BILL ANALYSIS Ó
SB 493
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Date of Hearing: August 30, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
SB 493 (Hernández) - As Amended: August 19, 2013
Policy Committee: Business and
Professions Vote: 14-0
Health Vote: 18-0
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill expands the scope of practice of pharmacists,
establishes an advance practice pharmacist (APP) recognition,
and allow pharmacists recognized as APPs to perform specified
activities. Specifically, this bill:
1)Allows pharmacists to provide patient education about drug
therapy, disease management, and disease prevention; furnish
specified drugs, including hormonal contraceptives, smoking
cessation drugs, and travel-related drugs; order and interpret
drug therapy-related tests; and initiate and furnish
recommended immunizations.
2)Allows APPs to perform patient assessments, refer patients to
other health care providers, participate in the evaluation and
management of diseases and health conditions in collaboration
with other health care providers, and initiate, adjust, or
discontinue drug therapy. Establishes education and
experience credentials for APPs, and establishes biennial
review of recognition status.
3)Provides authority for the Board of Pharmacy (BOP) to
establish a fee for the issuance and renewal of APP
recognition at the reasonable cost of regulating APPs, and
limits maximum fees to $300.
FISCAL EFFECT
1)One-time costs to BOP of $100,000 for regulations establishing
APP recognition process, rules, and fees. In addition,
one-time costs of $20,000 to modify IT systems to accommodate
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a new licensure type (Pharmacy Board Contingent Fund).
2)Ongoing costs of approximately $300,000 annually for licensing
and regulation of APPs (Pharmacy Board Contingent Fund).
3)Potential fee revenues of approximately $300,000 annually
(Pharmacy Board Contingent Fund).
4)Unknown potential increase in enforcement costs (Pharmacy
Board Contingent Fund). Since the activities permitted under
this bill are newly allowed for pharmacists outside the
supervision of a physician, it is unclear whether or how many
increased complaints may occur. The Department of Justice
(DOJ) and/or the BOP may experience increased enforcement
costs; any DOJ costs would be reimbursed by the Pharmacy Board
Contingent Fund.
5)The net effect on health care costs from expanding the role of
pharmacists in delivery of care is unclear. Increased access
to care may result in increased costs due to greater
utilization, which could be counterbalanced by cost savings
related to improved medication adherence, reduced hospital
readmissions, and other benefits stemming from provision of
care pharmacists would provide.
COMMENTS
1)Rationale . The author indicates this bill will better utilize
pharmacists, who are highly trained and skilled, to provide
targeted preventative and primary care services. There is a
well-documented shortage of primary care providers, and the
federal Patient Protection and Affordable Care (ACA) will add
millions to the ranks of the insured beginning next year. The
author states California has a robust network of pharmacists
who are well-trained, evenly distributed throughout the state,
and well positioned to pay particular attention to currently
underserved areas.
2)Background . The BOP regulates over 40,000 pharmacists in
California. 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 can perform certain
tasks in specified settings, such as ordering tests and
administering drugs, under protocols developed with a
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physician. This bill allows pharmacists to perform certain
tasks independently, and additionally allows an APP-recognized
pharmacist to assess patients and initiate drug therapy.
According to the BOP, functions and services that an APP may
perform under this bill are not new; pharmacists can currently
perform these types of functions and services in certain
settings under certain conditions.
3)Related Legislation . SB 491 (Hernandez) and SB 492
(Hernandez) expand the scope of practice for nurse
practitioners and optometrists, respectively. SB 491 is
pending on the Suspense File of this committee, and SB 492 is
pending in Assembly Business and Professions.
4)Support . The University of California and pharmacy schools,
health plans, hospitals and clinics, the Board of Pharmacy,
the Medical Board, business groups, pharmacists, and retailers
support this bill. Supporters indicate the bill will improve
workforce capacity, improve access to care, more fully
integrate the pharmacy profession into the health care team,
and potentially offer much-needed costs savings to California.
5)Opposition . Numerous physician groups were opposed to a
previous version of this bill, citing patient safety concerns.
Most physician groups, including the California Medical
Association and the California Academy of Family Physicians
removed their opposition and now have a neutral position on
this bill. Several organizations concerned with the provision
of contraceptives remain opposed.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081