Scope of practice decisions, such as granting pharmacists independent prescriptive authority, are governed at the state level and are often contentious debates. Five states – Florida (FL), New Mexico (NM), Colorado (CO), Idaho (ID), and Oregon (OR) -- have created structures that can theoretically expand independent prescriptive authority through decentralized approaches rather than needing the legislature to approve each drug that pharmacists may prescribe. These approaches have the potential advantage of allowing the states to expand independent pharmacist prescriptive authority to address public health needs more quickly. Four distinct models have been identified from most to least restrictive in practice: 1) medical veto; 2) interdisciplinary committee; 3) board of pharmacy; and 4) pharmacist-determined. These models have generally focused on postdiagnostic and preventive care by pharmacists. In terms of enabling broad pharmacist prescribing, only two of these models have demonstrated success: board of pharmacy and pharmacist-determined. Pharmacy and public health stakeholders considering similar legislation in their own states should consider the success of these decentralized models prior to enacting legislation.

实践范围的决定，例如授予药剂师独立的处方权，在州一级进行管理，并且通常是有争议的辩论。五个州——佛罗里达州 (FL)、新墨西哥州 (NM)、科罗拉多州 (CO)、爱达荷州 (ID) 和俄勒冈州 (OR)——已经创建了结构，理论上可以通过分散的方法扩大独立的规定性权威，而不需要立法机构批准药剂师可能开出的每种药物。这些方法具有允许各州扩大独立药剂师处方权以更快地满足公共卫生需求的潜在优势。在实践中已经确定了四种不同的模式，从最严格到最不严格：1）医疗否决权；2) 跨学科委员会；3) 药房委员会；4) 药剂师确定。这些模型通常侧重于药剂师的诊断后和预防性护理。在实现广泛的药剂师处方方面，这些模式中只有两种取得了成功：药房委员会和药剂师确定。考虑在本州进行类似立法的药房和公共卫生利益相关者应在制定立法之前考虑这些分散模式的成功。