Obamacare success falls on California

Obamacare success falls on California

SACRAMENTO — Obamacare implementation in 2014 depends on injecting California adrenaline into its system, according to state Sen. Ed Hernandez, D-West Covina. An optometrist, he authored three bills to advance the Affordable Care Act, the reform’s official name.

PharmacistsMortar.svg“The success of the Affordable Care Act depends on the success of the health exchange in California,” Hernandez told the Assembly Health Committee Tuesday at a hearing I attended. “The success of the exchange is of the utmost importance.”

fact sheet from Hernandez’s office claims the bills address the current “primary care physician workforce shortage” that will be compounded by the incoming flood of 3 to 7 million Californians eligible for health insurance with Obamacare’s 2014 implementation. At each hearing on the three bills, Hernandez explained that efforts to train more primary care physicians will take seven to 10 years. In the meantime, millions of patients will be waiting to access health care as Obamacare brings in more patients.

SB 491 would have expanded what nurse practitioners can perform. It was killed in the Assembly Business, Professions, and Consumer Protection Committee last week.

SB 492 would have expanded the scope of the practice of optometrists; I wrote about it Monday. It was pulled by Hernandez after failing to pass the Assembly Business, Professions, and Consumer Protection Committee.

The third bill in the package, SB 493,  passed the Assembly Health Committee Tuesday. SB 493 would authorize a pharmacist to administer drugs and biological products that have been ordered by a prescriber, such as a medical doctor. And it would allow the pharmacist to perform other functions, including furnishing self-administered hormonal contraceptives, nicotine replacement products, and medications not requiring a diagnosis. The bill also authorizes pharmacists to order tests on drug therapies.

Opponents say it’s risky to issue birth control medications without a medical doctor involved because of possible complications. For example, WebMD Health News reported, “Birth control pills that contain the hormone drospirenone must now carry a warning that they may increase the risk for potentially fatal blood clots, according to the FDA.”


“Pharmacists are highly trained and widely deployed throughout communities and so it makes perfect sense to use this health care workforce to provide basic primary care services to our residents,” according to the American Association of Pharmacists.220px-Legenogapotekeren

California Society of Anesthesiologists and the California Medical Association canceled their objections to SB 493 after amendments were made to tighten eligibility for the pharmacists whose duties would be expanded.

The CSA and CMA said the bill would create an “Advanced practice pharmacists” classification, which would allow pharmacists to evaluate and manage disease and health conditions, in collaboration with other health care providers.

The CSA and CMA testified that health care should be delivered in a coordinated team approach with a physician involved in patient care.

“We believe physician ‘extenders’ are beneficial for patient care and extend the reach of physicians,” the CSA website says. “However, allowing mid-level providers independent medical practice and prescribing authority creates a fragmented, uncoordinated, and dangerous situation for patients in California.”


Under the bill, pharmacists could:

* Provide consultation, training and education to patients about medication therapy, disease management and prevention;

* Participate in multi-disciplinary review of patient progress, including access to medical records;

* Furnish contraceptives (including non-emergency), prescription smoking cessation drugs and devices and prescription medications for travel purposes;

* Order and interpret tests for monitoring and managing efficacy and toxicity of medication therapy;

* Independently initiate and administer routine vaccines for persons 3 years of age and older.

SB 493 creates a new “advanced practice pharmacist,” who would have to do one of the following:

* Earn additional certification in an undefined area of practice;

* Complete a one-year post graduate residency that includes provision of direct patient care as part of an interdisciplinary team;

* Have experience managing patients for at least one year through a collaborative practice agreement or protocol with specified provider or entity.

SB 493 would allow the new “advanced practice pharmacist” to:

* Perform physical assessments;

* Order and interpret medication therapy related tests;

* Refer patients to other health care providers;

* Initiate, adjust or discontinue medication therapy in collaboration with other health care providers;

* Participate in the evaluation and management of disease and health conditions in collaboration with other health care providers.


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