As medications have become an a growing part of people’s daily health treatment, maintenance and promotion, pharmacists play an essential role in assuring people’s access to and safety with their medications. In turn, those organizations and entities that support, train, license, regulate and oversee pharmacists and state and federal legislation affecting them also play a foundational role in medication access and safety. The California Board of Pharmacy is one such entity. As a way of educating advocates, beneficiaries, and others about these foundational entities, and where to go for certain questions, complaints, assistance, this article provides an overview of the Board in a simple question and answer format with questions that were submitted to and answered by Board of Pharmacy staff. This Q&A clarifies the Board’s work and jurisdiction, and how it assists and can assist the work of advocates. Future newsletter editions will also explore the role and jurisdiction of other pharmacy foundational entities such as the California Pharmacists Association.
1) What is the California Board of Pharmacy, its mission and area of authority/regulation?
The Board was created over 100 years ago to protect and promote the health and safety of Californians by ensuring the highest quality of pharmacist’s care and the appropriate use of pharmaceuticals through education, communication, licensing, legislation, regulation and enforcement. Through venues such as public meetings, community health fairs, and its website (particularly its page on consumer services) the Board communicates with and educates the public on medication safety, complaint processes, patients’ bill of rights, consumer tips on lowering medication costs (including information on Consumer Reports Best Buy Drugs Program), advice on buying foreign drugs, and the basics on Medicare Part D, to name a few areas.
Other entities, such as the California Pharmacists Association (CPhA) and the Centers for Medicare and Medicaid Services (CMS), represent the interests of pharmacies and provide focused education to pharmacists in specific areas such as on the details of Medicare Part D. The Board focuses more on licensing pharmacists, technicians, and other professionals who dispense and/or sell pharmaceutical products obtained through prescriptions, and overseeing and enforcing laws pertaining to pharmacists and consumer safety. For example, with a staff of just over 50, the Board has inspectors statewide to check on pharmacists’ compliance with state and federal laws, such as making sure consumers receive a pharmacist consultation when bringing in a prescription from the doctor. (See last edition’s article on medication errors for more information on additional recommended actions for consumer medication safety.) The Board can also impose citations or fines on pharmacists, and even revoke licenses in instances of noncompliance, negligence and/or abuse.
As far as legislative authority, the Board does have a legislative committee that drafts, sponsors and advocates for legislation benefiting consumer protection and safety. For example, the Board recently sponsored a piece of legislation that by 2009 will establish a program to track drugs from the time they’re manufactured to the time they are dispensed. Currently at least 10 percent of the drugs sold internationally are not the drugs the manufacturers say they are. This electronic tracking system will reduce the instances of people taking intentionally mislabeled medications.
2) Does the Board work with physicians and other providers when prescription coverage issues arise?
No. The California Pharmacists Association may cover some of these issues with physicians and providers. The Board, however, works with medical professionals mainly through their direct contact with staff at licensing agencies such as the California Medical Board and the California Board of Registered Nursing, an area where there has been joint collaborations involving pain management.
3) If the Board receives beneficiary or provider questions/problems regarding Medicare Part D, do they refer people to the Health Insurance Counseling & Advocacy Program (HICAP) for assistance?
Yes. Through the Board’s work with the public and its open meetings, its staff periodically receives questions and concerns from beneficiaries and providers regarding Medicare Part D and often refers these people to their local HICAP.
4) Who makes up the Board? Are major chain pharmacies members of the Board? e.g. RiteAid, Walgreens, etc. Are rural pharmacists and their particular challenges represented on the Board?
A list of the Board members and their backgrounds is posted online. They are picked to represent the general public’s interest. Currently there are seven pharmacists, six public members, and two vacant positions. Two members are affiliated with Walgreens and Safeway pharmacies. Some of the other members include a university professor, a Los Angeles deputy city attorney, an advocate for members of the United Food and Commercial Workers Union, a retired US army lieutenant colonel, and an ambulatory care pharmacist for Kaiser Permanente. The Governor appoints these seats and the Assembly and Senate also each appoint one seat.
While the Board currently does not have a member with a background specific to rural pharmacists, the entire board works to represent all pharmacist and public interests. The Board holds meetings open to the public and pharmacists statewide and encourages communication of particular challenges/needs that pharmacists are facing. The Board can then recommend legislation and/or work with other organizations and agencies to help meet pharmacists’ particular needs. The Board also sends out biannual newsletters and provides helpful information and resources on their website.
6) Does the Board provide tips/education for pharmacists to bill Medi-Cal for dual eligible drugs covered only by Medi-Cal?
No, this is not an area in which the Board is involved. In general, the California Pharmacists Association is the entity that provides such tips and education.
7) Does the Board handle certain complaints such as when a pharmacist charges the wrong price for a medication and/or refuses to bill an insurance plan? What about if a pharmacist refuses to use the Point-of-Sale option as a back up for Medicare beneficiaries on Medi-Cal who are not in Part D plans due to a lag in being automatically assigned and enrolled into a plan?
In general, pricing and billing complaints are outside of the Board’s authority (see the ‘Filing a Complaint’ section of their website). The Board typically handles complaints regarding pharmacist misconduct (such as not keeping confidentiality or providing a prescription consultation) or medication errors. People with pricing and billing complaints can still contact the Board and their staff will assist in identifying where such a problem can be resolved. Oftentimes, as with the case if a pharmacist refuses to use the Point-of-Sale option for dual eligibles, the Board will refer such complaints to HICAP and/or CMS.
8) What statutory responsibility, if any, do pharmacists have in billing drug plans and other coverages? Can a pharmacist flat-out refuse to bill a certain type of plan, such as the Medi-Cal Emergency drug coverage?
According to Board staff, pharmacists do not have statutory responsibility to bill plans and other coverages. Most will, as that is how they often are paid, yet it is not required.
For more information on the California Board of Pharmacy and the resources and information they provide, visit their website at www.pharmacy.ca.gov.