Update and Recommendations: Pharmacists’ Prescriptive Authority for Tobacco Cessation Medications in the United States

Abstract

Objective: To characterize state laws in the U.S. regarding the expansion of pharmacists’ prescriptive authority for smoking cessation medications, compare key components across different models, and discuss important considerations for states that are considering similar legislation or policies.

Data sources: Legislative language was reviewed and summarized for all states with pharmacist prescriptive authority for tobacco cessation medications, and state boards of pharmacy were contacted to determine the number of registered complaints or safety concerns received as a result of pharmacists’ prescribing under these authorities.

Summary: As of June 2022, 17 states have enacted laws for pharmacists’ prescriptive authority for smoking cessation medications; most (n=16) have implemented procedures, and 1 is in the process of adopting a similar prescribing model. Of 16 states with fully delineated protocols, 8 (Colorado, Idaho, Indiana, New Mexico, North Dakota, Oregon, Utah, Vermont) include all medications approved by the U.S. Food and Drug Administration for smoking cessation, and 8 (Arizona, Arkansas, California, Iowa, Maine, Minnesota, Missouri, North Carolina) include nicotine replacement therapy medications only. Most protocols specify minimum cessation education requirements for pharmacists and define required intervention elements (e.g., screening, cessation intervention components, follow-up, and documentation requirements). Personal communications with state boards of pharmacy revealed no complaints or safety concerns regarding pharmacists’ prescribing for cessation medications since these authorities were first implemented, in New Mexico, in 2004.

Conclusion: The number of states with pharmacists’ prescriptive authority for tobacco cessation medications has increased substantially in recent years. There have been no registered complaints or safety concerns since the inception of this expanded scope of practice. While the profession has made meaningful progress, there are inconsistencies across states with respect to medications that are included and requirements for implementing tobacco cessation services, which may impede broader adoption.