) 525-8012; fax: (217) 525-8018.