health system may restrict APRN prescribing more than the law does. The VA and health maintenance organizations such as Kaiser Permanente use preferred drug lists, or formularies, to promote evidence‐based prescribing and control costs. Similarly, Medicaid and Medicare set guidelines for drug benefits, while private health plans usually have different tiers of drug coverage to promote prescribing of effective lowest cost drugs.
Pharmacy benefit managers are another aspect of the medication distribution chain, negotiating with drug companies and pharmacies on behalf of health plans. They develop formularies on behalf of the health plans, negotiate discounts and rebates with the manufacturers, and contract with pharmacies to reimburse for drugs dispensed to health plan beneficiaries (Commonwealth Fund, 2019). Some retailers have drugs dispensed for reduced costs, such as a $4 or $10 prescription, or offer reduced rates based on membership (Torrey, 2019). Discount coupons are often available from the manufacturer for some high‐cost medications or discount programs.
THE FUTURE OF THE APRN PRESCRIBING ROLE
The US opioid epidemic, increasing antibiotic resistance, the escalating costs of prescription drugs, and limited access to medication in under resourced countries are a few examples of why rational prescribing is imperative. A balance between pharmacological and non‐pharmacological treatment options is becoming increasingly desirable as many patients use herbal remedies and supplements and seek more holistic healing approaches, choosing to avoid medication risks and side effects. New scientific information may also reveal additional considerations about medication safety or sequelae. The APRN has the opportunity to meet these demands using evidence‐based practices and rational prescribing. As the evidence base for pharmacological treatment changes and the use of electronic prescribing increases, the APRN must adapt prescribing practices. Adoption of the prescriber role is a career‐long process that requires vigilance and wisdom.
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