State of the States: How Iowa Pharmacists Pushed for New Practice Regulations

When Iowa lawmakers voted this spring to revamp how the state regulates pharmacy practice, John Hamiel says he finally breathed a sigh of relief.

IPA’s House of Delegates voted in 2019 to create a task force to study changing the state practice act. This task force, which included members, non-members, and representatives from the Iowa Board of Pharmacy, hosted in-person and virtual hearings across the state in 2021 to gather broad input, said IPA CEO Kate Gainer.

Although the standard of care framework regulates other healthcare professions in the state, the concept was new to pharmacy — and not just in Iowa. When IPA first embarked on the work, only one other state in the nation — Idaho — had adopted a standard of care framework for pharmacy practice.

The National Association of Boards of Pharmacy defines standard of care as “the degree of care a prudent and reasonable licensee or registrant with similar education, training, and experience will exercise under similar circumstances.” A 2019 study found that when compared to medicine and nursing, pharmacy regulations are longer and more restrictive.

Gainer said IPA believed that portraying the effort as a progressive pharmacy initiative could bring unnecessary opposition. Instead, she said, IPA articulated the move as an opportunity to put pharmacy on par with other healthcare professions.

IPA included the changes to modernizing the practice act as a legislative priority for a few legislative sessions but did not have a bill to show for it. “The work of the task force and public hearings across the state had concluded, but we didn’t have a legislative pathway,” Gainer said.

Then IPA’s advocacy team found an opportunity. In January 2023, Iowa Gov. Kim Reynolds issued an executive order requiring every state agency, including the Iowa Board of Pharmacy, to review their administrative code sections, with an aim of reducing restrictions and administrative burdens.

The standard of care framework removed restrictive language and reduced the page count in the state pharmacy practice act, IPA and other supporters argued, aligning with the governor’s executive order.

“Strong policy has to be coupled with political pathways before there can be legislative success,” Gainer said.

HF 555 was introduced in 2023, passing the House but failing to get a full vote on the Senate floor. Hamiel recalled that he and other IPA leaders and staff began calling their senators, asking for the legislation to pass in 2024. “It was just making sure they had all the information they needed,” he said.

IPA asked members to contact their representatives, though Gainer noted that widespread grassroots advocacy was not necessary given the favorable political timing.

Once the legislation passed and received the governor’s signature, Iowa became the third state (after Idaho and Alaska) to adopt a standard of care regulatory framework for pharmacists. Under this new framework, pharmacists are now defined as practitioners and may prescribe and provide therapeutic substitution. 

The Iowa Board of Pharmacy is updating its rules to determine how these changes will look in practice. The board has held public hearings and expects to release a final draft of new rules in spring of 2025. 

IPA members are now focused on helping shape what comes next. In February, the affiliate will host a special Standard of Care Symposium, intended to help prepare pharmacists and pharmacy technicians to adapt the new regulations to their practices. Topics will include liability and credentialing under the new framework.

“It’s very exciting to be part of getting legislation passed and moving things forward,” Hamiel said.