AMA Resolution 218 – Misguided and Misinformed Public Policy

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Story by Anusha McNamara, Pharm.D.

During the American Medical Association’s (AMA) 2013 Annual Meeting, the AMA House of Delegates adopted several policies that could shape the future of medicine.  Most of the media attention focused on the vote to recognize obesity as a disease.  But pharmacists should take notice of AMA resolution 218 entitled AMA Response to Drug Store Intrusion into Medical Practice.  This resolution was a stern warning against “inappropriate inquiries” from pharmacies to verify the medical rationale behind prescriptions and diagnoses, calling them "unwarranted interference with the practice of medicine."1  The resolution also calls for the AMA to work with pharmacy organizations, the Drug Enforcement Administration (DEA), and other federal regulators to develop appropriate policy for pharmacists to work with physicians in order to reduce the incidence of drug diversion and inappropriate dispensing.2  It does not, however, call on the AMA to work with physicians to reduce the incidence of inappropriate prescribing.

Pharmacy national organizations have responded.  Kevin Nicholson, the Vice President of Policy and Regulatory Affairs of the National Association of Chain Drug Stores (NACDS) said, “It is not the intent of pharmacists to intrude on medical practice…pharmacies have had to respond to new levels of scrutiny by the Drug Enforcement Administration, which has been investigating chain pharmacies for perceived over-dispensing of controlled substances.”3

The DEA has continued to remind pharmacists of their responsibility to work with physicians (and other practitioners) to ensure the proper prescribing and dispensing of controlled substances.  Pharmacists must ensure that prescriptions for controlled substances conform to all legal and regulatory requirements. The DEA traditionally viewed medical practitioners as the gatekeepers who determined whether a patient had legitimate need for a controlled medication.  However, in recent years, due to the diversion of controlled drug through rogue pain clinics and Internet pharmacies, the DEA has begun to focused more attention on pharmacists as the controlled substance gatekeepers, holding them accountable for dispensing controlled substances to patients when there is no clear legitimate medical purpose.4

Leaders of the American Pharmacist Association (APhA) and National Community Pharmacists Association (NCPA) have encouraged collaboration among physicians and pharmacists to find solutions for to this growing problem. The passage of this AMA resolution is disappointing and it appears to discourage team-based care and shared responsibility.  Moreover, the resolution does little to address the prescription drug abuse epidemic, a very complex problem which requires creative thinking and better care coordination.5,6

References:

1. Annual Meeting Assembly Meeting. In: Proceedings of the American Medical Association Organized Medical Staff Section.  June 13-15, 2013; Chicago, IL; 2004:12. Accessed August 4, 2013.
2. Delegates shape new policies for the future of medicine at AMA annual meeting. AMA Wire. June 2013. Accessed August 4, 2013.
3. Lubell J. AMA meeting: Pharmacists warned on intruding into prescribing decisions. Am Med News. July 2013. Accessed August 4, 2013.
4. Houck LK. AMA tells pharmacists: “Don’t call us we’ll call you”. FDA Law Blog. June 2013. Accessed August 4, 2013.
5. Buck J. AMA cautions pharmacists to not intrude in medical practice; APha responds. News Line. June 2013. Accessed August 4, 2013.
6. Schweers K. NCPA weighs in on AMA’s pharmacist resolution. NCPA The Dose. June 2013. Accessed August 4, 2013.