BILL ANALYSIS
AB 977
Page 1
Date of Hearing: January 5, 2010
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 977 (Skinner) - As Amended: January 4, 2010
SUBJECT : Pharmacists: immunization administration.
SUMMARY : Permits pharmacists to administer pneumococcal and
influenza vaccines to persons 11 years and older.
Specifically, this bill :
1)Permits a pharmacist to administer influenza and pneumococcal
immunizations to persons 11 years and older pursuant to
standardized protocols developed and approved by the
California State Board of Pharmacy and the California Medical
Board, in consultation with public health officers, as
specified.
2)Requires pharmacists, before initiating and administering
immunizations, to complete the American Pharmacists
Association's Pharmacy-Based Immunization Delivery Certificate
Training Program or another pharmacy-based immunization
training certificate program endorsed by the Centers for
Disease Control and Prevention (CDC) or the Accreditation
Council for Pharmaceutical Education.
3)Requires pharmacists initiating and administering
immunizations pursuant to this bill to be certified in basic
life support and complete three hours of immunization-related
continuing education coursework annually. Requires, in the
case that a pharmacist fails to satisfy this requirement, to
retake training as required in #2 above in addition to the
three hour training prior to initiating and administering any
further immunizations. Permits this three hour training to be
applied toward existing continuing pharmacy education
requirements.
4)Requires pharmacists to obtain the consent of a parent or
guardian before administering immunizations to patients under
age 18.
5)Requires pharmacists, at the time of administration of
immunizations, to provide the patient or the patient's agent
with the appropriate CDC Vaccine Information Statement for
each vaccine, provide documentation of immunization
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administration to the patient and the patient's physician or
primary care provider, if one can be identified, and provide
documentation of the immunization administration to the
appropriate immunization registry.
6)Requires pharmacists to maintain immunization administration
records, as specified, for 10 years in the case of an adult
and for three years after the 18th birthday in the case of a
child.
7)Permits pharmacists administering immunizations to initiate
and administer epinephrine by injection for severe allergic
reactions and requires any adverse event to be reported to the
federal Vaccine Adverse Event Reporting System.
8)Makes pharmacists who receive vaccines for administration
pursuant to this bill to be responsible for assuring that
proper vaccine temperatures are maintained during storage and
handling to preserve the potency of the vaccine.
EXISTING LAW :
1)Provides for the licensing and regulation of pharmacists by
the Pharmacy Board in the Department of Consumer Affairs.
2)Authorizes a pharmacist to, among other things, administer
prescribed drugs and biologicals orally and topically, and in
a licensed health care facility, administer prescribed drugs
and biologicals by injection, order or perform
drug-therapy-related patient assessment procedures and tests,
and initiate or adjust the drug regimen of a patient pursuant
to specific order by the patient's prescriber, as specified.
Permits a pharmacist to administer immunizations pursuant to a
protocol with a prescriber.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
needed to increase access to immunizations. The author cites
a recent report by Families USA, which states more than 12
million, or about 37% of nonelderly Californians were
uninsured at some point in the two-year period from 2007-08,
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and three-quarters of these were uninsured for more than six
months. Researchers at the University of California, Berkeley
Labor Center predict the number of uninsured Californians is
increasing significantly with the economic recession and,
absent health care reform, will increase by 4 million over
pre-recession levels by 2012. The author states pharmacists
are on the front line of preventative care, and are currently
formally trained to screen, administer, and respond to the few
adverse events associated with administering immunizations.
The author argues pharmacists are the most accessible health
care provider, located in more than 6,000 pharmacies in over
1,100 Zip codes throughout the state, and often do not require
appointments.
The author states that since 1995, pharmacy law allowed a
pharmacist to administer immunizations pursuant to a protocol
with a physician, and as a result, pharmacists have safely
initiated and administered thousands of immunizations to
Californians. However, the author states that the full
potential of pharmacist-delivered vaccines has not been
realized because many pharmacists are unable to obtain a
prescriber's signature on their vaccination protocol, making
them unable to administer vaccines. According to the author,
even after extensive education of physicians regarding the
minimal liability incurred, many remain apprehensive and
choose not to sign immunization protocols with pharmacists.
Further, the author argues the need for a prescriber protocol
disproportionately affects independent pharmacies, which are
small businesses that often serve low-income, ethnically
diverse communities in suburban and rural locations throughout
California. According to the author, by enabling more
pharmacists to administer vaccines, this bill will increase
access to care.
2)BACKGROUND . According to an article in the Journal of the
American Pharmaceutical Association, "Pharmacists and
Immunizations," Gallup Polls have consistently named the
pharmacist among the most trusted professionals. People in
many communities, especially rural areas, look to their
community pharmacist for medical advice. This respect can be
pivotal in helping educate parents and other adults about the
importance of timely immunization. When patients pick up
prescriptions, pharmacists can take advantage of their
accessibility and reputation to ask them about their
immunization status and counsel them on the importance of
immunization.
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3)EXISTING PRACTICE . Currently, 49 states (including California)
allow a pharmacist to administer immunizations pursuant to a
protocol with a prescriber. A protocol typically identifies:
a) The individual who has delegated activity;
b) The pharmacist authorized to administer vaccine;
c) Types of vaccines the pharmacist is authorized to
administer;
d) Procedures, decision criteria, or the plan a pharmacist
should follow, including when to refer a patient;
e) Procedure for emergency situations; and,
f) Record keeping and documentation procedures.
This bill would, among other things, instead permit
pharmacists to administer immunizations under a statewide,
standardized protocol.
4)AUTHOR'S AMENDMENT . The author intends to amend this bill in
committee to: a) Make the provisions of the bill a 4-year
pilot program under which pharmacists would be permitted to
administer only influenza vaccine to adults; and, b) Require
the Medical Board and the Board of Pharmacy to conduct an
evaluation of the program and report back to relevant Senate
and Assembly committees.
5)DOUBLE REFERRAL . This bill, in a related but substantially
different form, was approved by the Assembly Business and
Professions Committee by a vote of 10-0 on May 5, 2009. As a
result of the January 4, 2010 amendments, the bill will be
heard again by that Committee on January 12, 2010.
REGISTERED SUPPORT / OPPOSITION :
Support (previous version)
California State Board of Pharmacy (sponsor)
California Retailers Association
National Association of Chain Drug Stores
Opposition (previous version)
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American College of Obstetricians and Gynecologists, District IX
California Medical Association
California Nurses Association
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097