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An often-outdated pharmacy law test is “absolutely” making Indiana lose would-be pharmacists — and it shouldn’t be a licensing requirement, medical professionals told lawmakers Thursday.
“It can lead to confusion when pharmacists are trying to study for this exam in our state: do I look at the old laws or the new laws? Do you want your pharmacist to know the current law in the state, or what was law five years ago?” asked Veronica Vernon, a Butler University pharmacy professor.
Hoosier license applicants must pass a general practice knowledge exam — the North American Pharmacist Licensure Examination — and a pharmacy law test: the Multistate Pharmacy Jurisprudence Examination.
Both are by the National Association of Boards of Pharmacy, but Indiana’s Board of Pharmacy writes state-specific questions for the second. That’s the one Vernon and others want to scrap.
The witnesses spoke before an interim study committee focused on licensing barriers.
“Is the pass-fail rate on this causing us to lose pharmacists?” Rep. Mark Genda, R-Frankfort, asked.
“Absolutely, it is,” Vernon replied. “It’s out of date; it depends on what questions get asked.”
The testimony came at a meeting of the Interim Study Committee on Commerce and Economic Development.
Sarah Trovinger, a pharmacist representing the Indiana Pharmacy Association, said the test’s questions also disadvantage pharmacists working in hospitals and other, less common settings.
“‘How many square feet does a community pharmacy have to be?’ … Those are things that you’re not even going to come in contact with while you’re there,” she said.
Trovinger explained that pharmacists are working in hospitals through nationally accredited residency programs, which require participants to be licensed for at least part of the program.
“If they don’t pass it the first time, then they get kicked out of that residency program,” she said.
Genda commented that it seems like the state’s Board of Pharmacy “is asleep” and “not doing their job” by appropriately selecting and updating the questions.
“Our Board of Pharmacy is great,” Trovinger said. “… Their main job is to make sure that our patients are safe and that our pharmacists … are doing the things they want to do. This should not be where they’re having to spend their time and energy every year because we teach pharmacy law.”
Some lawmakers were openly skeptical.
“You don’t think that there should be that initial (check) of, ‘Do you understand the law of Indiana to practice here?’” Rep. Matt Lehman, R-Berne, asked Vernon. “Or … should that just be the approach here, is to make sure the exam is up to date, versus totally eliminating anything to do with understanding the law before you start?”
“I think we need to eliminate the law exam, and it’s because we teach it in our schools,” she said.
Vernon also argued that many other health care professionals that can write and dispense prescriptions, like physicians or nurses, don’t have have to take a law exam.
Dr. Amanda Wright, the dean of the College of Osteopathic Medicine at Marian University, said parity is important.
“I bet you don’t hear that a lot, physicians saying, ‘I’m here for the the pharmacists and (physician assistants), but that’s what we’re going to have to do to get our Hoosiers cared for,” Wright added. She also serves as an associate family medicine professor.
Physician assistant rules
Jason Kolkmeier, a physician assistant representing the Indiana Association of Physician Assistants, asked lawmakers to join an interstate compact to make it easier for licensees to work across state lines. He also requested updates to “antiquated” PA laws.
“We’re the only provider in the state of Indiana that has a ratio limit,” he said. This means that only a certain number of PA’s can be assigned to one doctor.
Collaborative practice agreements are another barrier, per Kolkmeier.
“Every task that we are allowed to do has to be delegated and written out on that collaborative practice agreement. As you can see, that’s burdensome for (the) administrative side,” he said.
If some authority isn’t listed, he has to reschedule care or refer patients to another provider. If a new drug isn’t on there, it can’t be prescribed until the agreement is updated.
And, PAs are tied to one doctor.
“If that physician were to unfortunately die tonight in car accident, I could not practice and provide care for my patients tomorrow,” Kolkmeier said. “So, we want to make arrangements where we’re allowed to practice to the top of our license and our education, so that Hoosiers have access to the care, whether that’s being tied to a facility or something like that.”
Eliminate PLA?
Lawmakers also expressed appetite for ditching the Professional Licensing Agency, an umbrella body overseeing 33 profession-specific licensing entities — like the Board of Pharmacy.
“Not to sound conspiracy theorist or accusatory in any way, (and) please don’t take my questions as an indictment of the current administration’s practices or even the previous one,” said Sen. Scott Baldwin, R-Noblesville. “… It looks like we collect $10 million in license fees to spend $10 million on budget to do things that 104 (PLA employees) don’t have the qualifications to do, and the boards that have been appointed do have those qualifications. It seems duplicative to me.”
PLA representatives said board members — who work day jobs in their fields and mostly meet to make disciplinary decisions — don’t have the time or administrative expertise.
“If we had an extra $16 million … and we disseminated that out to these boards, would that be enough to (cover) the administrative needs to do this without a Professional Licensing Agency? I know that’s an extreme statement,” Baldwin said.
Sen. Andrea Hunley, D-Indianapolis, asked if the Legislative Services Agency could get information — the number of employees dedicated to licensure, their statistics, and so on — from each agency that handles its own licensing. That data could be compared against PLA’s numbers.
The committee’s chair, Sen. Brian Buchanan, R-Lebanon, said he’d work with LSA staff on that.
The group has one more meeting before wrapping up its work.
The Indiana Capital Chronicle is an independent, nonprofit news organization that covers state government, policy and elections.
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