85R9615 EES-F

By: Roberts H.B. No. 2444

A BILL TO BE ENTITLED

AN ACT

relating to the authority of pharmacists to furnish certain medications and receive compensation for certain services and procedures.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 483.001(11), Health and Safety Code, is amended to read as follows:

(11) "Practice of pharmacy" has the meaning assigned by Section 551.003, Occupations Code [means:

[(A) provision of those acts or services necessary to provide pharmaceutical care;

[(B) interpretation and evaluation of prescription drug orders or medication orders;

[(C) participation in drug and device selection as authorized by law, drug administration, drug regimen review, or drug or drug-related research;

[(D) provision of patient counseling;

[(E) responsibility for:

[(i) dispensing of prescription drug orders or distribution of medication orders in the patient's best interest;

[(ii) compounding and labeling of drugs and devices, except labeling by a manufacturer, repackager, or distributor of nonprescription drugs and commercially packaged prescription drugs and devices;

[(iii) proper and safe storage of drugs and devices; or

[(iv) maintenance of proper records for drugs and devices. In this subdivision, "device" has the meaning assigned by Subtitle J, Title 3, Occupations Code; or

[(F) performance of a specific act of drug therapy management for a patient delegated to a pharmacist by a written protocol from a physician licensed by the state under Subtitle B, Title 3, Occupations Code].

SECTION 2. Section 1451.001, Insurance Code, is amended by adding Subdivision (13-a) to read as follows:

(13-a) "Pharmacist" means an individual licensed to practice pharmacy by the Texas State Board of Pharmacy.

SECTION 3. Subchapter C, Chapter 1451, Insurance Code, is amended by adding Section 1451.1261 to read as follows:

Sec. 1451.1261. REIMBURSEMENT FOR CERTAIN SERVICES AND PROCEDURES PERFORMED BY PHARMACISTS. (a) Notwithstanding any other law except Subsection (c), in addition to applying to a policy, agreement, or contract described by Section 1451.102, this section applies to any other individual or group health benefit plan that provides benefits described by Section 1451.102, including:

(1) a health benefit plan issued by:

(A) a group hospital service corporation operating under Chapter 842;

(B) a health maintenance organization operating under Chapter 843; or

(C) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846;

(2) a small employer health benefit plan subject to Chapter 1501;

(3) a standard health benefit plan issued under Chapter 1507;

(4) health benefits provided by or through a church benefits board under Subchapter I, Chapter 22, Business Organizations Code;

(5) a regional or local health care program operated under Section 75.104, Health and Safety Code;

(6) a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code;

(7) a county employee health benefit plan established under Chapter 157, Local Government Code; and

(8) health and accident coverage provided by a risk pool created under Chapter 172, Local Government Code.

(b) Notwithstanding Section 1451.102, except as provided by Subsection (c), this section applies to coverage under a group health benefit plan provided to a resident of this state regardless of whether the group policy, agreement, or contract is delivered, issued for delivery, or renewed in this state.

(c) This section does not apply to:

(1) a group health benefit plan that is offered or administered by:

(A) the Teacher Retirement System of Texas under Chapter 1575 or 1579; or

(B) the Employees Retirement System of Texas under Chapter 1551; or

(2) a Medicaid managed care program operated under Chapter 533, Government Code, or a Medicaid program operated under Chapter 32, Human Resources Code.

(d) An insurer or other health benefit plan issuer to which this section applies or a third-party administrator or pharmacy benefit manager of a health benefit plan to which this section applies may not deny reimbursement to a pharmacist for the provision of a service or procedure within the scope of the pharmacist's license that:

(1) would be covered by the insurance policy or other coverage agreement or an evidence of coverage if the service or procedure were provided by:

(A) a physician;

(B) an advanced practice nurse; or

(C) a physician assistant; and

(2) is performed by the pharmacist in strict compliance with laws and rules related to the pharmacist's license.

SECTION 4. Subchapter C, Chapter 157, Occupations Code, is amended by adding Section 157.102 to read as follows:

Sec. 157.102. DELEGATION TO PHARMACIST TO FURNISH CERTAIN DRUGS. (a) In this section:

(1) "Acute condition" means a condition or disease that begins abruptly, intensifies rapidly, and is generally not long-lasting.

(2) "Pharmacist" has the meaning assigned by Section 551.003.

(3) "Smoking cessation drug" means a prescription drug approved by the United States Food and Drug Administration for use in the treatment of nicotine or smoking addiction.

(4) "Travel drug" means a prescription drug recommended by the federal Centers for Disease Control and Prevention for individuals traveling outside of the United States for the prevention and management of a disease before a diagnosis of the disease.

(5) "Waived clinical laboratory test" means a clinical laboratory test that is classified as waived under federal regulations issued under the Clinical Laboratory Improvement Amendments of 1988 (42 U.S.C. Section 263a).

(6) "Written protocol" means a physician's written order, standing medical order, standing delegation order, or other order or protocol as defined by rule of the board.

(b) Notwithstanding any other law, a physician may delegate to a pharmacist the authority, as provided by the physician's written protocol, to initiate a prescription drug order for and to furnish to a patient a prescription drug that is:

(1) a drug to treat an acute condition that is identified through performance of one of the following tests, if the test is a waived clinical laboratory test:

(A) a rapid strep test or rapid antigen detection test used in the identification of group A streptococcus (GAS); or

(B) a rapid influenza diagnostic test used in the identification of influenza types A and B;

(2) a hormonal contraceptive;

(3) a travel drug;

(4) a prenatal vitamin supplement;

(5) a smoking cessation drug;

(6) a vitamin D supplement; or

(7) a drug identified by the executive commissioner of the Health and Human Services Commission by rule as necessary for pharmacists to furnish to patients for public health purposes.

(c) The board shall adopt rules jointly with the Texas State Board of Pharmacy to establish the minimum content of the written protocol required under Subsection (b). The written protocol may permit a pharmacist to initiate a prescription drug order and furnish a prescription drug.

(d) A written protocol under this section must require notice to the patient's primary care physician, as identified by the patient if the patient has a primary care physician, and prescribe the period for providing the notice and the form of the notice, in accordance with prevailing practices for the provision of notice to a patient's primary care physician. The period for providing the notice for furnishing a drug under Subsection (b)(1) may not be later than the 14th day after the date the drug is furnished by the pharmacist.

SECTION 5. Section 551.003(33), Occupations Code, is amended to read as follows:

(33) "Practice of pharmacy" means:

(A) providing an act or service necessary to provide pharmaceutical care;

(B) interpreting or evaluating a prescription drug order or medication order;

(C) participating in drug or device selection as authorized by law, and participating in drug administration, drug regimen review, or drug or drug-related research;

(D) providing patient counseling;

(E) being responsible for:

(i) dispensing a prescription drug order or distributing a medication order;

(ii) compounding or labeling a drug or device, other than labeling by a manufacturer, repackager, or distributor of a nonprescription drug or commercially packaged prescription drug or device;

(iii) properly and safely storing a drug or device; or

(iv) maintaining proper records for a drug or device;

(F) performing for a patient a specific act of drug therapy management delegated to a pharmacist by a written protocol from a physician licensed in this state in compliance with Subtitle B; [or]

(G) administering an immunization or vaccination under a physician's written protocol; or

(H) initiating a prescription drug order for and furnishing a prescription drug to a patient under a physician's written protocol under Section 157.102.

SECTION 6. Subchapter B, Chapter 562, Occupations Code, is amended by adding Sections 562.058 and 562.059 to read as follows:

Sec. 562.058. TRAINING REQUIRED TO INITIATE DRUG ORDER OR FURNISH CERTAIN DRUGS. (a) A pharmacist may not initiate a prescription drug order or furnish a prescription drug under Section 157.102 unless the pharmacist has completed a training program that is approved by the board and is relevant to the condition treated by the drug.

(b) The training program required by Subsection (a) may include:

(1) a training program approved by the Accreditation Council for Pharmacy Education;

(2) a curriculum-based program offered by a college of pharmacy that is accredited by the Accreditation Council for Pharmacy Education; or

(3) any other training program recognized by the board.

Sec. 562.059. FEES FOR CERTAIN PROFESSIONAL SERVICES. A pharmacist may charge a fee for providing a professional service under Section 157.102 that is within the pharmacist's scope of practice in addition to a fee charged for dispensing a drug.

SECTION 7. Section 1451.1261, Insurance Code, as added by this Act, applies only to a health benefit plan that is delivered, issued for delivery, or renewed on or after January 1, 2018. A plan delivered, issued for delivery, or renewed before January 1, 2018, is governed by the law as it existed immediately before the effective date of this Act, and that law is continued in effect for that purpose.

SECTION 8. Not later than January 1, 2018, the Texas State Board of Pharmacy and the Texas Medical Board shall adopt the rules required under Section 157.102, Occupations Code, as added by this Act.

SECTION 9. (a) Except as provided by Subsection (b) of this section, this Act takes effect January 1, 2018.

(b) Section 8 of this Act takes effect September 1, 2017.