1-1 By: Madla S.B. No. 786
1-2 (In the Senate - Filed February 26, 1997; March 3, 1997, read
1-3 first time and referred to Committee on Health and Human Services;
1-4 April 11, 1997, reported adversely, with favorable Committee
1-5 Substitute by the following vote: Yeas 11, Nays 0; April 11, 1997,
1-6 sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 786 By: Madla
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to the authority of pharmacists to administer
1-11 immunizations and vaccinations.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. Subdivision (38), Section 5, Texas Pharmacy Act
1-14 (Article 4542a-1, Vernon's Texas Civil Statutes), is amended to
1-15 read as follows:
1-16 (38) "Practice of pharmacy" means:
1-17 (A) provision of those acts or services
1-18 necessary to provide pharmaceutical care;
1-19 (B) interpretation and evaluation of
1-20 prescription drug orders or medication orders;
1-21 (C) participation in drug and device selection
1-22 as authorized by law, drug administration, drug regimen review, or
1-23 drug or drug-related research;
1-24 (D) provision of patient counseling;
1-25 (E) responsibility for:
1-26 (i) dispensing of prescription drug orders
1-27 or distribution of medication orders;
1-28 (ii) compounding and labeling of drugs and
1-29 devices, except labeling by a manufacturer, repackager, or
1-30 distributor of nonprescription drugs and commercially packaged
1-31 prescription drugs and devices;
1-32 (iii) proper and safe storage of drugs and
1-33 devices; or
1-34 (iv) maintenance of proper records for
1-35 drugs and devices; [and]
1-36 (F) performance of a specific act of drug
1-37 therapy management for a patient delegated to a pharmacist by a
1-38 written protocol from a physician licensed in this state in
1-39 compliance with the Medical Practice Act (Article 4495b, Vernon's
1-40 Texas Civil Statutes); and
1-41 (G) administration of immunizations and
1-42 vaccinations under a physician's written protocol.
1-43 SECTION 2. Section 17, Texas Pharmacy Act (Article 4542a-1,
1-44 Vernon's Texas Civil Statutes), is amended by amending Subsection
1-45 (a) and adding Subsections (y), (z), and (aa) to read as follows:
1-46 (a) The board is responsible for the regulation of the
1-47 practice of pharmacy in this state, including the following:
1-48 (1) the licensing by examination or by reciprocity of
1-49 applicants who are qualified to engage in the practice of pharmacy
1-50 and the licensing of pharmacies under this Act;
1-51 (2) the renewal of licenses to engage in the practice
1-52 of pharmacy and licenses to operate pharmacies;
1-53 (3) the determination and issuance of standards for
1-54 recognition and approval of degree requirements of colleges of
1-55 pharmacy whose graduates shall be eligible for licensing in this
1-56 state and the specification and enforcement of requirements for
1-57 practical training, including internship;
1-58 (4) the enforcement of those provisions of this Act
1-59 relating to the conduct or competence of pharmacists practicing in
1-60 this state and the conduct of pharmacies operating in this state
1-61 and the suspension, revocation, fining, reprimanding, cancellation,
1-62 or restriction of licenses to engage in the practice of pharmacy or
1-63 to operate a pharmacy;
1-64 (5) the specifications of conditions under which a
2-1 pharmacist may administer medications, including immunizations and
2-2 vaccinations, which at a minimum shall include the following:
2-3 (A) a licensed health care provider authorized
2-4 to administer the medication is not reasonably available to
2-5 administer the medication;
2-6 (B) failure to administer the medication, other
2-7 than an immunization or vaccination, might result in a significant
2-8 delay or interruption of a critical phase of drug therapy;
2-9 (C) the pharmacist possesses the necessary
2-10 skill, [and] education, and certification to administer the
2-11 medication as specified by the board;
2-12 (D) the pharmacist notifies the appropriate
2-13 licensed health care provider responsible for the patient's care
2-14 within a reasonable time that the medication was administered;
2-15 (E) a pharmacist may not administer medications
2-16 to a patient where the patient resides, except in a licensed
2-17 nursing home or hospital;
2-18 (F) the pharmacist administers immunizations or
2-19 vaccinations under a physician's written protocol and meets the
2-20 standards established by the board;
2-21 (G) the authority of the pharmacist to
2-22 administer medications may not be delegated;
2-23 (H) [(G)] nothing in this subdivision shall be
2-24 construed to prohibit a pharmacist from preparing or manipulating
2-25 biotechnological agents or devices; and
2-26 (I) [(H)] nothing in this subdivision shall be
2-27 construed as prohibiting a pharmacist from performing an act
2-28 delegated by a physician in accordance with the provisions of
2-29 Subsection (d), Section 3.06, Medical Practice Act (Article 4495b,
2-30 Vernon's Texas Civil Statutes), and the pharmacist performing such
2-31 a delegated medical act shall be considered to be performing a
2-32 medical act and not as engaged in the practice of pharmacy;
2-33 (6) the regulation of the training, qualifications,
2-34 and employment of pharmacist-interns; and
2-35 (7) the enforcement of this Act and any rules adopted
2-36 under this Act.
2-37 (y) The board by rule shall require pharmacists to notify a
2-38 physician who prescribes an immunization or vaccination within 24
2-39 hours of administering the immunization or vaccination and shall
2-40 establish minimum education and continuing education standards for
2-41 pharmacists who administer immunizations and vaccinations. The
2-42 standards must include Centers for Disease Prevention and Control
2-43 training, basic life support training, and hands-on training in
2-44 techniques for administering immunizations and vaccinations.
2-45 (z) Physician supervision is considered to be adequate for
2-46 the purposes of this section if a delegating physician:
2-47 (1) is responsible for the formulation or approval of
2-48 the physician's order, standing medical order, standing delegation
2-49 order, or other order or protocol and periodically reviews the
2-50 order or protocol and the services provided to a patient under the
2-51 order or protocol;
2-52 (2) has established a physician-patient relationship
2-53 with each patient under 14 years of age and referred the patient to
2-54 the pharmacist;
2-55 (3) is geographically located so as to be easily
2-56 accessible to the pharmacy administering the immunization or
2-57 vaccination;
2-58 (4) receives, as appropriate, a periodic status report
2-59 on the patient, including any problem or complication encountered;
2-60 and
2-61 (5) is available through direct telecommunication for
2-62 consultation, assistance, and direction.
2-63 (aa) The Texas State Board of Medical Examiners by rule
2-64 shall establish the minimum content of a written order or protocol.
2-65 The order or protocol may not permit the delegation of medical
2-66 diagnosis.
2-67 SECTION 3. Subchapter E, Chapter 21, Insurance Code, is
2-68 amended by adding Article 21.53K to read as follows:
2-69 Art. 21.53K. PROVISION OF SERVICES RELATED TO IMMUNIZATIONS
3-1 AND VACCINATIONS UNDER MANAGED CARE PLANS
3-2 Sec. 1. PROHIBITION. (a) A managed care entity may not
3-3 require a physician participating in a managed care plan to issue
3-4 an immunization or vaccination protocol for an immunization or
3-5 vaccination to be administered to an enrollee in the plan.
3-6 (b) This section prohibits a managed care entity from:
3-7 (1) limiting benefits to enrollees for immunizations
3-8 or vaccinations to circumstances in which an immunization or
3-9 vaccination protocol is issued;
3-10 (2) providing financial incentives to physicians to
3-11 issue an immunization or vaccination protocol; or
3-12 (3) imposing a financial or other penalty on a
3-13 physician who refuses to issue an immunization or vaccination
3-14 protocol.
3-15 Sec. 2. RULES. The commissioner may adopt rules to
3-16 implement this article.
3-17 SECTION 4. This Act takes effect September 1, 1997.
3-18 SECTION 5. Article 21.53K, Insurance Code, as added by this
3-19 Act, applies only to a managed care plan that is delivered, issued
3-20 for delivery, or renewed on or after January 1, 1998. A managed
3-21 care plan that is delivered, issued for delivery, or renewed before
3-22 January 1, 1998, is governed by the law as it existed immediately
3-23 before the effective date of this Act, and that law is continued in
3-24 effect for that purpose.
3-25 SECTION 6. The importance of this legislation and the
3-26 crowded condition of the calendars in both houses create an
3-27 emergency and an imperative public necessity that the
3-28 constitutional rule requiring bills to be read on three several
3-29 days in each house be suspended, and this rule is hereby suspended.
3-30 * * * * *