Iowa bill updates pharmacy practice act to standard of care framework

On April 22, 2024, Iowa governor Kim Reynolds signed a bill into law that updates the state’s pharmacy practice act and puts in place a standard of care regulatory framework, aligning pharmacists with other providers in the state.

The standard of care framework removes the regulatory burden on states to write detailed rules on how to implement and enforce legislation for pharmacy practice. A couple of states have already moved in this direction, including Idaho, Alaska, and now Iowa.

“In a standard of care model, each person involved in a patient’s care can practice to the top of their ability. This removes the need for continually needing to go to the legislature and ask for one more test to be added to the approved list, one more vaccination, or one more clinical service,” said Julie Akers, PharmD, associate professor at Washington State University College of Pharmacy and Pharmaceutical Sciences and associate dean of external relations. “It greatly simplifies the process, putting the onus on the care provider themselves to ensure they only participate in care provision that they are prepared to do.”

Physicians, nurses, and all other health care providers are regulated with a standard of care model.

Iowa’s Pharmacy Practice Act was last fully rewritten nearly 40 years ago, according to Kate Gainer, executive vice president and CEO of the Iowa Pharmacy Association (IPA). The new Iowa bill reduces the state’s practice act from 27 pages to 16 pages.

“Significant pieces that were added,” said Gainer, “are the standard of care definition and ‘pharmacist’ to the definition of practitioner.”

Significant pieces that were removed, she added, include brightline lists of duties that technicians can or can’t do, and brightline lists of which statewide protocols can be implemented.

“Strategy and timing are always important considerations when advocating for a pharmacy priority,” said Gainer. “Following years of work by IPA’s Practice Act task force, IPA’s legislative priorities included ‘Modernize the Pharmacy Practice Act’ for 2 years before we ever introduced a bill.”

In 2023, there were other factors that created a favorable political environment for introducing the pharmacy practice act rewrite in Iowa.

Akers said that some skeptics have suggested it was easy to adopt less regulation, which the standard of care provides, in a conservative state such as Idaho. Idaho was the first state to adopt this model. However, as researchers of a February 2024 JAPhA commentary pointed out, an increasing number of states, whether blue or red, have adopted a standard of care regulatory model for nurse practitioners.

“Interested stakeholders should draw parallels to existing regulatory structures for other health professions within their own states and educate lawmakers about the commonalities between such professions, noting the benefits of the flexible standard of care approach,” said the JAPhA commentary.

“Changing legislation to allow for a standard of care model may be easier in a conservative state when using the argument that less regulation is better. But it isn’t the only way forward,” said Akers. “In many states, like Washington, there is an extreme provider shortage. There is not one county in Washington state that does not have some form of provider shortage. Removing restrictive and unnecessary legislative barriers that currently inhibit providers practicing at the top of their training and experience should be something everyone can get behind, regardless of their political affiliation.”

To inform pharmacists about standard of care in Iowa, Gainer said they have launched a resource page (www.iarx.org/soc). They have also hosted a one-day Standard of Care Symposium, and created an FAQ where questions can be submitted online at any time.

“The [Iowa] Board of Pharmacy will be reviewing the entirety of its administrative code chapters to align regulation with the new practice act. It is anticipated those rules will be finalized in spring of 2025,” said Gainer.

The Iowa bill’s effective date is July 1, 2024. However, there are no immediate changes to pharmacy practice on July 1, 2024.