BILL ANALYSIS
AB 2660
Page 1
Date of Hearing: March 30, 2004
ASSEMBLY COMMITTEE ON HEALTH
Rebecca Cohn, Chair
AB 2660 (Leno) - As Amended: March 26, 2004
SUBJECT : Prescriptions: issuance by a pharmacist.
SUMMARY : Revises existing law that permits qualified
pharmacists to initialize and adjust drug therapies in clinical
settings for the purpose of registering with the United States
Drug Enforcement Agency (DEA). Specifically, this bill :
1)Authorizes a pharmacist to initiate and adjust prescription
drug therapies using controlled substances under specific
physician protocols;
2)Requires a pharmacist initiating or adjusting controlled
substances to register with the DEA;
3)Authorizes the Board of Pharmacy to issue new or renewal
licenses to pharmacists who initiate or adjust drug therapies
under specific circumstances; and,
4)Makes other nonsubstantive technical changes.
EXISTING LAW
1)Defines "prescription" and sets requirements on how medication
is dispensed and who is authorized to issue a prescription.
2)Makes specific requirements for issuing prescriptions for a
controlled substance, and requires a copy of the prescription
to be submitted to the Department of Justice at the end of the
month in which the prescription was filled.
3)Authorizes pharmacists to furnish, transmit, and administer
prescription medication. Authorizes them to perform routine
drug therapy-related patient assessment procedures, including
temperature, pulse and respiration, ordering drug
therapy-related lab tests, administering drugs and biologicals
by injection, and initiating or adjusting the drug regimen of
a patient pursuant to an order or authorization made by the
patient's prescriber. Allows pharmacists to furnish emergency
contraception drug therapy as long as the pharmacist completes
AB 2660
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a training program on emergency contraception drug therapy.
4)Allows certified nurse-midwives, nurse practitioners, and
physician assistants to order or furnish drugs or devises
under the supervision of a physician and surgeon.
5)Allows a pharmacist, under physician supervision, who is
functioning as part of a multidisciplinary group in a clinical
setting, to initialize or adjust a drug therapy.
6)Precludes any person from possessing a controlled substance,
unless a person has a valid prescription for that drug.
EXISTING FEDERAL LAW . Requires any person who dispenses or
proposes to dispense any controlled substance to obtain a
registration number from the Attorney General annually.
FISCAL EFFECT : Unknown
COMMENTS :
1)PURPOSE OF THE BILL . This bill would make the appropriate
changes to qualify pharmacists to register for a DEA number
and therefore initiate or adjust controlled substance drug
therapy.
2)BACKGROUND . The California Pharmacist Practice Act allows
specifically authorized and specially qualified pharmacists to
initiate and adjust prescription drug therapy under protocols
jointly developed by physicians and pharmacists. This
authority applies to both controlled and non-controlled
substances. Controlled substances are also regulated by
federal law, which requires anyone handling controlled
substances to have a DEA registration number. The DEA issues
registration numbers to mid-level practitioners, in accordance
with state law. Without DEA numbers, qualified pharmacists
cannot assist physicians with drug therapy involving
controlled substances, although they are still permitted to
initiate or adjust drug therapy involving non-controlled
substances.
The DEA issued registration numbers to qualified California
pharmacists prior to the passage of SB 816 (Escutia) Chapter
749, Statutes of 1999. SB 816 specifically designated
certified nurse-midwives, nurse practitioners and physician
AB 2660
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assistants as mid-level practitioners, but left out
pharmacists. This exclusion resulted in the DEA categorizing
pharmacists apart from other health providers who otherwise
are permitted to initiate or adjust controlled or
non-controlled substances. As a result, pharmacists have been
denied DEA registration numbers have been unable to assist
physicians in managing controlled substance drug therapies.
3)SUPPORT . According to Kaiser Permanente Medical Care Program
(KPMCP), this bill would allow pharmacists to continue to help
physicians manage prescription drug therapies by restoring
their ability to initiate or adjust drug therapies under
physician protocols. KPMCP states that the DEA formerly
issued registration numbers to California pharmacists but
stopped after the Legislature passed a law that recognized
nurse practitioners and physician assistants as mid-level
practitioners. Since pharmacists were not included in that
designation, the DEA implied that pharmacists are not
mid-level practitioners and therefore were not entitled to
registration numbers.
In addition, the California Association of Physician Groups
(CAPG) supports the bill because it encourages the managed
care delegated model of health care. By allowing pharmacists
to initiate or adjust controlled drug therapies, healthcare
resources and physician time are maximized, resulting in
controlled health care costs.
REGISTERED SUPPORT / OPPOSITION :
Support
California Association of Physician Groups
Kaiser Permanente Medical Care Program
Opposition
None
Analysis Prepared by : Clara Craven / HEALTH / (916) 319-2097