AN ACT
1-1 relating to the authority of pharmacists to administer
1-2 immunizations and vaccinations.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Subdivision (38), Section 5, Texas Pharmacy Act
1-5 (Article 4542a-1, Vernon's Texas Civil Statutes), is amended to
1-6 read as follows:
1-7 (38) "Practice of pharmacy" means:
1-8 (A) provision of those acts or services
1-9 necessary to provide pharmaceutical care;
1-10 (B) interpretation and evaluation of
1-11 prescription drug orders or medication orders;
1-12 (C) participation in drug and device selection
1-13 as authorized by law, drug administration, drug regimen review, or
1-14 drug or drug-related research;
1-15 (D) provision of patient counseling;
1-16 (E) responsibility for:
1-17 (i) dispensing of prescription drug orders
1-18 or distribution of medication orders;
1-19 (ii) compounding and labeling of drugs and
1-20 devices, except labeling by a manufacturer, repackager, or
1-21 distributor of nonprescription drugs and commercially packaged
1-22 prescription drugs and devices;
1-23 (iii) proper and safe storage of drugs and
2-1 devices; or
2-2 (iv) maintenance of proper records for
2-3 drugs and devices; [and]
2-4 (F) performance of a specific act of drug
2-5 therapy management for a patient delegated to a pharmacist by a
2-6 written protocol from a physician licensed in this state in
2-7 compliance with the Medical Practice Act (Article 4495b, Vernon's
2-8 Texas Civil Statutes); and
2-9 (G) administration of immunizations and
2-10 vaccinations under a physician's written protocol.
2-11 SECTION 2. Section 17, Texas Pharmacy Act (Article 4542a-1,
2-12 Vernon's Texas Civil Statutes), is amended by amending Subsection
2-13 (a) and adding Subsections (y), (z), and (aa) to read as follows:
2-14 (a) The board is responsible for the regulation of the
2-15 practice of pharmacy in this state, including the following:
2-16 (1) the licensing by examination or by reciprocity of
2-17 applicants who are qualified to engage in the practice of pharmacy
2-18 and the licensing of pharmacies under this Act;
2-19 (2) the renewal of licenses to engage in the practice
2-20 of pharmacy and licenses to operate pharmacies;
2-21 (3) the determination and issuance of standards for
2-22 recognition and approval of degree requirements of colleges of
2-23 pharmacy whose graduates shall be eligible for licensing in this
2-24 state and the specification and enforcement of requirements for
2-25 practical training, including internship;
3-1 (4) the enforcement of those provisions of this Act
3-2 relating to the conduct or competence of pharmacists practicing in
3-3 this state and the conduct of pharmacies operating in this state
3-4 and the suspension, revocation, fining, reprimanding, cancellation,
3-5 or restriction of licenses to engage in the practice of pharmacy or
3-6 to operate a pharmacy;
3-7 (5) the specifications of conditions under which a
3-8 pharmacist may administer medications, including immunizations and
3-9 vaccinations, which at a minimum shall include the following:
3-10 (A) a licensed health care provider authorized
3-11 to administer the medication is not reasonably available to
3-12 administer the medication;
3-13 (B) failure to administer the medication, other
3-14 than an immunization or vaccination, might result in a significant
3-15 delay or interruption of a critical phase of drug therapy;
3-16 (C) the pharmacist possesses the necessary
3-17 skill, [and] education, and certification to administer the
3-18 medication as specified by the board;
3-19 (D) the pharmacist notifies the appropriate
3-20 licensed health care provider responsible for the patient's care
3-21 within a reasonable time that the medication was administered;
3-22 (E) a pharmacist may not administer medications
3-23 to a patient where the patient resides, except in a licensed
3-24 nursing home or hospital;
3-25 (F) the pharmacist administers immunizations or
4-1 vaccinations under a physician's written protocol and meets the
4-2 standards established by the board;
4-3 (G) the authority of the pharmacist to
4-4 administer medications may not be delegated;
4-5 (H) [(G)] nothing in this subdivision shall be
4-6 construed to prohibit a pharmacist from preparing or manipulating
4-7 biotechnological agents or devices; and
4-8 (I) [(H)] nothing in this subdivision shall be
4-9 construed as prohibiting a pharmacist from performing an act
4-10 delegated by a physician in accordance with the provisions of
4-11 Subsection (d), Section 3.06, Medical Practice Act (Article 4495b,
4-12 Vernon's Texas Civil Statutes), and the pharmacist performing such
4-13 a delegated medical act shall be considered to be performing a
4-14 medical act and not as engaged in the practice of pharmacy;
4-15 (6) the regulation of the training, qualifications,
4-16 and employment of pharmacist-interns; and
4-17 (7) the enforcement of this Act and any rules adopted
4-18 under this Act.
4-19 (y) The board by rule shall require pharmacists to notify a
4-20 physician who prescribes an immunization or vaccination within 24
4-21 hours of administering the immunization or vaccination and shall
4-22 establish minimum education and continuing education standards for
4-23 pharmacists who administer immunizations and vaccinations. The
4-24 standards must include Centers for Disease Prevention and Control
4-25 training, basic life support training, and hands-on training in
5-1 techniques for administering immunizations and vaccinations.
5-2 (z) Physician supervision is considered to be adequate for
5-3 the purposes of this section if a delegating physician:
5-4 (1) is responsible for the formulation or approval of
5-5 the physician's order, standing medical order, standing delegation
5-6 order, or other order or protocol and periodically reviews the
5-7 order or protocol and the services provided to a patient under the
5-8 order or protocol;
5-9 (2) has established a physician-patient relationship
5-10 with each patient under 14 years of age and referred the patient to
5-11 the pharmacist;
5-12 (3) is geographically located so as to be easily
5-13 accessible to the pharmacy administering the immunization or
5-14 vaccination;
5-15 (4) receives, as appropriate, a periodic status report
5-16 on the patient, including any problem or complication encountered;
5-17 and
5-18 (5) is available through direct telecommunication for
5-19 consultation, assistance, and direction.
5-20 (aa) The Texas State Board of Medical Examiners by rule
5-21 shall establish the minimum content of a written order or protocol.
5-22 The order or protocol may not permit the delegation of medical
5-23 diagnosis.
5-24 SECTION 3. Subchapter E, Chapter 21, Insurance Code, is
5-25 amended by adding Article 21.53K to read as follows:
6-1 Art. 21.53K. PROVISION OF SERVICES RELATED TO IMMUNIZATIONS
6-2 AND VACCINATIONS UNDER MANAGED CARE PLANS
6-3 Sec. 1. PROHIBITION. (a) A managed care entity may not
6-4 require a physician participating in a managed care plan to issue
6-5 an immunization or vaccination protocol for an immunization or
6-6 vaccination to be administered to an enrollee in the plan.
6-7 (b) This section prohibits a managed care entity from:
6-8 (1) limiting benefits to enrollees for immunizations
6-9 or vaccinations to circumstances in which an immunization or
6-10 vaccination protocol is issued;
6-11 (2) providing financial incentives to physicians to
6-12 issue an immunization or vaccination protocol; or
6-13 (3) imposing a financial or other penalty on a
6-14 physician who refuses to issue an immunization or vaccination
6-15 protocol.
6-16 Sec. 2. RULES. The commissioner may adopt rules to
6-17 implement this article.
6-18 SECTION 4. This Act takes effect September 1, 1997.
6-19 SECTION 5. Article 21.53K, Insurance Code, as added by this
6-20 Act, applies only to a managed care plan that is delivered, issued
6-21 for delivery, or renewed on or after January 1, 1998. A managed
6-22 care plan that is delivered, issued for delivery, or renewed before
6-23 January 1, 1998, is governed by the law as it existed immediately
6-24 before the effective date of this Act, and that law is continued in
6-25 effect for that purpose.
7-1 SECTION 6. The importance of this legislation and the
7-2 crowded condition of the calendars in both houses create an
7-3 emergency and an imperative public necessity that the
7-4 constitutional rule requiring bills to be read on three several
7-5 days in each house be suspended, and this rule is hereby suspended.
_______________________________ _______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 786 passed the Senate on
April 17, 1997, by a viva-voce vote.
_______________________________
Secretary of the Senate
I hereby certify that S.B. No. 786 passed the House on
May 13, 1997, by a non-record vote.
_______________________________
Chief Clerk of the House
Approved:
_______________________________
Date
_______________________________
Governor