OPINION: End to Occupational Regulation for Pharmacy is Not Worth the Risk

By Naida Rivera, fourth-year doctor of pharmacy candidate, Florida A&M University

Abstract

Occupational regulatory programs can have an adverse impact on professional licensed individuals in Florida.

Feb. 17, my first day on the AssociaNaida Rivera tion management rotation, is a day I will always remember. It was the day I was able to witness firsthand the excitement of different bills being recognized in the state Legislature. One bill caught my attention. SB 1124 and its House companion, HB 707 caught my interest because of my status as student. Imagine losing the one thing that attests to your hard work and tenacity. The possibility of practicing in a profession that is licensed and controlled and having it taken away from you after eight challenging years of proving your determination. Pharmacy school is no walk in the park. Hard work, sleepless nights, sweat and tears have gone into my path of one day becoming a licensedpharmacist.

I can finally see the light at the end of the tunnel, just a few more months until graduation day and … another predicament to surmount.

Introduction

SB 1124, otherwise known as the Occupational Regulation Sunset Act, will have anyone with a professional license on the edge of their seat. Occupational licensure is a regulatory system that requires people to have some kind of

credential in order to be qualified to provide a service. These licenses are required by the state of Floridato practice certain trades and professions.

When implemented efficiently, occupational licensure helps to protect the public’s health and welfare and enhances the quality of goods and services. Conversely, occupational licensure may create unintended consequences by creatingobstaclesforpeople who are not licensed and potential workers en

tering the labor market. Colorado was the first state to implement a sunset re

view process in 1976. Later, 36 states adopted sunset legislation. Thus far, Col

orado performed two sunrise and 15 sunset reviews. 1 In most of these states, the common results of sunset reviews were not terminations of agencies and boards as was projected and feared, but managerial and fundamental alterations. By 1990, six states had abolished their sunset laws and another six hadpostponedthe process. 2

There are more than 100 occupational regulatory programs in Florida. The bill’s intent is to have the legislature review each program before the scheduled effective date of repeal of the

program. The review will permit the program to be terminated, reinstated with or without revisions, or one of the other suitable measures. 3 An example of an unintended consequence due to a sunset provision not being addressed is the health access dental license. Florida laws allowed out-of-state licensed people in good standing with no discipline to practice in the state of Florida without sitting for the board exam. The dental licensure did good for the community by increasing access to underserved public community health centers and county health departments.

A sunset provision in Florida laws resulted in a removal of the out-of-state licensed dental services in our state. There are now efforts in place fighting to reinstate that section of Florida law. To avoid the troubling process of reinstatement, the matter of verbiage of SB 1124 should be addressed before history repeats itself.

The bill provides:

“Within 60 days after the date on which any occupational regulatory program is allowed to expire through scheduled repeal under this act, the personnel positions which are

IN MOST OF THESE STATES, THE COMMON RESULTS OF SUNSET REVIEWS WERE NOT TERMINATIONS OF AGENCIES AND BOARDS AS WAS PROJECTED AND FEARED, BUT MANAGERIAL AND FUNDAMENTAL ALTERATIONS. BY 1990, SIX STATES HAD ABOLISHED THEIR SUNSET LAWS AND ANOTHER SIX HAD POSTPONED THE PROCESS. 2

responsible for carrying out the program shall be abolished, and all unexpended balances of appropriations, allocations, or other funds for such program shall revert to the fund from which they were appropriated or, if that fund is abolished, to the General Revenue Fund. Except as authorized under this section, all 60 regulatory activities related to the repealed program shall cease after the date of repeal.”

This bill has intentions of providing more opportunity for relaxing regulation and increasing job opportunity. With a broad opening for no longer regulating a profession that was once licensed, this would allow people who have the skills to be employed without the hurdle of licensing. An example would be an instance where people may have the skills of a licensed barber or cosmetologist, but not granted that same employment opportunity because they may have fallen short of licensure requirements. Some professions are an accumulation of skills and knowledge acquired over the years and can be selftaught.

I do believe in creating more jobs and opportunities, but there are also jobs that must be taught through hours, months or years of learning and skills development to shield consumers from harm.

On one hand, these licenses are being regulated for the safety of the public. The people deserve to have services rendered by a competent person that will not put them in harm’s way. If someone is practicing negligently, ramifications can impact that person’s license. Having a license holds that person to professional standards and expectations. If someone takes their mother’s prescription to the pharmacy after being diagnosed with heart failure, there should be a licensed pharmacist behind the counter catching mistakes, reviewing medication interactions and making sure their mother is being given the most optimal care possible.

SB 1124 allowed for deregulation of any license if not reviewed on the date it was set to be reviewed by the Legislature. This proclamation leaves room for licenses to sunset because lawmakers were not able to review it in time. There are some professions that should be considered essential and should not be up for debate. A deregulated profession would have the opportunity to become saturated with less knowledgable practitioners making unsuitable decisions that will place the public in jeopardy. Does the public need complex services provided by personnel with limited training? Licensure facilitates a way to make sure that a provider is qualified and reliable. I do understand the intent is to deregulate, however, if licensure is taken away, this could create massive disruptions in the pharmacy career space. More than 33,000 Florida licensed pharmacists will have their lives changed.

Let us take a closer look into the profession of pharmacy. The years of education, the student loans and hours of practice, experience and preparation alone calls for a separation of non-licensed individuals and pharmacy doctorate graduates. If this bill would have found its way to the governor’s desk, I could see poor medication compliance or possibly an increase in hospital bills. Pharmacists help bridge the understanding of what the medications are for and the importance of taking them for your health. Hypertension, the silent killer, takes thousands of lives a year. Without a pharmacist in place managing medications and counseling, the numbers would only increase. The profession of pharmacy gives patients and other health care professionals further support and peace of mind when it comes to the patient’s medications and health.

A pharmacist’s obligation is not merely preparing the medications which are prescribed by a general practitioner or other health professionals. It is to provide optimal pharmaceutical care by evaluating the appropriateness of the medication for each patient, taking into consideration their medical history, as well as possible side effects and interactions with other medications that are being used. A critical fact of a pharmacist’s patient care services also includes commitment and interaction with patients, so that patients have basic knowledge of the medication, its functions, targets, effects and the dosage regimen. Pharmacists also

embark on health promotions, such as delivering education on specific areas of health and disease prevention. There are pharmacy practices that even concentrate on, for example, asthma or diabetes care and deliver individualized support, guidance and essential services. Without the help of a licensed pharmacist, a wide array of problematic errors can come about.

Deregulation can result in stiff job competition, lower costs and lower prices to consumers, but still follow with a greater cost to the consumer. In achieving these targets, thousands of companies can be forced out of business, resulting in lower earnings and the creation of oligopolies through mergers and acquisitions. 4 With a competitive job market, employee compensation pay would have to be forfeited to lower the cost to consumers. Smaller business may have to close their doors because their customers are now dispersed elsewhere, and income would not be enough to stay above water. SB 1124 and its house companion HB 707 did not appear to have made it past the finish line this legislative session. There is always room for improvement, but the chance of deregulating pharmacy should not be the choice of policy makers.

I am thankful that the Florida Pharmacy Association kept a close eye on this matter.

Reference

1. Hentze I. Improving Occupational Licensing with Sunrise and Sunset Reviews. https://www.ncsl.org/ research/labor-and-employment/ improving-occupational-licensingwith-sunrise-and-sunset-reviews.aspx.

Accessed February 24, 2020. 2. CLEAR - Sunrise, Sunset & Agency

Audits. https://www.clearhq.org/ page-486181. Accessed February 24, 2020. 3. The Florida Senate: Bill Analysis and

Fiscal Impact Statement.; 2019. https:// www.clearhq.org/page-486181.

Accessed February 24, 2020. 4. Collins M. Did Deregulation Work? | IndustryWeek. https://www. industryweek.com/the-economy/ regulations/article/22007281/didderegulation-work. Published 2016. Accessed March 9, 2020.