BILL ANALYSIS SB 490 Page 1 Date of Hearing: August 20, 2003 ASSEMBLY COMMITTEE ON APPROPRIATIONS Darrell Steinberg, Chair SB 490 (Alpert) - As Amended: July 16, 2003 Policy Committee: Business and Professions Vote: 10-3 Health 16-6 Urgency: No State Mandated Local Program: Yes Reimbursable: No SUMMARY This bill authorizes a pharmacist to furnish emergency contraception drug therapy (EC) in accordance with standardized procedures and protocols developed by the Board of Pharmacy (Pharmacy Board) and the Medical Board of California (Medical Board). Specifically, this bill: 1)Requires the standardized procedures or protocols developed and approved by both the Pharmacy Board and the Medical Board to be developed in consultation with the American College of Obstetricians and Gynecologists, the California Pharmacist Association, and other appropriate entities. 2)Grants the Pharmacy Board and the Medical Board the authority to ensure compliance with this bill, and charges both Boards with enforcement with respect to their respective licensees. 3)Repeals a requirement that a pharmacist, prior to furnishing EC, have completed a training program on EC, which includes, but is not limited to, conduct of sensitive communications, quality assurance, referral to additional services, and documentation, and instead requires a pharmacist, prior to furnishing EC, to complete a training program on EC consisting of at least one hour of approved continuing education on EC drug therapy. 4)Prohibits this bill from being construed to expand the authority of a pharmacist to prescribe any prescription medication. SB 490 Page 2 FISCAL EFFECT Minor and absorbable costs to the Medical Board and the Pharmacy Board. Medical Board operating costs are funded from physician licensing fees deposited in the Medical Board Contingency Fund, and Pharmacy Board operating costs are funded from pharmacist licensing fees deposited in the Pharmacy Board Contingent Fund. COMMENTS 1)Purpose . This bill would create a statewide EC protocol under which pharmacists can furnish EC. Under current law, a pharmacist may initiate (this bill changes "initiate" to "furnish") EC under standardized protocols developed by the pharmacist and a prescriber (e.g., a physician). The author states that current law works for women who can locate a pharmacy with a protocol in place, but access is limited because each pharmacist must locate and secure protocols with an individual physician. Only about 14% of all retail pharmacies open to the public provide EC. The author also asserts that few private physicians have authorized protocols because of perceived risk of malpractice, and that approximately 85% of the 700 EC protocols in use in the state have been signed by a handful of physicians. This bill would create one standard protocol, and pharmacists would simply need to follow the treatment protocol created by the two licensing boards. This bill would also streamline the EC training requirements, providing the boards with greater flexibility to design the requirements. This measure is sponsored by the Public Health Institute. 2)Background . Emergency contraception therapy is a drug regimen that reduces the chance of pregnancy significantly if administered within 72 hours of unprotected intercourse (sometimes referred to as "morning after pills"). SB 1169 (Alpert), Chapter 900, Statutes of 2001, which was also sponsored by the Public Health Institute, authorized a pharmacist to initiate ED drug therapy in accordance with standardized protocols developed by the pharmacist and an authorized prescriber acting within his or her scope of practice. SB 1169 requires a pharmacist, prior to initiating emergency contraception drug therapy, to complete a training program on emergency contraception that covers the conduct of sensitive communications, quality assurance, referral to SB 490 Page 3 additional services, and documentation. The pharmacist must also provide each recipient of the emergency contraception services with a standardized fact sheet, developed by the Pharmacy Board, that includes the indications for the drug, the appropriate method for using the drug, the need for medical follow-up, and other information. Pharmacists must also sign "protocol" agreements with individual physicians so that the pharmacist can dispense the drugs as directed. 3)Related Legislation . SB 545 (Speier), also pending before the Assembly Appropriations Committee today, prohibits pharmacists from charging a separate consultation fee if they provide EC, and limits the administrative fee pharmacists can charge above the retail cost of the drug to $10. Analysis Prepared by : Scott Bain / APPR. / (916) 319-2081