Expanded pharmacist prescribing can shorten routes to treatment, but statutory authority does not itself establish a service able to assess, prescribe, escalate, monitor, and recover from uncertainty safely. This conceptual/policy article develops a Scope–Support Policy-Alignment Framework that separates formal scope from the responsibilities generated by prescribing and from the supports needed to discharge them: diagnostic and information support, referral and escalation access, follow-up and continuity capacity, and enabling governance. Evidence from prescribing implementation, point-of-care testing, collaboration, care transitions, and implementation studies shows that these supports vary independently across services and jurisdictions. Implementation is therefore treated as configurational. A service may be legally enabled yet operationally constrained when diagnostic inputs are unusable, referral routes are nominal, follow-up is unreachable, or organizational resources do not permit responsibility to be completed. Policy evaluation should consequently measure realized prescribing, usable support, completed escalation and follow-up, continuity, and equity alongside formal scope.
