Reps. Donna Sweaney, D-Windsor, and Debbie Evans, D-Essex Junction
Naturopaths were cleared Thursday morning for enhanced authority to prescribe drugs in Vermont.
At a meeting of the Legislative Committee on Administrative Rules, all but one committee member withdrew an earlier objection to the change in naturopathic prescribing powers.
Naturopathic doctors currently are limited to prescribing from a formulary — a list of specific pharmaceuticals approved for naturopathic prescriptions that must be updated yearly in coordination with the Department of Health. Under the new rule, naturopathic authority will expand in line with a principle that governs other doctors’ prescribing powers: no restrictions except those of their own “scope of practice.”
Once the new rule is filed, which Secretary of State Jim Condos’ office expects to complete Monday, it will take effect in 15 days.
The rule change comes after years of work. Wrangling among policymakers reached a fever pitch in September when LCAR objected to the rule, saying the Secretary of State’s Office of Professional Regulation had not followed proper protocols — an assertion Condos strenuously denied.
“I believe the foundation of your objection letter to be faulty,” Condos told LCAR members Thursday morning.
In an interview after the meeting, Condos said he thought the committee’s “confusion” about OPR’s process had come from Vermont Medical Society testimony that followed OPR’s presentation at a previous hearing.
“We believe all three of their (LCAR’s) objections were answered at the last meeting, but because VMS came in after and provided further input, it kind of confused the issue,” Condos said. “The way we laid it out today straightened them out so they understood.”
In nearly 10 minutes of testimony followed by extensive questions and answers, and a bit of editorializing about the legislative process by committee members, Condos detailed how staffers previously had addressed the points of contention about the proposed rule: That OPR had not consulted adequately with clinical pharmacists or the University of Vermont Medical School, and had not specified the training naturopaths must undergo to safely navigate unfettered prescriptive authority.
OPR had done all those things, Condos said. Reps. Donna Sweaney, D-Windsor, and Debbie Evans, D-Essex Junction, also testified to the “considerable” work the Legislature had put into the rule over the course of two bienniums. Letters from Health Commissioner Harry Chen and Sen. Jeanette White, D-Windham, chair of the Government Operations Committee, further affirmed Condos’ defense.
“This rule does not increase their scope of practice at all,” Evans said. “It just enhances their ability.”
The committee apparently was convinced. Even Sen. Peg Flory, R-Rutland, the lone holdout on LCAR’s affirmative vote, said Thursday afternoon that the morning’s testimony reassured her to some extent.
Flory had questioned whether naturopaths’ pharmacological training had been sufficiently addressed. Further conversations with OPR lawyer Colin Benjamin helped assure her that the agency’s directives for rulemaking had been been followed.
The group that remains unconvinced, however, is the Vermont Medical Society.
Madeleine Mongan, deputy executive vice-president of the society, said Thursday afternoon that her organization had withdrawn its formal objection to the rule, although it still had “underlying concerns.” Detailed in June, those include include the extent of naturopaths’ pharmacological training and the unlimited scope of their new authority to prescribe classes of drugs such as psychotropics, chemotherapy and intravenous medications, among others.
Mongan said that because OPR had agreed to form an interdisciplinary committee of naturopaths, medical doctors and pharmacists to serve in an advisory role, VMS opted to withdraw its objection. The committee “hopefully” will address VMS concerns, Mongan said.
“It’s not going to have any power,” Condos said in an interview Thursday afternoon. “We will lean on them to help us … protect the public and at the same time allow the naturopaths that have training who are primary care physicians to do their jobs to best of their abilities.”
The committee’s exact formation and charge is not yet clear, nor is the medical society’s participation in it. Mongan said it was the reason VMS had withdrawn its objection to the rule, but Condos was not aware even after Thursday’s meeting that their objection had been withdrawn.
“Because we believe that the interdisciplinary committee is good public policy, we plan to go ahead with it as an advisory group despite an unwillingness on the part of VMS to play a constructive role,” Condos said, reading from his own letter to the committee, dated Sept. 25.
While naturopaths technically will be able to prescribe any drug under the new rule, they’ll effectively only be allowed to order drugs that they’re trained to prescribe.
All naturopaths who want prescribing power will have to pass a pharmacological exam. Those who don’t wish to prescribe can simply not take the exam and not obtain the prescription endorsement on their state licenses.
The first 100 prescriptions written by naturopathic physicians must be reviewed by another physician with an unlimited prescription license. Only doctors with at least five years of prescription experience will be allowed to review naturopaths during that probationary period.