A growing national debate over pharmacists' rights to refuse to fill prescriptions has spurred the AAFP Commission on Legislation and Governmental Affairs to recommend a policy on the issue.
The proposed policy focuses on the primacy of the patient-physician relationship and the importance of having the health care system provide appropriately prescribed medications, said Kevin Burke, director of the Government Relations Division.
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The recommendation has been submitted to the AAFP Board of Directors for consideration during its May meeting. The text of the recommendation: "The AAFP believes that a pharmacist's right of conscientious objection to filling a specific prescription should be reasonably accommodated, but to safeguard the physician-patient relationship, governmental policies must be in place to protect patients' rights to obtain legally prescribed and medically indicated treatments."
Legislation on a pharmacist's right to act on his or her conscience in deciding whether to fill a prescription has percolated since March, when national news media picked up on the debate. Since then, 10 states -- Arizona, Arkansas, Georgia, Indiana, Maryland, Rhode Island, South Dakota, Tennessee, Texas and Vermont -- have introduced bills that protect pharmacists who refuse to fill prescriptions based on conscientious objections.
Four states -- California, Missouri, New Jersey and West Virginia -- have bills that would require pharmacists to fill all legally written prescriptions. Meanwhile, the governor of Illinois has issued an emergency executive order requiring pharmacies to accept and fill all legal prescriptions.
Federal lawmakers jumped into the fray April 14 when Sen. Frank Lautenberg, D-N.J., and Reps. Carolyn Maloney, D-N.Y., and Debbie Wasserman-Schwartz, D-Fla., introduced the Access to Legal Pharmaceuticals Act.
The bill acknowledges individuals' rights to religious belief and to legal contraception, but says, "An individual's right to religious belief and worship cannot impede an individual's access to legal prescriptions, including contraception." Under the bill's provisions, a pharmacist can, based on personal beliefs, refuse to fill a prescription. In such circumstances, the pharmacy must take these actions:
Legislation on a pharmacist's right to act on his or her conscience in deciding whether to fill a prescription has percolated since March, when national news media picked up on the debate. Since then, 10 states -- Arizona, Arkansas, Georgia, Indiana, Maryland, Rhode Island, South Dakota, Tennessee, Texas and Vermont -- have introduced bills that protect pharmacists who refuse to fill prescriptions based on conscientious objections.
Four states -- California, Missouri, New Jersey and West Virginia -- have bills that would require pharmacists to fill all legally written prescriptions. Meanwhile, the governor of Illinois has issued an emergency executive order requiring pharmacies to accept and fill all legal prescriptions.
Federal lawmakers jumped into the fray April 14 when Sen. Frank Lautenberg, D-N.J., and Reps. Carolyn Maloney, D-N.Y., and Debbie Wasserman-Schwartz, D-Fla., introduced the Access to Legal Pharmaceuticals Act.
The bill acknowledges individuals' rights to religious belief and to legal contraception, but says, "An individual's right to religious belief and worship cannot impede an individual's access to legal prescriptions, including contraception." Under the bill's provisions, a pharmacist can, based on personal beliefs, refuse to fill a prescription. In such circumstances, the pharmacy must take these actions:
- Direct a nondissenting pharmacist to immediately fill prescriptions for in-stock items.
- Inform the patient if the item is not in stock and offer to order it immediately.
Moreover, the pharmacy cannot employ individuals who, after refusing to fill a valid prescription, would then:
- refuse to return the prescription to the consumer,
- refuse to transfer the prescription to another pharmacy,
- subject the consumer to humiliation or otherwise harass the individual, or
- breach medical confidentiality with respect to the prescription.
AAFP's proposed policy is purposely broad and does not focus on reproductive health issues, said Burke. As a result, it would have the flexibility to apply in several areas, from contraception to pain management to end-of-life care.
If approved by the AAFP Board, the policy would provide a context from which constituent chapters could decide whether to support or oppose conscience clause legislation in their states, according to Diana Ewert, AAFP senior manager for state government relations.
With the policy, chapters could look at proposed legislation and ask whether the health care system ensured patients would have access to the care they needed, Ewert said.
"The CLGA wanted to uphold the patient-physician relationship," said Ewert. "It recognizes that, just as doctors have the right to refuse to do things, pharmacists also have this right. But ultimately what the commission wanted to get across was that, within the patient-physician relationship, the physician has done the counseling and talking, and the health care system should ensure that the patient has the right to the appropriately prescribed medications."
If approved by the AAFP Board, the policy would provide a context from which constituent chapters could decide whether to support or oppose conscience clause legislation in their states, according to Diana Ewert, AAFP senior manager for state government relations.
With the policy, chapters could look at proposed legislation and ask whether the health care system ensured patients would have access to the care they needed, Ewert said.
"The CLGA wanted to uphold the patient-physician relationship," said Ewert. "It recognizes that, just as doctors have the right to refuse to do things, pharmacists also have this right. But ultimately what the commission wanted to get across was that, within the patient-physician relationship, the physician has done the counseling and talking, and the health care system should ensure that the patient has the right to the appropriately prescribed medications."
