BILL ANALYSIS                                                                                                                                                                                                    







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          |Hearing Date:April 28, 2003    |Bill No:SB                |
          |                               |490                       |
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                    SENATE COMMITTEE ON BUSINESS AND PROFESSIONS
                             Senator Liz Figueroa, Chair

                         Bill No:        SB 490Author:Alpert
                   As Amended:April 24, 2003          Fiscal:  Yes

          
          SUBJECT:  Pharmacy; prescriptions.
          
          SUMMARY:  Authorizes a pharmacist to furnish emergency  
          contraception drug therapy in accordance with standardized  
          procedures or protocol developed and approved by both the  
          Board of Pharmacy and the Medical Board in consultation  
          with the appropriate entities.

          Existing law:
          
          1)Provides for the licensing and regulation of pharmacists  
            under the jurisdiction of the Board of Pharmacy.

          2)Provides for the licensing and regulation of physicians  
            under the jurisdiction of the Medical Board.

          3)Requires a pharmacist to provide consultation when  
            furnishing drugs, with certain exceptions.

          4)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.

          5)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,  





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            quality assurance, referral to additional services, and  
            documentation.

          6)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.









































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          7)Requires the Board of Pharmacy to develop the fact sheet  
            in consultation with the Department of Health Services,  
            the American College of Obstetricians and Gynecologists,  
            the California Pharmacists Association, and other health  
            care organizations.

          This bill:

          1)Additionally authorizes a pharmacist to furnish emergency  
            contraception drug therapy in accordance with  
            standardized procedures or protocol developed and  
            approved by both the Board of Pharmacy and the Medical  
            Board, in consultation with the American College of  
            Obstetricians and Gynecologists, the California  
            Pharmacist Association and other appropriate entities.

          2)Provides that the Medical Board shall have the authority,  
            with the Board of Pharmacy, to ensure compliance and that  
            these boards are specifically charged with the  
            enforcement of this provision with respect to their  
            respective licensees.

          3)Provides that the new law created by this measure shall  
            not be construed to expand the authority of the  
            pharmacist to prescribe any prescription medication.

          FISCAL EFFECT:  Unknown.

          COMMENTS:

          1.Purpose.  According to information provided by the  
            Author's office, the intent of this measure is to further  
            expand access to emergency contraception thereby  
            preventing unintended pregnancy and reducing abortion in  
            California.  While existing law (created by SB 1169 and  
            discussed in Comment #2b below) allows pharmacists to  
            provide emergency contraception to patients under a  
            protocol developed by the pharmacist and an authorized  
            prescriber, the current system is cumbersome and presents  
            significant barriers to pharmacists.

          2.Background.  

             a)   What is emergency contraception?  According to the  
               Office of Population Research at Princeton University,  
               which operates an emergency contraception website,  





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               emergency contraceptives are methods of  preventing   
               pregnancy  after  unprotected 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.  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 called progestin, and is  
               specially packaged and labeled for use as the brand  
               name  Plan B  .  Plan B reduces the risk of pregnancy by  
               89%.  Some people call emergency contraception pills  
               "morning after pills."  But women can start the pills  
               right away or up to five days after unprotected sex.   
               Therapy is more effective the earlier it is initiated  
               within the  120-hour window  .

             b)   SB 1169 (Alpert, Chap. 900, Statutes of 2001).  SB  
               1169 authorizes a  pharmacist, who has completed a  
               specified training program, to initiate emergency  
               contraception in accordance with standardized  
               procedures or protocols developed by the pharmacist  
               and an authorized prescriber.  Additionally, requires  
               the pharmacist, for each emergency contraception drug  
               therapy initiated, to provide the recipient of the  
               emergency contraception drugs with a standardized fact  
               sheet (created by the Board of Pharmacy) 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.  

               SB 1169 was sponsored by the Public Health Institute  
               and was intended to make emergency contraception  
               easily accessible to women in order to dramatically  
               reduce unintended pregnancies and abortions.

             c)   Existing Protocol Structure Not Resulting in  
               Adequate Participation.  According to proponents of  
               the measure, each pharmacist in California must locate  
               and secure protocols with an individual medical  
               doctor.  Only about 14% of all retail pharmacies open  





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               to the public provide emergency contraception therapy.  
                About 40% of the pharmacies that offer emergency  
               contraception therapy experience occasions when they  
               cannot provide this service due to a lack of  
               pharmacists with protocols.  About 85% of the more  
               than 700 emergency contraception protocols in use in  
               California have been signed by a handful of  
               public-spirited physicians.

             d)   This measure heard by the Senate Health and Human  
               Services Committee.  This is the second policy  
               committee hearing on this measure.  This measure was  
               heard by the Senate Health and Human Services on April  
               2, 2003, and was approved by a vote of 7 to 1.

          1.Related Measure This Session.  SB 545 (Speier) among  
            other things, provides that a pharmacist can initiate  
            emergency contraception drug therapy without having to  
            complete a training program and that the pharmacist  
            cannot charge a separate consultation fee to a patient  
            seeking the therapy.  SB 545 is sponsored by the American  
            College of Obstetricians and Gynecologists.  It was heard  
            by this Committee on April 7, 2003, and was approved by a  
            vote of 4 to 1. 
          


























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          SUPPORT AND OPPOSITION:
          
           Support  (to the March 27, 2003 version):

          Public Health Institute (Sponsor)
          American College of Obstetricians and Gynecologists
          California Commission on the Status of Women
          California Medical Association
          California Pharmacist Association
          California National Organization for Women
          California Women Lawyers
          Planned Parenthood, Golden Gate
          Planned Parenthood, Los Angeles
          Planned Parenthood, Mar Monte
          Planned Parenthood of Santa Barbara, Ventura and San Luis  
                  Obispo Counties


            Opposition  :None reported to the Committee as of April 22,  
                     2003.


          Consultant:Kristin J. Triepke