BILL ANALYSIS                                                                                                                                                                                                    �



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          SENATE THIRD READING
          SB 204 (Corbett)
          As Amended June 10, 2014
          Majority vote

           SENATE VOTE  :Vote not relevant  
           
           HEALTH              13-5        BUSINESS & PROFESSIONS      8-4 
           
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          |Ayes:|Pan, Ammiano, Bonilla,    |Ayes:|Bonilla, Bocanegra,       |
          |     |Bonta, Chesbro, Gomez,    |     |Campos, Dickinson,        |
          |     |Gonzalez,                 |     |Eggman, Gordon, Skinner,  |
          |     |Roger Hern�ndez,          |     |Ting                      |
          |     |Lowenthal, Nazarian,      |     |                          |
          |     |Ridley-Thomas, Rodriguez, |     |                          |
          |     |Wieckowski                |     |                          |
          |     |                          |     |                          |
          |-----+--------------------------+-----+--------------------------|
          |Nays:|Maienschein, Ch�vez,      |Nays:|Jones, Hagman,            |
          |     |Mansoor, Patterson,       |     |Maienschein, Wilk         |
          |     |Wagner                    |     |                          |
          |     |                          |     |                          |
           ----------------------------------------------------------------- 
           APPROPRIATIONS      12-5                                        
           
           ----------------------------------------------------------------- 
          |Ayes:|Gatto, Bocanegra,         |     |                          |
          |     |Bradford,                 |     |                          |
          |     |Ian Calderon, Campos,     |     |                          |
          |     |Eggman, Gomez, Holden,    |     |                          |
          |     |Pan, Quirk,               |     |                          |
          |     |Ridley-Thomas, Lowenthal  |     |                          |
          |     |                          |     |                          |
          |-----+--------------------------+-----+--------------------------|
          |Nays:|Bigelow, Donnelly, Jones, |     |                          |
          |     |Linder, Wagner            |     |                          |
          |     |                          |     |                          |
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           SUMMARY  :  Requires the Board of Pharmacy (BOP) to survey  
          pharmacists and electronic health record (EHR) vendors to  
          determine utilization of standardized prescription directions  
          for use adopted pursuant to BOP regulations.  Specifically,  this  
          bill  :  








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          1)Requires the BOP survey pharmacists to collect data on whether  
            and how often pharmacists utilize standardized directions for  
            use, challenges or barriers for use, and other directions used  
            by pharmacists. 

          2)Requires the BOP to conduct a survey of vendors that provide  
            EHRs to pharmacies and prescribers to determine the type of  
            directions for use included in the software.  Requires the  
            survey to include, but not be limited to, whether standardized  
            directions for use are used in the software, challenges or  
            barriers for use, and other directions used by the vendor. 

          3)Specifies the surveys to be conducted with other surveys  
            performed during routine course of business.  Requires the BOP  
            to report the finding of the surveys at the July 2016 BOP  
            meeting, and publish the findings on its Internet Web site. 

          4)Sunsets the provisions of this bill on January 1, 2020. 

          
          FISCAL EFFECT  :  According to the Assembly Appropriations  
          Committee, $50,000 in estimated costs to the BOP to contract for  
          the mandated surveys.  
           
           COMMENTS  :  According to the author, although the BOP adopted  
          regulations to develop a patient-centered prescription label and  
          standardized directions for use in 2010, the BOP does not know  
          how many doctors are using these standardized directions, nor do  
          they have any method for determining whether or not pharmacies  
          are utilizing them.  The BOP also does not know and has no  
          method for determining if the vendors of EHRs are using the  
          standardized directions for use in the products that they market  
          to prescribers and pharmacies.  The author further states that  
          the BOP should determine if the standardized directions for use  
          are being utilized and what the barriers are to using the  
          standardized directions in prescriptions and EHRs for  
          prescribers and pharmacists.  These surveys will provide the BOP  
          with the necessary data to determine how to better ensure the  
          use of this important aspect of the patient-centered  
          regulations.

          Medication Errors.  SCR 49 (Speier), Resolution Chapter 123,  
          Statutes of 2005, established the Medication Errors Panel  








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          (Panel) which published a report in March 2007 entitled,  
          Prescription for Improving Patient Safety:  Addressing  
          Medication Errors.  The report listed six general goals to  
          reduce medication errors.  Under each goal were recommendations  
          (12 in all) and methods to accomplish each recommendation.  The  
          Panel report states that "the information that consumers need to  
          know about their medication is often complex and may include  
          unfamiliar language or concepts.  Expecting a consumer to retain  
          all the pertinent knowledge from a brief verbal encounter may  
          not be reasonable in many instances."  Although the Panel did  
          not come to consensus on the most important subset of consumers  
          that are at "high risk" for medication errors, it did  
          acknowledge that there are a variety of factors which may  
          increase an individual's risk for experiencing a medication  
          error.  The Panel stated that these factors must be taken into  
          consideration in the development of any consumer education  
          efforts.

          In response to the panel report, SB 472 (Corbett), Chapter 470,  
          Statutes of 2007, established the California Patient Medication  
          Safety Act, which required the BOP to promulgate regulations  
          that require a standardized, patient-centered prescription drug  
          label on all prescription medicine dispensed to patients.  In an  
          effort to create a consumer friendly drug label, the BOP  
          elicited feedback from consumers between May 2008 and November  
          2009, with an open-ended prescription label survey which was  
          distributed at public outreach events.  After numerous meetings,  
          BOP adopted regulations in 2010 to create a standardized,  
          patient-centered prescription drug label, which included the  
          standardized directions for use.

          The California Pan Ethnic Health Network, sponsor of this bill,  
          states that a large percentage of patients misunderstand dosage  
          instructions on their labels.  Simple, explicit, and specific  
          instructions can help alleviate patients' misunderstanding.   
          Pursuant to previous legislation, the BOP Pharmacy adopted  
          standardized instruction, but there is no data about whether  
          pharmacies are actually using the instructions.

          There is no opposition to this bill. 


           Analysis Prepared by  :    Dharia McGrew / HEALTH / (916) 319-2097  









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