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Drug Dispensing to Improve Patient Care One crucial aspect of patient care affected by these federal regulations is how patients obtain their drugs from local pharmacies. Local pharmacies are critical in ensuring medications are dispensed safely and labeled correctly.[2] Pharmacists' counseling on medication use falls under state rather than federal law. Since the federal government has not established a national, standardized disbursement practice for pharmacists, the standard of care and medication counseling may not be consistent among patients receiving care from different pharmacists nationwide. There have been numerous studies, as recent as 2021, analyzing the effect that direct drug disbursement from local pharmacies has on patients' clinical and economic outcomes.[3] These studies show that pharmacist counseling has a positive outcome on the patient's clinical and financial well-being, regardless of the amount of time spent counseling on medication safety.[3] Conscientious Objection Another concern when discussing medication dispensing is the conscientious objection, which means that a healthcare provider opposes a legal healthcare treatment, procedure, or medication due to a religious or ethical reason.[4] Recently, most objections were directed to administering legal abortifacient or birth control medications. Although state laws differ to the extent of what pharmacists may do in leu of dispensing these medications, most states require pharmacists to ensure patients get their medications somewhere else by transferring the prescription to another pharmacy.[5] Some pharmacists may struggle in referring patients to other pharmacies because the patient will eventually receive these medications.[5] After multiple cases of pharmacist misconduct in Idaho and Washington, pharmacists went to the federal government requesting further protections for providers and their right to apply conscientious objections. As a result, in 2018, the Department of Health and Human Services established a "Conscience and Religious Freedom Division." This division enforces existing federal laws, protecting healthcare workers' rights when enacting a conscientious objection. However, the formation of this division did not require any change to the existing state laws regarding conscientious objection.

After multiple cases of pharmacist misconduct in Idaho and Washington, pharmacists went to the federal government requesting further protections for providers and their right to apply conscientious objections. As a result, in 2018, the Department of Health and Human Services established a "Conscience and Religious Freedom Division." This division enforces existing federal laws, protecting healthcare workers' rights when enacting a conscientious objection. However, the formation of this division did not require any change to the existing state laws regarding conscientious objection. Although the federal government is willing to enforce the reasonable objection of prescription medications by providers, individual states regulate alternative measures providers must take to ensure patients receive their medications. [Level 5]

Prescriptive Authority Prescriptive authority refers to the ability of healthcare providers to prescribe specific medications, including controlled substances. Although prescriptive authority refers to a provider's role in prescribing and dispensing legal drugs as described in Title 21, the regulation of this authority does not fall under the federal government's purview. Instead, prescriptive authority is regulated by each state's government.[6] In every state within the United States, all physicians holding an MD or DO degree have full prescriptive authority. However, there have been some legal disparities between states regarding providing prescriptive authority to other certified providers, such as registered nurse practitioners (NPs) and physician assistants (PAs). In some states, these providers may only prescribe certain medications under the supervision of a licensed clinician.[7] In other states, these providers can prescribe some medications but not controlled substances, and in other states, they have full prescriptive authority at the same level as doctors.[7][6] Recently, a group of providers petitioned the FDA for defined federal regulations on prescriptive authority in order to globally protect a provider's ability to prescribe medications. The FDA has not yet taken a stance on federal prescriptive authority legislation. For now, regulating prescriptive authority remains at the state level.