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
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           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
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            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