BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 2660|
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THIRD READING
Bill No: AB 2660
Author: Leno (D)
Amended: 4/12/04 in Assembly
Vote: 21
SENATE BUSINESS & PROFESSIONS COMMITTEE : 6-0, 6/14/04
AYES: Figueroa, Aanestad, Brulte, Cedillo, Machado,
Vincent
NO VOTE RECORDED: Murray
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 72-0, 4/29/04 (Passed on Consent) - See
last page for vote
SUBJECT : Prescriptions: issuance by a pharmacist
SOURCE : Kaiser Permanente
DIGEST : This bill amends existing law to reinstate
pharmacists authority to register with the U.S. Drug
Enforcement Agency (DEA) and therefore initiate or adjust
controlled substance drug therapy under specified
conditions.
ANALYSIS : Existing law:
1.Provides for the licensure and regulation by the State
Board of Pharmacy (Board) of pharmacies, pharmacists, and
pharmacy practices.
CONTINUED
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2.Defines "prescription," in part, as being issued by
designated healing arts practitioners, not including a
pharmacist.
3.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.
4.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
in accordance with policies, procedures and protocols.
Allows pharmacists to furnish emergency contraception
drug therapy as long as the pharmacist completes a
training program on emergency contraception drug therapy.
5.Allows certified nurse-midwives, nurse practitioners, and
physician assistants to order or furnish drugs or devices
under the supervision of a physician and surgeon.
6.Allows a pharmacist, under physician supervision, who is
functioning as part of a multidisciplinary group in a
clinical setting, to initiate or adjust a drug therapy.
7.Precludes any person from possessing a controlled
substance, unless a person has a valid prescription for
that drug.
8.Prohibits the Board from issuing a pharmacy license to,
or renewing a pharmacy license of, specified persons,
including those who are authorized to write a
prescription.
This bill:
1.Revises the definition of "prescription" to include a
drug order issued by a pharmacist under conditions
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specified where the pharmacist is authorized to initiate
or adjust the drug regimen of a patient.
2.Requires a pharmacist who is authorized to issue an order
to initiate or adjust a controlled substance therapy to
personally register with the DEA.
3.Authorizes a person to possess a controlled substance
furnished under a drug order by a pharmacist under
specified conditions.
4.Authorizes the Board to issue or renew a license for a
pharmacy that is owned and operated by a pharmacist who
is authorized to issue a drug order under specified
conditions.
5.Makes other nonsubstantive technical changes.
Comments
According to the author's office, until recently the DEA
issued registration numbers to qualified California
pharmacists. However, based on legislation unrelated to
pharmacists that specifically authorized other mid-level
practitioners to furnish drugs under physician protocols
(but unintentionally excluded pharmacists), the DEA
believes that California law no longer allows them to do
so. The Author states that this bill continues
pharmacists' ability to help physicians manage prescription
drug therapies by restoring their ability to initiate or
adjust drug therapies under physician protocols.
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. DEA issues
registration numbers to mid-level practitioners, in
accordance with state law.
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The DEA used to issue registration numbers to qualified
California pharmacists because they were considered
mid-level practitioners. In 1999, the Legislature passed SB
816 (Escutia), Chapter 749, Statutes of 1999, which
specifically designated certified nurse-midwives, nurse
practitioners and physician assistants as mid-level
practitioners, so that they could continue to exercise
there authority to furnish drugs under physician protocols.
However, SB 816 did not include pharmacists in its
provisions. This legislation was unrelated to pharmacists
and no one thought to include pharmacists or knew that this
would prevent pharmacists from assisting physicians with
drug therapy involving controlled substances. As a result,
pharmacists have been denied DEA registration numbers and
have been unable to assist physicians in managing
controlled substance drug therapies, though state law still
permits them to do so. This bill simply rectifies the
oversight of not including pharmacists as mid-level
practitioners in SB 816 and re-establishes the ability of
qualified pharmacists to work under a physician in
adjusting controlled substance drug therapy.
The inability of pharmacists to continue to assist
physicians in managing controlled substance drug therapies
unnecessarily burdens physicians, who are required to
personally approve even the slightest adjustment to any
controlled substance therapy. According to the Author's
office, this is particularly problematic in managing pain
therapy, which a qualified pharmacist could assist with
under this bill.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 6/28/04)
Kaiser Permanente (source)
California Association of Nurse Practitioners (CANP)
California Association of Physician Groups (CAPG)
California Medical Association (CMA)
California Pharmacists Association (CPhA)
California Retailers Association (CRA)
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California Society of Health-System Pharmacists (CSHP)
California State Board of Pharmacy
ARGUMENTS IN SUPPORT : According to Kaiser Permanente
(Kaiser), the sponsor of this bill, the bill will allow
pharmacists to continue to help physicians manage
prescription drug therapies by restoring their ability to
initiate or adjust controlled substance drug therapies
under physician protocols. Kaiser's support notes that the
bill will rectify the oversight that left pharmacists out
of state law designation as mid-level practitioners that
the DEA requires as a prerequisite to issuing its
registration number.
The California Association of Physician Groups (CAPG)
supports the bill because it encourages the managed care
delegated model of health care. CAPG states that by
allowing pharmacists to initiate or adjust controlled drug
therapies, healthcare resources and physician time are
maximized, resulting in controlled health care costs.
The bill is also supported by others including the
California Medical Association (CMA), the California State
Board of Pharmacy, and the California Retailers Association
for the same reasons as stated by Kaiser and CAPG.
ASSEMBLY FLOOR :
AYES: Aghazarian, Bates, Benoit, Berg, Bermudez, Bogh,
Calderon, Campbell, Canciamilla, Chan, Chavez, Chu,
Cogdill, Cohn, Corbett, Correa, Cox, Daucher, Diaz,
Dutra, Dutton, Dymally, Firebaugh, Frommer, Garcia,
Goldberg, Hancock, Harman, Jerome Horton, Shirley Horton,
Houston, Jackson, Keene, Kehoe, Koretz, La Malfa, La
Suer, Laird, Leno, Levine, Lieber, Liu, Longville,
Lowenthal, Maddox, Matthews, Maze, McCarthy, Montanez,
Mountjoy, Mullin, Nakanishi, Nakano, Nation, Negrete
McLeod, Oropeza, Parra, Reyes, Richman, Ridley-Thomas,
Runner, Salinas, Samuelian, Simitian, Spitzer, Steinberg,
Strickland, Wesson, Wolk, Wyland, Yee, Nunez
NO VOTE RECORDED: Haynes, Leslie, Maldonado, Pacheco,
Pavley, Plescia, Vargas, Wiggins
CP:nl 6/28/04 Senate Floor Analyses
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SUPPORT/OPPOSITION: SEE ABOVE
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