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Taking TPA legislation one step further
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April 22, 1998. The day Mayor Marion Barry Jr. signed legislation permitting optometrists in our nation's capital to prescribe therapeutic agents. The day all optometrists, regardless of geographic locale, could treat ocular disease. The day optometry, collectively, breathed a sigh of relief.
Indeed, as optometrists, we spell relief T-P-A. And for good reason. Our quest to prescribe therapeutic agents has been nothing short of daunting. Our efforts commenced over two decades ago, guided largely by grassroots optometry, a few visionary leaders, the American Optometric Association and willing legislators.
A few states - viewing our profession as well trained, geographically diverse and primary eye care providers - embraced the concept and pioneered the way. In these "early" states, our colleagues shouldered the responsibility well, produced exceptional outcomes and paved the way for those states adopting a "wait-and-see" attitude. Still other states, condemned to political purgatory, languished along the way.
Though discouraged at times, optometry forged onward, legislating a few states each year. And now - as a result of our convictions and perseverance - optometry is a therapeutic pharmaceutical agent (TPA) profession. Certainly, it seems like a perfect time to sit back and enjoy the fruits of our labor.
Unfortunately, with TPA privileges comes greater responsibilities and challenges. First, and foremost, there is the issue of formularies. Whereas all optometrists can prescribe a variety of topical agents, including antihistamines, mast-cell stabilizers, nonsteroidal anti-inflammatories and anti-infectives, not all states permit the use of steroids or glaucoma medications.
Next, there is the matter of oral medications. Granted, orals are required less frequently than topicals, but they are essential in treating certain forms of ocular injury and disease. Arguably, oral antihistamines, analgesics and antibiotics are key components in any optometric formulary.
To me, it has always seemed illogical that a practitioner's prescribing acumen be a function of geographic local. Suffice it to say, it is imperative we eliminate state-imposed therapeutic barriers.
Additionally, there is the issue of parity. It is one thing to have therapeutic privileges and quite another to be recognized as such. Whereas optometry has been quite vocal in this arena, it is not uncommon to encounter pharmacists, physicians, hospitals and insurance administrators who are unaware of our ability to prescribe. Recognition - and participation - is critical to our profession but, more importantly, to our patients' well being. Only through ongoing educational efforts will we achieve parity in the eyes of fellow health care providers, in insurance plans and as hospital staff members.
Ultimately, the solution involves legislating toward a uniform scope of therapeutic practice: a mode of practice easily understood by legislators, recognized by fellow health care providers and consistent in the eyes of the health insurance industry.
So, how do you spell relief? It may be as simple as R-E-C-I-P-R-O-C-I-T-Y!