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Ohio News: Optometrist Prescribing Changes
Published in the May 2008 Ohio State Board of Pharmacy Newsletter
The legislature recently revised the optometry laws (HB 149), and the law became effective on March 24, 2008. This bill changed, among other things, the prescribing privileges for optometrists in a number of ways. Most of the changes will be relatively transparent to pharmacists as the optometrists will not be prescribing too many different drugs than they have been. However, the formulary of approved drugs has been eliminated. Instead of a listing of individual drugs, the optometrists now have a listing of classes of drugs from which they may prescribe. The exact wording from the new law (§4725.01 ORC) about the classes of drugs that may be prescribed is as follows:
(C) “Therapeutic pharmaceutical agent” means a drug or dangerous drug that is used for examination, investigation, diagnosis, treatment, or prevention of any disease, injury, or other abnormal condition of the visual system in the practice of optometry by a licensed optometrist who holds a therapeutic pharmaceutical agents certificate, and is any of the following:
(1) An oral drug or dangerous drug in one of the following classifications:
(a) Anti-infectives, including antibiotics, antivirals, antimicrobials, and antifungals;
(b) Anti-allergy agents;
(d) Analgesics, including only analgesic drugs that are available without a prescription, analgesic drugs or dangerous drugs that require a prescription but are not controlled substances, and schedule III controlled substances authorized by the state board of optometry in rules adopted under section 4725.091 of the Revised Code;
(e) Anti-inflammatories, excluding all drugs or dangerous drugs classified as oral steroids other than methylpredisolone, which may be used under a therapeutic pharmaceutical agents certificate only if all of the following conditions are met:
(i) The drug is prescribed for use in allergy cases;
(ii) The drug is prescribed for use by an individual who is eighteen years of age or older;
(iii) The drug is prescribed on the basis of an individual’s particular episode of illness;
(iv) The drug is prescribed in an amount that does not exceed the amount packaged for a single course of therapy.
(2) Epinephrine administered by injection to individuals in emergency situations to counteract anaphylaxis or anaphylactic shock. Notwithstanding any provision of this section to the contrary, administration of epinephrine in this manner does not constitute performance of an invasive procedure.
(3) An oral drug or dangerous drug that is not included under division (C)(1) of this section, if the drug or dangerous drug is approved, exempt from approval, certified, or exempt from certification by the federal food and drug administration for ophthalmic purposes and the drug or dangerous drug is specified in rules adopted by the state board of optometry under section 4725.09 of the Revised Code.
Please note that the Ohio State Board of Optometry has to adopt rules specifying which Schedule III analgesics an optometrist may prescribe. At the time of the writing of this Newsletter, the Optometry Board was planning on submitting their rules after their April Board meeting. By the time the rules make it through the state’s process, it should be June 2008, at the earliest before the rules are made final. After that, DEA will need to issue licenses to those optometrists who apply, so it should be late June or July at the earliest before you should see any Schedule III prescriptions from optometrists.
Please also note that optometrists’ prescribing is limited to “examination, investigation, diagnosis, treatment, or prevention of any disease, injury, or other abnormal condition of the visual system in the practice of optometry” and, with the exception of epinephrine for emergencies, is limited to topical ocular and oral medications. Once again, pharmacists should use good judgment when deciding whether an optometrist’s prescription should be dispensed. Optometrists are also limited practitioners and their scope of practice is limited to the visual system. The prescription must be to treat a condition that is affecting the visual system. Based on a review of the law, that can cover a wide array of drugs, including oral antihistamines, and antibiotics, that could also be used to treat another medical condition not involving the eye. Any optometrist’s prescription issued for a purpose that does not involve the visual system is not valid and should not be filled. However, just as with the PAs, most of the optometrists will be doing their best to stay within their limitations. If you have any questions, talk to the optometrist first and call the Board office second, if needed.
