Should Pharmacists in NYS write Rx for Epinephrine?

Many of the initiatives your Allergy Advocacy Association was successful in implementing were from legislation that had been passed in other states. Our next goal is an idea from the state of Idaho where pharmacists are now allowed to write prescriptions for epinephrine, thanks to the efforts of a pharmacist whose son has food allergies. You can read the full article here.

Should Pharmacists in NYS write Rx for Epinephrine?

>Starla and Mitchell Higdon at the Idaho state capitol
Starla and Mitchell Higdon at the Idaho state capitol.

By Jon Terry
March 12, 2018

After founding the Allergy Advocacy Association eight years ago, I knew I would have to imitate the already existing ideas and creations from other people’s work. Why did I decide to do this? Because I was determined to do whatever it takes to raise awareness of the dangers of anaphylaxis. To become an effective public advocate, I would have to learn about new things but also copy many things that already existed. There was no good reason for our association to re-invent the wheel, so to speak. And when it came to advocate for new legislation in my home state of New York, I searched for successful laws already enacted in other states. If it “plays in Peoria,” why not try it in Albany as well? Sure, some folks might accuse me of stealing promising ideas from others. But I prefer to think of the process not as larceny, but as flattery instead.

"Imitation is the sincerest form of flattery!"

Charles Caleb Colton (1780–1832) was an English cleric, writer and collector, well known for his eccentricities. Colton's books, including collections of epigrammatic aphorisms and short essays on conduct, though now almost forgotten, had a phenomenal popularity in their day.[1]

Take the Emergency Allergy Treatment Act 2016 Chapter 373[2] that allows public entities to stock non-patient specific epinephrine. This law was first enacted in several other states (including Florida) before it became law in NY. The purpose was to further improve public access to life-saving epinephrine in an anaphylaxis emergency. EATA was signed by Governor Andrew Cuomo after receiving broad-based bi-partisan support in both the assembly and the senate.

Stock epinephrine laws allow trained people to give epinephrine to anyone experiencing a severe allergic reaction, or anaphylaxis. The laws allow certain public places and businesses (such as restaurants, amusement parks, theaters, camps, etc.) to have the auto-injectors on hand in case of allergy emergencies.

That same year the state of Idaho also enacted their own entity stocking law, but with an important enhancement. Their state law allows PHARMACISTS to prescribe epinephrine (as a doctor already does) directly to people at risk for anaphylaxis. Pharmacists can also prescribe it to those who may care for, or have contact with, people at risk for severe reactions. Organizations looking to stock epinephrine must go through a training program to be able to recognize and treat anaphylaxis.

Starla Higdon is a pharmacist living and working in Idaho; she is also the mother of a 12-year-old son, Mitchell, who is allergic to eggs and barley.

“The legislation that I helped become law in my state was originally just a bill to allow ‘other’ entities to stock epinephrine. Our schools had already obtained the right to utilize nurse authorized stock epinephrine two years prior, via legislation that I also worked on,” says Higdon. Here in New York State we also have NASE enacted for all public-school systems; they are “authorized” to have epinephrine auto-injector (EAI) devices, like Mylan Pharma’s Epi-PenTM but are not “mandated” to do so.

Starla says the Idaho law already authorizes pharmacists to dispense certain prescriptions directly (fluoride supplements, antidotes for drug overdoses and vaccinations, for example). Starla’s professional background allowed her to work with lawmakers and the Idaho Board of Pharmacy to get the bill through successfully.

Both houses of the Idaho legislature unanimously passed the bill. “Since I'm a pharmacist, I met with the director of my state's Board of Pharmacy to discuss the legislation, and he was the one that suggested we add giving pharmacists prescriptive authority over epinephrine.”

The increasing number of individuals at risk for anaphylaxis is an established fact. The American College of Allergy Asthma and Immunology (ACAAI) estimates 500 to 1,000 deaths per year in the US from anaphylaxis. Despite decades of scientific research costing millions of dollars, causes and solutions are still largely unknown.

In October 2013, the Journal of Allergy and Clinical Immunology (JACI) published a landmark survey by the Asthma and Allergy Foundation of America (AAFA), which found that severe life-threatening allergic reactions – anaphylaxis – are common in the U.S. According to the survey of 1,000 adults, sponsored by Sanofi US, anaphylaxis very likely occurs in nearly 1-in-50 Americans (1.6%), and the rate is probably higher, close to 1-in-20 (5.1%). According to Anaphylaxis in America: The Prevalence and Characteristics of Anaphylaxis in the United States there are alarming patterns of inaction when anaphylaxis occurs: most patients are not getting their prescriptions, not keeping their auto-injectors nearby or not using them during allergic reactions when they should. [3]

According to Dr. Kirsi Jarvinen-Seppo, director for the Food Allergy Center at U-R Golisano Children’s Hospital, in an anaphylaxis emergency it is more dangerous NOT to administer epinephrine promptly. “Even if the patient might be at risk for some side effects from epi, you should still use it promptly; it is the ONLY medication proven to mediate all dangerous symptoms quickly and effectively.” The New England Journal of Medicine has indicated that four out of six deaths from food allergy anaphylaxis occur in schools and were associated with significant delay in treating reactions with epinephrine. Eighty-eight percent of the deaths show significant delays or failure to administer epinephrine.

Is this a promising idea for our state? Our association believes there is no time like the present to find out. During the current session of the NYS legislature we will seek more discussion, information and support for pharmacist-prescribed epinephrine. Any actions we can advocate that improve access to epinephrine must be pursued patiently and persistently. On Wednesday, May 16th we will participate in Allergy and Anaphylaxis Awareness Day at the State Capitol Legislative Office Building in Albany.

Local advocacy groups like mine and others at the national level—the Allergy and Asthma Network, the Asthma and Allergy Foundation of America, Food Allergy Research and Education, Food Allergy and Anaphylaxis Connection Team—all need your support. We need more money to raise awareness and improve access to epinephrine. And we need your active participation to carry out our program of action in New York State and across America.

And please check out our Web site, too! It’s all about life—NOT life-style!




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