87R12691 KKR-F
 
  By: Cortez, Clardy, Price, et al. H.B. No. 678
 
  Substitute the following for H.B. No. 678:
 
  By:  Klick C.S.H.B. No. 678
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the administration of a medication and the ordering and
  administration of an immunization or vaccination by a pharmacist.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  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)  subject to Section 554.052(c-1), ordering or
  administering an immunization or vaccination to a patient who is at
  least three years of age; or
                     (H)  if the patient is younger than three years of
  age and is referred to a pharmacist by a physician, administering an
  immunization or vaccination to a patient under a physician's
  written protocol.
         SECTION 2.  The heading to Section 554.004, Occupations
  Code, is amended to read as follows:
         Sec. 554.004.  ADMINISTRATION OF MEDICATION; ORDERING AND
  ADMINISTRATION OF IMMUNIZATION OR VACCINATION.
         SECTION 3.  Section 554.004(a), Occupations Code, is amended
  to read as follows:
         (a)  The board shall specify conditions under which a
  pharmacist may administer medication and order or administer [,
  including] an immunization or [and] vaccination. The conditions
  for ordering or administering an immunization or vaccination must
  ensure that:
               (1)  [a licensed health care provider authorized to
  administer the medication is not reasonably available to administer
  the medication;
               [(2)  failure to administer the medication, other than
  an immunization or vaccination, might result in a significant delay
  or interruption of a critical phase of drug therapy;
               [(3)]  the pharmacist possesses the necessary skill,
  education, and certification as specified by the board to order or 
  administer the immunization or vaccination [medication];
               (2) [(4)]  within a reasonable time after
  administering an immunization or vaccination that is prescribed by
  a licensed health care provider [medication], the pharmacist
  notifies the licensed health care provider responsible for the
  patient's care that the immunization or vaccination [medication]
  was administered;
               [(5)  the pharmacist may not administer medication to a
  patient at the patient's residence, except at a licensed nursing
  home or hospital;
               [(6)  the pharmacist administers an immunization or
  vaccination under a physician's written protocol and meets the
  standards established by the board;] and
               (3) [(7)]  the authority of a pharmacist to administer
  an immunization or vaccination [medication] may [not] be delegated
  to a certified pharmacy technician.
         SECTION 4.  Sections 554.052(a), (b), (c), and (c-1),
  Occupations Code, are amended to read as follows:
         (a)  The board by rule shall require a pharmacist to notify a
  physician who prescribes an immunization or vaccination not later
  than the 14th day [within 24 hours] after the date the pharmacist
  administers the immunization or vaccination.
         (b)  The board shall establish minimum education and
  continuing education standards for a pharmacist who orders or
  administers an immunization or vaccination. The standards must
  include Centers for Disease Control and Prevention training, basic
  life support training, and hands-on training in techniques for
  administering immunizations and vaccinations.
         (c)  Supervision by a physician is adequate if the delegating
  physician:
               (1)  is responsible for formulating or approving an
  order or protocol, including the physician's order, standing
  medical order, or standing delegation order, and periodically
  reviews the order or protocol and the services provided to a patient
  under the order or protocol;
               (2)  [except as provided by Subsection (c-1),] has
  established a physician-patient relationship with each patient who
  is younger than three [under 14] years of age and referred the
  patient to the pharmacist;
               (3)  is geographically located to be easily accessible
  to the pharmacy where an immunization or vaccination is
  administered;
               (4)  receives, as appropriate, a periodic status report
  on the patient, including any problem or complication encountered;
  and
               (5)  is available through direct telecommunication for
  consultation, assistance, and direction.
         (c-1)  A pharmacist may order or administer an immunization
  or [influenza] vaccination to a patient who is at least three [over
  seven] years of age without an established physician-patient
  relationship if the immunization or vaccination is:
               (1)  authorized or approved by the United States Food
  and Drug Administration or listed in the routine immunization
  schedule recommended by the federal Advisory Committee on
  Immunization Practices published by the federal Centers for Disease
  Control and Prevention; and
               (2)  ordered or administered in accordance with the
  federal Advisory Committee on Immunization Practices
  vaccine-specific recommendations.
         SECTION 5.  This Act takes effect September 1, 2021.