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        |  | A BILL TO BE ENTITLED | 
      
        |  | AN ACT | 
      
        |  | relating to the provision of pharmacy services through a | 
      
        |  | telepharmacy system; establishing a remote dispensing site | 
      
        |  | license. | 
      
        |  | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | 
      
        |  | SECTION 1.  Section 562.110, Occupations Code, is amended by | 
      
        |  | amending Subsections (a), (b), (d), (e), and (f) and adding | 
      
        |  | Subsections (g), (h), and (i) to read as follows: | 
      
        |  | (a)  In this section: | 
      
        |  | (1)  "Provider pharmacy" means a Class A pharmacy that | 
      
        |  | provides pharmacy services through a telepharmacy system at a | 
      
        |  | remote dispensing site. | 
      
        |  | (2)  "Remote dispensing site" means a location licensed | 
      
        |  | as a telepharmacy that is authorized by a provider pharmacy through | 
      
        |  | a telepharmacy system to store and dispense prescription drugs and | 
      
        |  | devices, including dangerous drugs and controlled substances. | 
      
        |  | (3)  "Telepharmacy[ , "telepharmacy] system" means a | 
      
        |  | system that monitors the dispensing of prescription drugs and | 
      
        |  | provides for related drug use review and patient counseling | 
      
        |  | services by an electronic method, including the use of the | 
      
        |  | following types of technology: | 
      
        |  | (A) [ (1)]  audio and video; | 
      
        |  | (B) [ (2)]  still image capture; and | 
      
        |  | (C) [ (3)]  store and forward. | 
      
        |  | (b)  A Class A or Class C pharmacy located in this state may | 
      
        |  | provide pharmacy services, including the dispensing of drugs, | 
      
        |  | through a telepharmacy system at locations separate from [ in a  | 
      
        |  | facility that is not at the same location as] the Class A or Class C | 
      
        |  | pharmacy. | 
      
        |  | (d)  A telepharmacy system may be located only at: | 
      
        |  | (1)  a health care facility in this state that is | 
      
        |  | regulated by this state or the United States; or | 
      
        |  | (2)  a remote dispensing site. | 
      
        |  | (e)  The board shall adopt rules regarding the use of a | 
      
        |  | telepharmacy system under this section, including: | 
      
        |  | (1)  the types of health care facilities at which a | 
      
        |  | telepharmacy system may be located under Subsection (d)(1), which | 
      
        |  | must include the following facilities: | 
      
        |  | (A)  a clinic designated as a rural health clinic | 
      
        |  | regulated under 42 U.S.C. Section 1395x(aa)[ , as amended]; and | 
      
        |  | (B)  a health center as defined by 42 U.S.C. | 
      
        |  | Section 254b[ , as amended]; | 
      
        |  | (2)  the locations eligible to be licensed as remote | 
      
        |  | dispensing sites, which must include locations in medically | 
      
        |  | underserved areas, areas with a medically underserved population, | 
      
        |  | and health professional shortage areas determined by the United | 
      
        |  | States Department of Health and Human Services; | 
      
        |  | (3)  licensing and operating requirements for remote | 
      
        |  | dispensing sites, including: | 
      
        |  | (A)  a requirement that a remote dispensing site | 
      
        |  | license identify the provider pharmacy that will provide pharmacy | 
      
        |  | services at the remote dispensing site; | 
      
        |  | (B)  a requirement that a provider pharmacy be | 
      
        |  | allowed to provide pharmacy services at not more than two remote | 
      
        |  | dispensing sites; | 
      
        |  | (C)  a requirement that a pharmacist employed by a | 
      
        |  | provider pharmacy make at least monthly on-site visits to a remote | 
      
        |  | dispensing site or more frequent visits if specified by board rule; | 
      
        |  | (D)  a requirement that each month the perpetual | 
      
        |  | inventory of controlled substances at the remote dispensing site be | 
      
        |  | reconciled to the on-hand count of those controlled substances at | 
      
        |  | the site by a pharmacist employed by the provider pharmacy; | 
      
        |  | (E)  a requirement that a pharmacist employed by a | 
      
        |  | provider pharmacy be physically present at a remote dispensing site | 
      
        |  | when the pharmacist is providing services requiring the physical | 
      
        |  | presence of the pharmacist, including immunizations; | 
      
        |  | (F)  a requirement that a remote dispensing site | 
      
        |  | be staffed by an on-site pharmacy technician who is under the | 
      
        |  | continuous supervision of a pharmacist employed by the provider | 
      
        |  | pharmacy; | 
      
        |  | (G)  a requirement that all pharmacy technicians | 
      
        |  | at a remote dispensing site be counted for the purpose of | 
      
        |  | establishing the pharmacist-pharmacy technician ratio of the | 
      
        |  | provider pharmacy, which, notwithstanding Section 568.006, may not | 
      
        |  | exceed three pharmacy technicians for each pharmacist providing | 
      
        |  | supervision; | 
      
        |  | (H)  a requirement that, before working at a | 
      
        |  | remote dispensing site, a pharmacy technician must: | 
      
        |  | (i)  have worked at least one year at a | 
      
        |  | retail pharmacy during the three years preceding the date the | 
      
        |  | pharmacy technician begins working at the remote dispensing site; | 
      
        |  | and | 
      
        |  | (ii)  have completed a board-approved | 
      
        |  | training program on the proper use of a telepharmacy system; and | 
      
        |  | (I)  any additional training or practice | 
      
        |  | experience requirements for pharmacy technicians at a remote | 
      
        |  | dispensing site; | 
      
        |  | (4)  the areas that qualify under Subsection (f); | 
      
        |  | (5) [ (3)]  recordkeeping requirements; and | 
      
        |  | (6) [ (4)]  security requirements. | 
      
        |  | (f)  A telepharmacy system located at a health care facility | 
      
        |  | under Subsection (d)(1) may not be located in a community in which a | 
      
        |  | Class A or Class C pharmacy is located as determined by board rule. | 
      
        |  | If a Class A or Class C pharmacy is established in a community in | 
      
        |  | which a telepharmacy system has been located under this section, | 
      
        |  | the telepharmacy system may continue to operate in that community. | 
      
        |  | (g)  A telepharmacy system located at a remote dispensing | 
      
        |  | site under Subsection (d)(2) may not dispense a controlled | 
      
        |  | substance listed in Schedule II as established by the commissioner | 
      
        |  | of state health services under Chapter 481, Health and Safety Code, | 
      
        |  | and may not be located within 25 miles by road of a Class A pharmacy. | 
      
        |  | (h)  If a Class A pharmacy is established within 25 miles by | 
      
        |  | road of a remote dispensing site that is currently operating, the | 
      
        |  | remote dispensing site may continue to operate at that location. | 
      
        |  | (i)  The board by rule shall require and develop a process | 
      
        |  | for a remote dispensing site to apply for classification as a Class | 
      
        |  | A pharmacy if the average number of prescriptions dispensed each | 
      
        |  | day the remote dispensing site is open for business is more than | 
      
        |  | 125, as calculated each calendar year. | 
      
        |  | SECTION 2.  The Texas State Board of Pharmacy shall adopt | 
      
        |  | rules under Section 562.110, Occupations Code, as amended by this | 
      
        |  | Act, not later than January 1, 2018. | 
      
        |  | SECTION 3.  This Act takes effect September 1, 2017. |