BILL ANALYSIS                                                                                                                                                                                                    



                                                                       


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          |SENATE RULES COMMITTEE            |                  SB 1169|
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                              UNFINISHED BUSINESS


          Bill No:  SB 1169
          Author:   Alpert (D), et al
          Amended:  9/4/01
          Vote:     21

           
           SENATE HEALTH & HUMAN SERV. COMMITTEE  :  7-1, 5/23/01
          AYES:  Ortiz, Chesbro, Figueroa, Kuehl, Romero,  
            Vasconcellos, Vincent
          NOES:  Haynes

           SENATE APPROPRIATIONS COMMITTEE  :  Senate Rule 28.8

           SENATE FLOOR  :  24-10, 6/6/01
          AYES:  Alarcon, Alpert, Bowen, Burton, Chesbro, Costa,  
            Dunn, Figueroa, Karnette, Kuehl, Machado, McPherson,  
            Murray, Ortiz, Peace, Perata, Polanco, Romero, Scott,  
            Sher, Speier, Torlakson, Vasconcellos, Vincent
          NOES:  Ackerman, Battin, Brulte, Haynes, Johannessen,  
            Johnson, Knight, Margett, Oller, Poochigian

           ASSEMBLY FLOOR  :  53-20, 9/6/01 - See last page for vote


           SUBJECT  :    Pharmacy

           SOURCE  :     Public Health Institute


           DIGEST  :    This bill permits a pharmacist to initiate  
          emergency contraception drug therapy in accordance with  
          standardized procedures or protocols developed by the  
          pharmacist and an authorized prescriber.

                                                           CONTINUED





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           Assembly amendments  :

          1. Require the pharmacist to complete a training program on  
             emergency contraception.

          2. Incorporate language included in AB 826 (Cohn), pending  
             the Governor's signature, to avoid chaptering out if  
             both bills are enacted and become law.

           ANALYSIS  :    Under existing law, a pharmacist may not, in  
          general, furnish a dangerous drug except upon the  
          prescription of a physician, dentist, podiatrist,  
          optometrist, or veterinarian.  However, existing law  
          provides for certain exemptions.

          This bill:

          1. Permits a pharmacist to initiate emergency contraception  
             drug therapy in accordance with standardized procedures  
             or protocols developed by the pharmacist and an  
             authorized prescriber who is acting within his or her  
             scope of practice. 

          2. Requires a pharmacist, prior to initiating emergency  
             contraception drug therapy, to complete a training  
             program on emergency contraception, delivered by an  
             American Council on Pharmaceutical Education provider or  
             another training program approved by the Board of  
             Pharmacy.  Requires this training program to include,  
             but not be limited to, conduct of sensitive  
             communications, quality assurance, referral to  
             additional services, and documentation. 

          3. Requires a pharmacist, for each emergency contraception  
             drug therapy initiated, to provide the recipient of the  
             emergency contraception drugs with a standardized fact  
             sheet that includes, but is not limited to, the  
             indications for use of the drug, the appropriate method  
             for using the drug, the need for medical follow-up, and  
             other appropriate information.

          4. Requires the board to develop the fact sheet required in  
             #3 above in consultation with the Department of Health  
             Services, the American College of Obstetricians and  







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             Gynecologists (ACOG), the California Pharmacists  
             Association, and other health care organizations.   
             Specifies that this bill does not preclude the use of  
             existing publications developed by nationally recognized  
             medical organizations. 

          5. Incorporates changes proposed by AB 826 (Cohn), pending  
             the Governor's signature, to avoid chaptering out if  
             both bills are enacted and become law. 

           Comments  

          According to the author, this bill seeks to make emergency  
          contraception available to women who are at risk of an  
          unwanted pregnancy.  The author states that making  
          emergency contraception available to women will reduce the  
          number of abortions.  The author notes that emergency  
          contraception differs from RU-486 in that it does not cause  
          an abortion, but rather prevents a pregnancy.  Under this  
          bill, the author states that women who have had unprotected  
          intercourse and do not want to risk becoming pregnant will  
          be able to obtain emergency contraception in a pharmacy  
          provided the pharmacy has a collaborative physician  
          protocol.  The net effect of this bill is to make emergency  
          contraception available in a pharmacy, without first having  
          to make an appointment with your physician to obtain a  
          prescription. 

          According to the Office of Population Research at Princeton  
          University, which operates the Emergency Contraception  
          World Wide Web server, emergency contraceptives are methods  
          of preventing pregnancy after sexual intercourse.  There  
          are two types of emergency contraceptive pills.  One type  
          uses hormones that are the same type and dose as hormones  
          used in some kinds of ordinary birth control pills.  These  
          hormones are called estrogen and progestin, and one brand  
          name called Preven is especially packaged and labeled for  
          emergency use, although other brands packaged for ongoing  
          contraception can be used for emergency use as well. Use of  
          this type of contraception cuts the chance of pregnancy by  
          75%.  The other type of emergency contraceptive pill  
          contains only the hormone progestin, and is specially  
          packaged and labeled for use as the brand name Plan B. Plan  
          B reduces the risk of pregnancy by 89%.  Women can start  







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          the pills right away or up to three days after unprotected  
          sex, and it is more effective the earlier it is initiated  
          within the 72 hour window. 

          Depending on the time during the menstrual cycle that the  
          emergency contraception pills are taken, emergency  
          contraception pills may inhibit or delay ovulation, inhibit  
          tubal transport of the egg or sperm, interfere with  
          fertilization, or alter the endometrium (the lining of the  
          uterus), thereby inhibiting implantation of a fertilized  
          egg.  Emergency contraception does not cause an abortion.   
          Emergency contraception prevents pregnancy and thereby  
          reduces the need for induced abortion.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  No

           SUPPORT  :   (Verified  9/7/01)

          Public Health Institute (source)
          California Medical Association
          Planned Parenthood
          California Pharmacists Association
          American College of Obstetricians and Gynecologists
          California Society of Health System Pharmacists
          California Coalition of Nurse Practitioners
          California Coalition for Reproductive Freedom
          California Conference of Local Health Officers
          California State Board of Pharmacy
          California Women Lawyers
          California Women's and Children's Health Coalition
          Commission on the Status of Women
          Kaiser Permanente
          National Organization for Women

           ARGUMENTS IN SUPPORT  :    This bill is sponsored by the  
          Public Health Institute (PHI), which states that more than  
          three million unplanned pregnancies occur each year in the  
          United States.  Making emergency contraception easily  
          accessible to women can dramatically reduce unintended  
          pregnancies and abortions.  PHI states that several medical  
          organizations representing physicians have developed  
          resolutions supporting emergency contraception pills being  
          made available to women on an over-the-counter basis.   







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          While the federal Food and Drug Administration has stated  
          that emergency contraception pills are safe and effective,  
          there is no indication it will change the class of these  
          products from prescription to over-the-counter.  PHI states  
          that California has no authority to grant drugs  
          over-the-counter status, but there are significant steps  
          California can take to broaden access to emergency  
          contraception pills.  PHI states that under current law,  
          pursuant to recent legislation, consumers can receive  
          services such as emergency contraception in pharmacies,  
          under limited protocols.  The current protocol requirements  
          must be patient-specific for a condition for which that  
          patient has seen their physician.  PHI states that while  
          programs utilizing this authority to provide emergency  
          contraception have been developed in several counties,  
          these programs have found a significant limitation in the  
          ability to provide service under the narrow protocol  
          requirements of current law.  For instance, women who do  
          not have a physician cannot currently access this safe and  
          effective service in a pharmacy.  PHI states that this bill  
          will broaden current law by allowing all women in need to  
          obtain emergency contraception services in a pharmacy,  
          provided the pharmacy  has a collaborative physician  
          protocol.

           ASSEMBLY FLOOR  :
          AYES:  Alquist, Aroner, Calderon, Canciamilla, Cardenas,  
            Cardoza, Chan, Chavez, Chu, Cohn, Corbett, Correa,  
            Daucher, Diaz, Dutra, Firebaugh, Frommer, Goldberg,  
            Harman, Havice, Horton, Jackson, Keeley, Kehoe, Koretz,  
            Liu, Longville, Lowenthal, Maldonado, Matthews, Migden,  
            Nakano, Nation, Negrete McLeod, Oropeza, Rod Pacheco,  
            Papan, Pavley, Reyes, Richman, Salinas, Shelley,  
            Simitian, Steinberg, Strom-Martin, Thomson, Vargas,  
            Wayne, Wesson, Wiggins, Wright, Zettel, Hertzberg
          NOES:  Aanestad, Ashburn, Bogh, Briggs, Bill Campbell, John  
            Campbell, Cox, Dickerson, Florez, Hollingsworth, Kelley,  
            La Suer, Leonard, Leslie, Maddox, Mountjoy, Pescetti,  
            Runner, Strickland, Wyman


          CP:sl  9/8/01   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE







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