The politics of Kentucky: Pharmacy regulation

This chapter examines pharmaceutical health policy in Kentucky by exploring the po litical pro cess behind the Commonwealth’s implementation of some key pharmaceutical regulations. Pharmaceutical regulations affect the distribution, sale, and access to medications, and are often po liti cally contentious because of the infl uence of opposing wellfi nanced interest groups, such as medical professional organizations, the pharmaceutical industry, and insurers or third- party payers. This chapter focuses on two themes, the interplay among competing interest groups and regulatory variation across states. State regulations are important because of the U.S. model of federalism, a system of shared governance between the national (federal) government and state governments. Under this framework, some decisions are made and implemented at the national level, some decisions are made and implemented at the state level, and some decisions are shared by both (or more) levels of government. Pharmacy, like most health professions, is licensed and regulated at the state level. Each state has authority to specify how health professionals are regulated, and a licensed pharmacist in one state cannot practice in another state unless that person completes additional licensing requirements. In addition to licensing differences, states specify additional criteria for the practice of pharmacy, such as operation and management rules, regulation of controlled substances, marketing, and dispensing. This chapter focuses on how interest- group infl uence has produced interesting variations across state regulatory policy with regard to mail- order pharmacies, prescribing authority for physician extenders, immunization authority for pharmacists, and the implementation of state programs to monitor prescription drugs.