UB pharmacy school’s Karl Williams is working to expand profession’s scope of practice

BUFFALO, N.Y. —  Increasingly, big swaths of the country, especially in rural and low-income areas, are experiencing a severe shortage of primary care doctors

As more physicians retire and medical students choose to pursue higher-paying specialties, the situation is only expected to grow worse. The American Association of Medical Colleges predicts a deficit of up to 124,000 primary care physicians by 2036.

In many states, community pharmacists are filling some of the crucial health care gaps by monitoring chronic conditions and diagnosing and treating diseases such as influenza, strep throat and COVID-19. This service keeps people out of the hospital and saves money, time and, in some cases, lives.

However, in New York State, pharmacists are not authorized to perform many of these tests or prescribe the drugs that their peers in at least 20 other states are.

Karl Williams, JD, who was appointed clinical professor and director of legislative advocacy at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences in 2025, is working with legislators in Albany to change this and other discrepancies in the scope of pharmacy practice.

 A 1980 graduate of the UB pharmacy undergraduate program, Williams earned several advanced degrees and taught in pharmacy schools at St. John Fisher University, St. John’s University and the University of Wyoming before returning to UB.

We recently sat down with Williams to discuss his first year of advocacy work at UB, the issues he’s most passionate about and the relaunch of the school’s Pharmacy Law Newsletter, for which he’ll serve as editor.

With the shifts in health care and the behavioral, societal and environmental factors affecting patients, what most concerns you?

My key concern is public health. Primary care, as it exists in New York State and, really, around the country, is lacking for a lot of folks. They wind up in primary care deserts, which creates public health problems. It’s been proven that people who don’t have access to primary care have shorter lifespans.

I spend much of my timing educating legislators on what pharmacists can bring to the table and how we’re prevented from doing so under current laws and regulations.

While we’re not going to be able to completely replace the gaps in primary care, we can address some of the problems and give patients access to care that pharmacists are capable of providing.

What should pharmacists be allowed to do in New York that they’re currently prohibited from doing?

Pharmacists should be allowed to give patients simple foolproof tests for conditions like blood glucose and cholesterol, as well as test for diseases including HIV, strep throat, upper respiratory infections and Hepatitis C, a widely underdiagnosed disease.

When patients don’t have a primary care physician or can’t get in to see one for several weeks, they go to the ER or other urgent care, where they can potentially contract other diseases. It’s expensive and inefficient.

If they can go to the pharmacy, however, and get those tests, they can obtain actionable information that they can take to their health care provider or, in many cases, get the care that they need right there.

The alignment between what we train students to do and what they’re permitted to do in their scope of practice falls far short of the national standard of care for education. My charge is to bring pharmacy practice up to the standard of care that is consistent with our training.

Why is it more prohibitive in New York than other states?

Changing professional practice laws here in New York is very difficult. It often opposed by very powerful lobbying organizations who view expansion as “scope creep” that encroaches on their professional turf.

One of the things we’re working on is changing the law to “standard of care regulation,” something many states have done. It would basically repeal the scope of practice constraints on pharmacists and allow us to practice at the level of education, training and experience that we have obtained.

What are the top issues you’re focused on right now?

Two issues that have risen to the top for me are reproductive health and the opioid crisis. We’ve had success in reproductive health with pharmacists being permitted to prescribe hormonal contraception, but more can be done.

With the opioid crisis, I’m working directly with the New York Assembly and the Senate to allow pharmacists to prescribe the most tried and true medication for opioid dependence: buprenorphine.

Pharmacists can prescribe it in 20 states now, mostly on the West Coast. If patients are faced with a prospect of withdrawal, it’s a very desperate situation for them. Instead of going through withdrawal, patients might seek street drugs just to feel normal and not get sick. They also might contemplate suicide.

We train our students to recognize opioid use disorder at the dispensing bench. We train them to understand the pharmacology, the effects and side effects of medication, and the process of buprenorphine induction. It’s something that pharmacists are competent to do. We just don’t have the legal authority to prescribe it at this point.

The school is relaunching its online Pharmacy Law Newsletter this spring. What role will it play?

There’s really not another place where professional pharmacists can get information on what’s new in legislative affairs, in regulatory affairs and in litigation. And I believe I’m in a position where I can provide context for many of these issues.

When it was announced that I was taking this position and relaunching the newsletter, I got so many positive comments. People loved it. I’m standing on the shoulders of two iconic faculty members, the late Robert Cooper and the recently retired Karl Fiebelkorn, who were the editors in the early years.

How often will the newsletter be published and who is the audience?

We’re planning to publish two editions this calendar year, with the first one in April. I’d like to see it become quarterly. There’s plenty of news to share.

The goal is to inform pharmacists and, hopefully, raise interest in advocacy about the important issues of the day.

What are some of the top stories you’re hoping to cover this year?

Legislative bills that have recently passed such as the Medical Aid in Dying (MAID) Act. It will allow a physician to work with a terminally ill patient with less than six months to live to receive medication that would permanently end their suffering.

I will cover issues such as: What is a pharmacist’s role? And I will explain about the conscientious objection piece of the law, which will allow pharmacists to decline participation if they receive that prescription.

Also, there’s a 2024 Supreme Court case regarding the FDA-approved medication mifepristone, which would terminate a pregnancy. There was an advocacy group that sought to have that FDA approval revoked and to have some other changes made around that medication. I will explain the impact on pharmacy practice.