BILL ANALYSIS Ó SB 493 Page 1 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 SB 493 Page 2 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 SB 493 Page 3 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