Pharmacists do substitutions for prescriptions that aren’t in stock. They did one for my daughter yesterday although it was just cutting 1mg pills in half for a .5 mg prescription. Anyone could do that. I have always been under the impression that pharmacists have the most technical and scientific experience required in any profession that rarely gets used. They know A LOT about drugs and are trained to know about interactions but that is mostly the domain of the prescribing doctors in practice. I know the job entails a lot of knowledge overall but it seems to be mainly dealing with the doctors and insurance agencies in the area plus management of stuff which isn’t how the profession is presented.
There are pharmacists that due specialty compounding but that is mostly in hospitals. The average pharmacist at a Wal-Mart or a mega-store does much less technical work and more practical and management work. They earn their pay in any case but it is a shame some of their skills often go to waste.
It’s not unusual for pharmacists to work in different areas over their lifetime - my dad at one point owned a corner pharmacy with his brother, then went on to work for drug manufacturers, then in a hospital pharmacy, then ran a hospital pharmacy, then semi-retired and went into specialty compounding work. So, over the course of his working life he actually did a lot of different things.
I also thing it’s pretty strange that when he first started pharmacy work the latest experimental drug to hit the shelves was this new thing called “penicillin” - he’s seen a LOT of changes.
In at least one personal experience, a pharmacist who knew us gave us a couple days’ supply of a medication without the prescription in hand. IIRC it was a Friday evening and we wouldn’t be able to contact the doc for a couple of days, so the pharmacist dispensed it on his own authority. It was just an ordinary prescription med, not a controlled substance or anything like that, but I’d say that was an exercise of discretion on the pharmacist’s part.
Any doctor worth her salt uses the pharmacist as a support and listens carefully to what they say- after all the average doctor spends maybe a couple of major credits on medication whereas the pharmacist has spent several years doing it!
In the UK a pharmacist can refuse to dispense the morning after pill because it is seen as termination of pregnancy and there is a conscience clause in the Abortion Act. They do however have to enable the person to get the tablets elsewhere- either from another pharmacist in the same practice or from another pharmacy.
Pharmacists are allowed to substitute the generic in the US, as well, and at some pharmacies, that’s actually SOP. However, the ordering physician can indicate on the prescription form that the drug must be dispensed exactly as written, which includes requiring the name-brand drug. This seems to be at the behest of the drug companies, although there are clinical reasons why this may be necessary. For example, the patient may be allergic to one of the inert ingredients in the generic, or the name-brand drug is easier to swallow, or what-have-you.
That being said, pharmacists do get to know most of the doctors whose prescriptions they fill. Some doctors are receptive to whatever advice the pharmacist has to offer, and will use the opportunity to learn something. Others are arrogant pricks who are never wrong. Most are somewhere in the middle. (The same is true of doctor’s office nurses. Some are wonderful and actually listen to the pharmacists; others assume that “if that’s the way Doctor ordered it, then it must be right.”) I’ve also seen more than one pharmacist chew doctors out when the doctors made serious mistakes or done something they shouldn’t have.
Patient: “Hey doctor, I’m having a little difficulty with that prescription you gave me.”
Doc: “What’s wrong?”
Patient: "I can’t find a pharmacy that will fill it. I’ve tried Corner Drug, Quality Town Drug, Joe’s Drug Store, and Medi-Qual Drug, and they all say that the medication is too dangerous for me and won’t fill it.
Doc <under breath> : “!@#$%^”
Pharmacists in the UK may provide medication for people off prescription if, for instance, you lose your medication when travelling. he have a special book for dispensing off prescription meds. Depending what you ask for they will make various efforts to check with your GP. If it is simple and common and they think you know what you are talking about (Dosage, reason for taking it, knowing the name etc.) they may dispense without speaking with the GP- but I doubt they would dispense anything unusual or open to abuse without speaking with your doctor.
Once or twice over the years our local pharmacy has advanced us a few of my husband’s allopurnol when the prescription hadn’t been renewed yet. It’s a maintenance medication that has no recreational uses and that he has been on for years.
According to Mom the Pharmacist, that conversation never (rarely) happens. It goes like this:
Pharma: Uh - I can’t prescribe this to you right now. There’s a chance it’s going to react with your blood pressure medication. I’m calling your doctor.
Doctor: Hello?
Pharma: Hi - this is Pharma, down at CVS. Were you aware that John Smith is also taking Blood Pressure Medication #54a, and that the script you wrote for Liver Conjunctivitis Medication #204 could react with that and make his heart explode?
Doctor: Oh…I never looked at the chart. Give him Liver Conjunctivitis Medication #205. (Usually the doctor just doesn’t have that information available, and this occurs rarely in the first place.)