By: Madla S.B. No. 786
A BILL TO BE ENTITLED
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
1-24 devices; or
2-1 (iv) maintenance of proper records for
2-2 drugs and devices; [and]
2-3 (F) performance of a specific act of drug
2-4 therapy management for a patient delegated to a pharmacist by a
2-5 written protocol from a physician licensed in this state in
2-6 compliance with the Medical Practice Act (Article 4495b, Vernon's
2-7 Texas Civil Statutes); and
2-8 (G) administration of immunizations and
2-9 vaccinations under a physician's written protocol.
2-10 SECTION 2. Section 17, Texas Pharmacy Act (Article 4542a-1,
2-11 Vernon's Texas Civil Statutes), is amended by amending Subsection
2-12 (a) and adding Subsections (y), (z), and (aa) to read as follows:
2-13 (a) The board is responsible for the regulation of the
2-14 practice of pharmacy in this state, including the following:
2-15 (1) the licensing by examination or by reciprocity of
2-16 applicants who are qualified to engage in the practice of pharmacy
2-17 and the licensing of pharmacies under this Act;
2-18 (2) the renewal of licenses to engage in the practice
2-19 of pharmacy and licenses to operate pharmacies;
2-20 (3) the determination and issuance of standards for
2-21 recognition and approval of degree requirements of colleges of
2-22 pharmacy whose graduates shall be eligible for licensing in this
2-23 state and the specification and enforcement of requirements for
2-24 practical training, including internship;
2-25 (4) the enforcement of those provisions of this Act
2-26 relating to the conduct or competence of pharmacists practicing in
2-27 this state and the conduct of pharmacies operating in this state
3-1 and the suspension, revocation, fining, reprimanding, cancellation,
3-2 or restriction of licenses to engage in the practice of pharmacy or
3-3 to operate a pharmacy;
3-4 (5) the specifications of conditions under which a
3-5 pharmacist may administer medications, including immunizations and
3-6 vaccinations, which at a minimum shall include the following:
3-7 (A) a licensed health care provider authorized
3-8 to administer the medication is not reasonably available to
3-9 administer the medication;
3-10 (B) failure to administer the medication, other
3-11 than an immunization or vaccination, might result in a significant
3-12 delay or interruption of a critical phase of drug therapy;
3-13 (C) the pharmacist possesses the necessary
3-14 skill, [and] education, and certification to administer the
3-15 medication as specified by the board;
3-16 (D) the pharmacist notifies the appropriate
3-17 licensed health care provider responsible for the patient's care
3-18 within a reasonable time that the medication was administered;
3-19 (E) a pharmacist may not administer medications
3-20 to a patient where the patient resides, except in a licensed
3-21 nursing home or hospital;
3-22 (F) the pharmacist administers immunizations or
3-23 vaccinations under a physician's written protocol and meets the
3-24 standards established by the board;
3-25 (G) the authority of the pharmacist to
3-26 administer medications may not be delegated;
3-27 (H) [(G)] nothing in this subdivision shall be
4-1 construed to prohibit a pharmacist from preparing or manipulating
4-2 biotechnological agents or devices; and
4-3 (I) [(H)] nothing in this subdivision shall be
4-4 construed as prohibiting a pharmacist from performing an act
4-5 delegated by a physician in accordance with the provisions of
4-6 Subsection (d), Section 3.06, Medical Practice Act (Article 4495b,
4-7 Vernon's Texas Civil Statutes), and the pharmacist performing such
4-8 a delegated medical act shall be considered to be performing a
4-9 medical act and not as engaged in the practice of pharmacy;
4-10 (6) the regulation of the training, qualifications,
4-11 and employment of pharmacist-interns; and
4-12 (7) the enforcement of this Act and any rules adopted
4-13 under this Act.
4-14 (y) The board by rule shall require pharmacists to notify a
4-15 physician who prescribes an immunization or vaccination within 24
4-16 hours of administering the immunization or vaccination and shall
4-17 establish minimum education and continuing education standards for
4-18 pharmacists who administer immunizations and vaccinations. The
4-19 standards must include Centers for Disease Prevention and Control
4-20 training, basic life support training, and hands-on training in
4-21 techniques for administering immunizations and vaccinations.
4-22 (z) Physician supervision is considered to be adequate for
4-23 the purposes of this section if a delegating physician:
4-24 (1) is responsible for the formulation or approval of
4-25 the physician's order, standing medical order, standing delegation
4-26 order, or other order or protocol and periodically reviews the
4-27 order or protocol and the services provided to a patient under the
5-1 order or protocol;
5-2 (2) has established a physician-patient relationship
5-3 with each patient under 14 years of age and referred the patient to
5-4 the pharmacist;
5-5 (3) is geographically located so as to be easily
5-6 accessible to the pharmacy administering the immunization or
5-7 vaccination;
5-8 (4) receives, as appropriate, a periodic status report
5-9 on the patient, including any problem or complication encountered;
5-10 and
5-11 (5) is available through direct telecommunication for
5-12 consultation, assistance, and direction.
5-13 (aa) The Texas State Board of Medical Examiners by rule
5-14 shall establish the minimum content of a written order or protocol.
5-15 The order or protocol may not permit the delegation of medical
5-16 diagnosis.
5-17 SECTION 3. Subchapter E, Chapter 21, Insurance Code, is
5-18 amended by adding Article 21.53K to read as follows:
5-19 Art. 21.53K. PROVISION OF SERVICES RELATED TO IMMUNIZATIONS
5-20 AND VACCINATIONS UNDER MANAGED CARE PLANS
5-21 Sec. 1. PROHIBITION. (a) A managed care entity may not
5-22 require a physician participating in a managed care plan to issue
5-23 an immunization or vaccination protocol for an immunization or
5-24 vaccination to be administered to an enrollee in the plan.
5-25 (b) This section prohibits a managed care entity from:
5-26 (1) limiting benefits to enrollees for immunizations
5-27 or vaccinations to circumstances in which an immunization or
6-1 vaccination protocol is issued;
6-2 (2) providing financial incentives to physicians to
6-3 issue an immunization or vaccination protocol; or
6-4 (3) imposing a financial or other penalty on a
6-5 physician who refuses to issue an immunization or vaccination
6-6 protocol.
6-7 Sec. 2. RULES. The commissioner may adopt rules to
6-8 implement this article.
6-9 SECTION 4. This Act takes effect September 1, 1997.
6-10 SECTION 5. Article 21.53K, Insurance Code, as added by this
6-11 Act, applies only to a managed care plan that is delivered, issued
6-12 for delivery, or renewed on or after January 1, 1998. A managed
6-13 care plan that is delivered, issued for delivery, or renewed before
6-14 January 1, 1998, is governed by the law as it existed immediately
6-15 before the effective date of this Act, and that law is continued in
6-16 effect for that purpose.
6-17 SECTION 6. The importance of this legislation and the
6-18 crowded condition of the calendars in both houses create an
6-19 emergency and an imperative public necessity that the
6-20 constitutional rule requiring bills to be read on three several
6-21 days in each house be suspended, and this rule is hereby suspended.