BILL ANALYSIS                                                                                                                                                                                                    Ó




                   Senate Appropriations Committee Fiscal Summary
                            Senator Kevin de León, Chair


          SB 493 (Hernandez) - Pharmacy practice.
          
          Amended: April 24, 2013         Policy Vote: B&P 9-0
          Urgency: No                     Mandate: Yes
          Hearing Date: May 23, 2013      Consultant: Brendan McCarthy
          
          SUSPENSE FILE.  AS PROPOSED TO BE AMENDED.
          
          
          Bill Summary: SB 493 would expand the scope of practice of  
          pharmacists, by authorizing pharmacists to administer certain  
          medications and furnish immunizations, hormonal contraceptives  
          and certain other drugs. The bill would establish advance  
          practice pharmacist recognition and allow such pharmacists to  
          perform specified activities.

          Fiscal Impact: 
              One-time costs of about $200,000 to adopt new regulations  
              and upgrade the existing system for processing license  
              applications (Pharmacy Board Contingent Fund).

              Ongoing costs of about $300,000 per year for licensing and  
              enforcement, offset by fees (Pharmacy Board Contingent  
              Fund).

              Indeterminate impact on state health care programs, such as  
              CalPERS and Medi-Cal. See below.

          Background: Under current law, pharmacists are licensed and  
          regulated by the Board of Pharmacy. Current law authorizes  
          pharmacists to perform certain health care functions, such as  
          dispensing medications upon the prescription of a physician and  
          administer immunizations pursuant to a protocol with a  
          prescriber (such as a physician). In addition, pharmacists may  
          take certain actions, under protocols authorized by a physician,  
          such as ordering tests and administering drugs.

          Proposed Law: SB 493 would expand the scope of practice of  
          pharmacists. 

          Specifically, the bill would authorize pharmacists to:
              Furnish self-administered hormonal contraceptives, in  








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              accordance with procedures developed by the Board of  
              Pharmacy and the California Medical Board;
              Furnish smoking cessation drugs and drugs recommended for  
              people travelling outside the United States;
              Order and interpret tests for the purpose of managing drug  
              therapies;
              Administer certain vaccines.

          The bill would establish advance practice pharmacist  
          recognition, with specified licensing and training requirements.  


          The bill would authorize advance practice pharmacists to:
              Perform patient assessments;
              Order and interpret tests;
              Refer patients to other providers;
              Initiate, adjust, or discontinue drug therapy (similar to  
              authority already granted in law for pharmacists in licensed  
              health care facilities).

          The bill requires the Board of Pharmacy to adopt regulations to  
          establish the means of documenting completion of the  
          requirements for advance practice pharmacy.

          Related Legislation: 
              SB 352 (Pavley) authorizes certain medical professionals to  
              supervise medical assistants. That bill is in the Assembly.
              SB 491 (Hernandez) would expand the scope of practice for  
              nurse practitioners. That bill will be heard in this  
              committee.
              SB 492 (Hernandez) would authorize an optometrist to  
              diagnose and treat certain medical conditions. That bill  
              will be heard in this committee.

          Staff Comments: By expanding the scope of practice for  
          pharmacists, this bill will allow pharmacists to provide more  
          care to patients. Additional care provided by pharmacists may  
          increase overall utilization of health care, to the extent that  
          patients are currently unable to get care from other  
          practitioners, such as primary care physicians. 

          On the other hand, patients may substitute care from a  
          pharmacist for care from another practitioner. In addition, to  
          the extent that patients are currently unable to access primary  








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          care services, those patients may ultimately end up receiving  
          care in another setting, such as an emergency room, urgent care  
          facility, or community clinic. Care provided in those settings  
          is likely to be more costly than primary care (for those  
          patients who require such care). 

          The overall impact on utilization and cost of health care from  
          this bill cannot be determined. Therefore any potential impact  
          on state health care programs, such as CalPERS and Medi-Cal,  
          cannot be determined.
          
          The only costs that may be incurred by a local agency relate to  
          crimes and infractions. Such costs are not reimbursable by the  
          state under the California Constitution.

          Proposed author's amendments: would require pharmacists to  
          consult with primary care physicians before dispensing certain  
          anti-smoking drugs and specify the maximum fee level for  
          advanced practice pharmacists.