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Physicians want to dispense drugs if pharmacists refuse

The American Medical Association (AMA) has approved a policy to permit physicians to dispense medication to patients, if a pharmacist refuses to fill a prescription because of conscientious objections.

At the AMA annual meeting in Chicago last week, delegates discussed how to deal with increasing numbers of pharmacists who are citing conscientious objection as a reason for not filling prescriptions. The response was overwhelming approval of a resolution for the AMA to pressure state legislatures to allow physicians to fill prescriptions for patients, when no pharmacist within a 30-mile radius agrees to do so.

According to Reuters, the new AMA policy also requested that the AMA lobby for legislation that "requires individual pharmacists or pharmacy chains to fill legally valid prescriptions or to provide immediate referral to an appropriate alternative dispensing pharmacy."

The impetus for the new AMA policy initially arose because some pharmacists began refusing to fill prescriptions for oral contraceptives and for the emergency contraceptive pill "Plan B". However, refusals have reportedly increased rapidly and now include psychiatric drugs (such as antidepressants) and pain medications. Moreover, some pharmacists refuse to return the prescription to the patient, preventing the patient from taking it to another pharmacy, or they lecture the patient.

AAFP President Mary Frank, MD, of Mill Valley, California, considers these actions inconsistent with professional protocol. "The pharmacist has the right to abide by his or her ethical principles or conscience, but not when that interferes with a decision the patient and doctor have made," said after the AMA vote. "The patient's needs have to take precedence."

Dr. Frank also pointed out that pharmacists might make faulty assumptions about a prescription, without knowing the specifics of a case. "Pharmacists...may refuse to fill a prescription for oral contraception, without knowing that the prescription is to treat polycystic ovary disease or menstrual cramps."

The American Pharmacists Association currently has no formal mechanism in place to deal with pharmacists who refuse to return prescriptions or to refer patients to a more compliant pharmacy. In cases where pharmacists pick up actual medication errors, such as incorrect dosage or unsafe drug combinations, the pharmacist are directed to contact the prescribing physician, discuss the problem and try to find a solution.

Posted: June 2005