Pharmacists could prescribe drugs without doctors’ orders under bill that passed Alaska Legislature

House Bill 195, the latest version known as CSHB 195(FIN), passed the Senate on a 15-5 vote on May 20, the final day of session, after earlier clearing the House 32-8. The bill sponsors call it a modernization of Alaska pharmacy law that would improve healthcare access, particularly in underserved communities.

But the legislation could very well serve as a slippery slope for expanded chemical abortion access in the future, despite a separate law that makes it a crime for anyone other than a doctor to perform an abortion.

The legislation allows pharmacists to prescribe and administer certain medications and medical devices for a range of minor and chronic conditions within their professional training and expertise. Examples discussed during legislative debate included treatment for influenza, strep throat, urinary tract infections, conjunctivitis, insect bites, asthma management, and diabetes care.

The bill also updates state statutes by changing the term “physician assistant” to “physician associate,” revises collaborative practice agreement rules, addresses opioid overdose medications, and streamlines pharmacist reciprocity licensing.

Proponents pointed to emergencies and severe weather events, including past typhoon-related disruptions in western Alaska, as examples of situations where pharmacists could provide faster frontline care.

Many small Alaska communities do not even have physical pharmacies, meaning much of the expanded prescribing authority could ultimately be exercised remotely through telehealth-style systems or centralized pharmacy operations.

However, the sharpest disagreement centered on abortion drugs.

Anti-abortion advocates, including Alaska Right to Life, warn that the bill’s broad language allowing pharmacists to prescribe “drugs and devices” could eventually be interpreted to permit distribution of abortion-inducing medications such as mifepristone and misoprostol without direct physician involvement.

The abortion law on the books in Alaska it makes it a crime for anyone other than a licensed physician to prescribe or use an abortion drug or device: “a) An abortion may not be performed in this state unless (1) the abortion is performed by a physician licensed by the State Medical Board under AS 08.64.200…”

This law from 1070 restricted abortions to licensed physicians only. Violations are a class A misdemeanor, punishable by up to one year in jail and a fine of up to $1,000 (some sources mention higher penalties in certain contexts)

However, a lawsuit from 2024 has that law on hold.

A permanent injunction blocking enforcement of this physician-only requirement was established in Alaska Superior Court, which ruled it violated Alaska’s constitutional rights to privacy and equal protection. 

Thus, advanced practice clinicians such as nurse practitioners and physician assistants can now perform abortions, including suction and medication abortions).

Although the state appealed the ruling, the case has not been resolved by the Alaska Supreme Court. But then, there’s federal law.

Mifepristone, the primary drug used in chemical abortions, is regulated under the federal Food and Drug Administration’s Risk Evaluation and Mitigation Strategy, or REMS, program.

When Alaska’s abortion law was passed in 1970, the drug did not yet exist. Under current federal rules, a pharmacist acting independently or dispensing mifepristone without a doctor’s prescription would be violating the law. The drug must be prescribed by a certified healthcare provider who meets specific qualifications under the REMS program, and it may only be dispensed by or under the supervision of a certified prescriber, or by a certified pharmacy acting on a valid prescription from a certified prescriber.

Although the FDA has expanded access in recent years by allowing some certified retail and mail-order pharmacies to participate, the agency still does not permit over-the-counter sales or dispensing without a prescription. These requirements are part of the legally binding Mifepristone REMS Program enforced by the FDA, and noncompliance can expose pharmacies, pharmacists, and manufacturers to penalties. Even after the 2023 rule changes eliminated the in-person dispensing requirement, a valid prescription remains mandatory.

The Alaska Department of Law maintains the bill does not authorize pharmacists to independently prescribe abortion drugs.

Still, some lawmakers and groups point out that the legislation expands pharmacy practice into what has traditionally been physician-directed medical care and could create future legal gray areas if or when federal or state abortion rules change.

The bill now awaits action from Gov. Mike Dunleavy. Because the Legislature has adjourned, the governor has 20 days, excluding Sundays, to sign, veto, or allow the measure to become law without his signature, once it is formally transmitted to him. As of May 23, it has not been transmitted.