BILL NUMBER: AB 826 CHAPTERED 09/10/01 CHAPTER 262 FILED WITH SECRETARY OF STATE SEPTEMBER 10, 2001 APPROVED BY GOVERNOR SEPTEMBER 8, 2001 PASSED THE ASSEMBLY AUGUST 23, 2001 PASSED THE SENATE JULY 21, 2001 AMENDED IN SENATE JULY 18, 2001 AMENDED IN SENATE JUNE 18, 2001 INTRODUCED BY Assembly Member Cohn FEBRUARY 22, 2001 An act to amend Sections 4050, 4051, and 4052 of the Business and Professions Code, relating to pharmacists. LEGISLATIVE COUNSEL'S DIGEST AB 826, Cohn. Pharmaceutical practice: prescriptions. Under existing law, a pharmacist may authorize initiation of a prescription and provide clinical advice or information or patient consultation from outside a pharmacy premises if certain conditions are met, and may adjust the drug regimen of a patient for care provided by specified facilities. Existing law makes a knowing violation of the Pharmacy Law a crime. This bill would, with respect to the requirements for initiation of prescriptions and providing clinical advice or information or patient consultation, delete the restriction that the transaction occur outside of a pharmacy premises. The bill would require that a pharmacist's initiation of a prescription be pursuant to specified provisions. This bill would revise the requirement for the providing of clinical advice, information, or client consultation to specify that the advice, information, or consultation be provided to a health care professional or a patient. The bill would also authorize a pharmacist to initiate the drug regimen of a patient in specified facilities pursuant to a written order or authorization by the patient's prescriber and would require the pharmacist to provide written or electronic notification of that action. This bill would incorporate additional changes in Section 4052 of the Business and Professions Code proposed by SB 1169, to be operative only if SB 1169 and this bill are both enacted and become effective on or before January 1, 2002, and this bill is enacted last. This bill would impose a state-mandated local program by changing existing crimes and creating new crimes. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 4050 of the Business and Professions Code is amended to read: 4050. (a) In recognition of and consistent with the decisions of the appellate courts of this state, the Legislature hereby declares the practice of pharmacy to be a profession. (b) Pharmacy practice is a dynamic patient-oriented health service that applies a scientific body of knowledge to improve and promote patient health by means of appropriate drug use, drug-related therapy, and communication for clinical and consultative purposes. SEC. 2. Section 4051 of the Business and Professions Code is amended to read: 4051. (a) Except as otherwise provided in this chapter, it is unlawful for any person to manufacture, compound, furnish, sell, or dispense any dangerous drug or dangerous device, or to dispense or compound any prescription pursuant to Section 4040 of a prescriber unless he or she is a pharmacist under this chapter. (b) Notwithstanding any other law, a pharmacist may authorize the initiation of a prescription, pursuant to Section 4052, and otherwise provide clinical advice or information or patient consultation if all of the following conditions are met: (1) The clinical advice or information or patient consultation is provided to a health care professional or to a patient. (2) The pharmacist has access to prescription, patient profile, or other relevant medical information for purposes of patient and clinical consultation and advice. (3) Access to the information described in paragraph (2) is secure from unauthorized access and use. SEC. 3. Section 4052 of the Business and Professions Code is amended to read: 4052. (a) Notwithstanding any other provision of law, a pharmacist may: (1) Furnish a reasonable quantity of compounded medication to a prescriber for office use by the prescriber. (2) Transmit a valid prescription to another pharmacist. (3) Administer, orally or topically, drugs and biologicals pursuant to a prescriber's order. (4) Perform the following procedures or functions in a licensed health care facility in accordance with policies, procedures, or protocols developed by health professionals, including physicians, pharmacists, and registered nurses, with the concurrence of the facility administrator: (A) Ordering or performing routine drug therapy-related patient assessment procedures including temperature, pulse, and respiration. (B) Ordering drug therapy-related laboratory tests. (C) Administering drugs and biologicals by injection pursuant to a prescriber's order (the administration of immunizations under the supervision of a prescriber may also be performed outside of a licensed health care facility). (D) Initiating or adjusting the drug regimen of a patient pursuant to an order or authorization made by the patient's prescriber and in accordance with the policies, procedures, or protocols of the licensed health care facility. (5) (A) Perform the following procedures or functions as part of the care provided by a health care facility, a licensed home health agency, a licensed clinic in which there is a physician oversight, a provider who contracts with a licensed health care service plan with regard to the care or services provided to the enrollees of that health care service plan, or a physician, in accordance, as applicable, with policies, procedures, or protocols of that facility, the home health agency, the licensed clinic, the health care service plan, or that physician, in accordance with subparagraph (C): (i) Ordering or performing routine drug therapy-related patient assessment procedures including temperature, pulse, and respiration. (ii) Ordering drug therapy-related laboratory tests. (iii) Administering drugs and biologicals by injection pursuant to a prescriber's order (the administration of immunizations under the supervision of a prescriber may also be performed outside of a licensed health care facility). (iv) Initiating or adjusting the drug regimen of a patient pursuant to a specific written order or authorization made by the patient's prescriber for the individual patient, and in accordance with the policies, procedures, or protocols of the health care facility, home health agency, licensed clinic, health care service plan, or physician. Adjusting the drug regimen does not include substituting or selecting a different drug, except as authorized by the protocol. The pharmacist shall provide written notification to the patient's prescriber, or enter the appropriate information in an electronic patient record system shared by the prescriber, of any drug regimen initiated pursuant to this clause within 24 hours. (B) A patient's prescriber may prohibit, by written instruction, any adjustment or change in the patient's drug regimen by the pharmacist. (C) The policies, procedures, or protocols referred to in this paragraph shall be developed by health care professionals, including physicians, pharmacists, and registered nurses, and, at a minimum, meet all of the following requirements: (i) Require that the pharmacist function as part of a multidisciplinary group that includes physicians and direct care registered nurses. The multidisciplinary group shall determine the appropriate participation of the pharmacist and the direct care registered nurse. (ii) Require that the medical records of the patient be available to both the patient's prescriber and the pharmacist. (iii) Require that the procedures to be performed by the pharmacist relate to a condition for which the patient has first been seen by a physician. (iv) Except for procedures or functions provided by a health care facility, a licensed clinic in which there is physician oversight, or a provider who contracts with a licensed health care plan with regard to the care or services provided to the enrollees of that health care service plan, require the procedures to be performed in accordance with a written, patient-specific protocol approved by the treating or supervising physician. Any change, adjustment, or modification of an approved preexisting treatment or drug therapy shall be provided in writing to the treating or supervising physician within 24 hours. (6) Manufacture, measure, fit to the patient, or sell and repair dangerous devices or furnish instructions to the patient or the patient's representative concerning the use of those devices. (7) Provide consultation to patients and professional information, including clinical or pharmacological information, advice, or consultation to other health care professionals. (b) Prior to performing any procedure authorized by paragraph (4) of subdivision (a), a pharmacist shall have received appropriate training as prescribed in the policies and procedures of the licensed health care facility. Prior to performing any procedure authorized by paragraph (5) of subdivision (a), a pharmacist shall have either (1) successfully completed clinical residency training or (2) demonstrated clinical experience in direct patient care delivery. (c) Nothing in this section shall affect the requirements of existing law relating to maintaining the confidentiality of medical records. (d) Nothing in this section shall affect the requirements of existing law relating to the licensing of a health care facility. SEC. 4. Section 4052 of the Business and Professions Code is amended to read: 4052. (a) Notwithstanding any other provision of law, a pharmacist may: (1) Furnish a reasonable quantity of compounded medication to a prescriber for office use by the prescriber. (2) Transmit a valid prescription to another pharmacist. (3) Administer, orally or topically, drugs and biologicals pursuant to a prescriber's order. (4) Perform the following procedures or functions in a licensed health care facility in accordance with policies, procedures, or protocols developed by health professionals, including physicians, pharmacists, and registered nurses, with the concurrence of the facility administrator: (A) Ordering or performing routine drug therapy-related patient assessment procedures including temperature, pulse, and respiration. (B) Ordering drug therapy-related laboratory tests. (C) Administering drugs and biologicals by injection pursuant to a prescriber's order (the administration of immunizations under the supervision of a prescriber may also be performed outside of a licensed health care facility). (D) Initiating or adjusting the drug regimen of a patient pursuant to an order or authorization made by the patient's prescriber and in accordance with the policies, procedures, or protocols of the licensed health care facility. (5) (A) Perform the following procedures or functions as part of the care provided by a health care facility, a licensed home health agency, a licensed clinic in which there is a physician oversight, a provider who contracts with a licensed health care service plan with regard to the care or services provided to the enrollees of that health care service plan, or a physician, in accordance, as applicable, with policies, procedures, or protocols of that facility, the home health agency, the licensed clinic, the health care service plan, or that physician, in accordance with subparagraph (C): (i) Ordering or performing routine drug therapy-related patient assessment procedures including temperature, pulse, and respiration. (ii) Ordering drug therapy-related laboratory tests. (iii) Administering drugs and biologicals by injection pursuant to a prescriber's order (the administration of immunizations under the supervision of a prescriber may also be performed outside of a licensed health care facility). (iv) Initiating or adjusting the drug regimen of a patient pursuant to a specific written order or authorization made by the patient's prescriber for the individual patient, and in accordance with the policies, procedures, or protocols of the health care facility, home health agency, licensed clinic, health care service plan, or physician. Adjusting the drug regimen does not include substituting or selecting a different drug, except as authorized by the protocol. The pharmacist shall provide written notification to the patient's prescriber, or enter the appropriate information in an electronic patient record system shared by the prescriber, of any drug regimen initiated pursuant to this clause within 24 hours. (B) A patient's prescriber may prohibit, by written instruction, any adjustment or change in the patient's drug regimen by the pharmacist. (C) The policies, procedures, or protocols referred to in this paragraph shall be developed by health care professionals, including physicians, pharmacists, and registered nurses, and, at a minimum, meet all of the following requirements: (i) Require that the pharmacist function as part of a multidisciplinary group that includes physicians and direct care registered nurses. The multidisciplinary group shall determine the appropriate participation of the pharmacist and the direct care registered nurse. (ii) Require that the medical records of the patient be available to both the patient's prescriber and the pharmacist. (iii) Require that the procedures to be performed by the pharmacist relate to a condition for which the patient has first been seen by a physician. (iv) Except for procedures or functions provided by a health care facility, a licensed clinic in which there is physician oversight, or a provider who contracts with a licensed health care plan with regard to the care or services provided to the enrollees of that health care service plan, require the procedures to be performed in accordance with a written, patient-specific protocol approved by the treating or supervising physician. Any change, adjustment, or modification of an approved preexisting treatment or drug therapy shall be provided in writing to the treating or supervising physician within 24 hours. (6) Manufacture, measure, fit to the patient, or sell and repair dangerous devices or furnish instructions to the patient or the patient's representative concerning the use of those devices. (7) Provide consultation to patients and professional information, including clinical or pharmacological information, advice, or consultation to other health care professionals. (8) 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. Prior to performing any procedure authorized under this paragraph, a pharmacist shall have completed a training program on emergency contraception, which includes, but is not limited to, conduct of sensitive communications, quality assurance, referral to additional services, and documentation. (b) (1) Prior to performing any procedure authorized by paragraph (4) of subdivision (a), a pharmacist shall have received appropriate training as prescribed in the policies and procedures of the licensed health care facility. (2) Prior to performing any procedure authorized by paragraph (5) of subdivision (a), a pharmacist shall have either (1) successfully completed clinical residency training or (2) demonstrated clinical experience in direct patient care delivery. (3) For each emergency contraception drug therapy initiated pursuant to paragraph (8) of subdivision (a), the pharmacist shall 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 followup, and other appropriate information. The board shall develop this form in consultation with the State Department of Health Services, the American College of Obstetricians and Gynecologists, the California Pharmacists Association, and other health care organizations. The provisions of this section do not preclude the use of existing publications developed by nationally recognized medical organizations. (c) Nothing in this section shall affect the requirements of existing law relating to maintaining the confidentiality of medical records. (d) Nothing in this section shall affect the requirements of existing law relating to the licensing of a health care facility. SEC. 5. Section 4 of this bill incorporates amendments to Section 4052 of the Business and Professions Code proposed by both this bill and SB 1169. It shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2002, (2) each bill amends Section 4052 of the Business and Professions Code, and (3) this bill is enacted after SB 1169, in which case Section 3 of this bill shall not become operative. SEC. 6. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.