HB 629: Enact the Pharmacist Prescribing Authority Act

To amend sections 339.78, 339.81, 1751.91, 3923.89, 1
4729.01, and 4729.39 and to enact sections 2
4729.21 and 4729.211 of the Revised Code to
authorize pharmacists to treat minor health
conditions and to name this act the Pharmacist
Prescribing Authority Act.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 339.78, 339.81, 1751.91, 3923.89, 7
4729.01, and 4729.39 be amended and sections 4729.21 and 8
4729.211 of the Revised Code be enacted to read as follows:

Sec. 339.78.

(A) As used in this section, "health care
provider" means any of the following:
(1) A physician;
(2) An advanced practice registered nurse licensed under
Chapter 4723. of the Revised Code who is designated as a
certified nurse practitioner, certified nurse-midwife, or
clinical nurse specialist;
(3) A physician assistant licensed under Chapter 4730. of
the Revised Code.
(B) When a physician health care provider completes
diagnostic studies confirming that an individual has
tuberculosis, the physician-health care provider shall report
the confirmed case of tuberculosis to the county or district
tuberculosis control unit. A physician-health care provider
shall make a report to the tuberculosis control unit prior to
completion of diagnostic studies if the signs and symptoms
demonstrated by an individual are sufficient for the physician-
health care provider to suspect that the individual has
tuberculosis. At any time it is determined that an individual's
tuberculosis is resistant to one or more drugs, the physician-
health care provider shall make a report to the unit.
The physician-health care provider attending an individual
with tuberculosis shall document the individual's adherence to
the treatment regimen that the physician-health care provider
prescribes and make a report to the tuberculosis control unit if
the individual does not adhere to the regimen.
In each report made under this division, the physician-
health care provider shall provide all information that the
tuberculosis control unit requests. The information shall be
provided at intervals specified by the tuberculosis control
unit.
(B) (C) In addition to accepting reports made by physicians
health care providers under division (A) (B) of this section, a
county or district tuberculosis control unit shall accept
reports made as follows:
(1) The administrator of a hospital, clinic, or other
facility that is providing services to an individual who is
confirmed to have or is suspected of having tuberculosis shall
report the case to the tuberculosis control unit;
(2) The administrator of a laboratory that performs tests ..... 49
for tuberculosis on human specimens shall report to the ..... 50
tuberculosis control unit each positive tuberculosis test result ..... 51
obtained; ..... 52
(3) Any person who suspects that an individual has ..... 53
tuberculosis may report that suspicion to the tuberculosis ..... 54
control unit.

Sec. 339.81.

Any information, data, and reports with ..... 56
respect to a case of tuberculosis that are furnished to, or ..... 57
procured by, a county or district tuberculosis control unit or ..... 58
the department of health shall be confidential and used only for ..... 59
statistical, scientific, and medical research for the purpose of ..... 60
controlling tuberculosis in this state. No-physicianA health ..... 61
care provider as defined in section 339.78 of the Revised Code, ..... 62
hospital, or other entity furnishing information, data, or ..... 63
reports pursuant to this chapter shall not by reason of such ..... 64
furnishing be deemed to have violated any confidential ..... 65
relationship, be held to answer for willful betrayal of a ..... 66
professional confidence, or be held liable in damages to any ..... 67
person.

Sec. 1751.91.

A-(A) Except as provided in division (B) of ..... 69
this section, a health insuring corporation may provide payment ..... 70
or reimbursement to a pharmacist for providing a health care ..... 71
service to a patient if both of the following are the case: ..... 72
(A)-(1) The pharmacist provided the health care service to ..... 73
the patient in accordance with Chapter 4729. of the Revised ..... 74
Code, including any of the following services: ..... 75
(1)-(a) Managing drug therapy under a consult agreement ..... 76
pursuant to section 4729.39 of the Revised Code; ..... 77
(2) (b) Administering immunizations in accordance with
section 4729.41 of the Revised Code;
(3) (c) Administering drugs in accordance with section 4729.45 of the Revised Code.
(B) (2) The patient's individual or group health insuring corporation policy, contract, or agreement provides for payment or reimbursement of the service.
(B) A health insuring corporation shall provide payment or reimbursement to a pharmacist for providing a health care service to a patient pursuant to section 4729.21 or 4729.211 of the Revised Code if the patient's individual or group health insuring corporation policy, contract, or agreement provides for payment or reimbursement of the service when provided by a licensed health professional authorized to prescribe drugs.

Sec. 3923.89.

A-(A) Except as provided in division (B) of this section, a sickness and accident insurer or public employee benefit plan may provide payment or reimbursement to a pharmacist for providing a health care service to a patient if both of the following are the case:
(A) (1) The pharmacist provided the health care service to the patient in accordance with Chapter 4729. of the Revised Code, including any of the following services:
(1) (a) Managing drug therapy under a consult agreement pursuant to section 4729.39 of the Revised Code;
(2) (b) Administering immunizations in accordance with section 4729.41 of the Revised Code;
(3) (c) Administering drugs in accordance with section 4729.45 of the Revised Code.
(B) (2) The patient's individual or group policy of
sickness and accident insurance or public employee benefit plan
provides for payment or reimbursement of the service.
(B) A sickness and accident insurer or public employee
benefit plan shall provide payment or reimbursement to a
pharmacist for providing a health care service to a patient
pursuant to section 4729.21 or 4729.211 of the Revised Code if
the patient's individual or group policy of sickness and
accident insurance or public employee benefit plan provides for
payment or reimbursement of the service when provided by a
licensed health professional authorized to prescribe drugs.

Sec. 4729.01.

As used in this chapter:
(A) "Pharmacy," except when used in a context that refers
to the practice of pharmacy, means any area, room, rooms, place
of business, department, or portion of any of the foregoing
where the practice of pharmacy is conducted.
(B) "Practice of pharmacy" means providing pharmacist care
requiring specialized knowledge, judgment, and skill derived
from the principles of biological, chemical, behavioral, social,
pharmaceutical, and clinical sciences. As used in this division,
"pharmacist care" includes the following:
(1) Interpreting prescriptions;
(2) Dispensing drugs and drug therapy related devices;
(3) Compounding drugs;
(4) Counseling individuals with regard to their drug
therapy, recommending drug therapy related devices, and
assisting in the selection of drugs and appliances for treatment
of common diseases and injuries and providing instruction in the
proper use of the drugs and appliances;
(5) Performing drug regimen reviews with individuals by
discussing all of the drugs that the individual is taking and
explaining the interactions of the drugs;
(6) Performing drug utilization reviews with licensed
health professionals authorized to prescribe drugs when the
pharmacist determines that an individual with a prescription has
a drug regimen that warrants additional discussion with the
prescriber;
(7) Advising an individual and the health care
professionals treating an individual with regard to the
individual's drug therapy;
(8) Acting pursuant to a consult agreement, if an
agreement has been established;
(9) Engaging in the administration of immunizations to the
extent authorized by section 4729.41 of the Revised Code;
(10) Engaging in the administration of drugs to the extent
authorized by section 4729.45 of the Revised Code;
(11) Prescribing drugs and drug therapy related devices
for the treatment of health conditions as authorized by section
4729.21 of the Revised Code;
(12) Prescribing and administering a tuberculin purified
protein derivative product as authorized by section 4729.211 of
the Revised Code.
(C) "Compounding" means the preparation, mixing,
assembling, packaging, and labeling of one or more drugs in any
of the following circumstances:
(1) Pursuant to a prescription issued by a licensed health
professional authorized to prescribe drugs;
(2) Pursuant to the modification of a prescription made in
accordance with a consult agreement;
(3) As an incident to research, teaching activities, or
chemical analysis;
(4) In anticipation of orders for drugs pursuant to
prescriptions, based on routine, regularly observed dispensing
patterns;
(5) Pursuant to a request made by a licensed health
professional authorized to prescribe drugs for a drug that is to
be used by the professional for the purpose of direct
administration to patients in the course of the professional's
practice, if all of the following apply:
(a) At the time the request is made, the drug is
not commercially available regardless of the reason that the drug is
not available, including the absence of a manufacturer for the
drug or the lack of a readily available supply of the drug from
a manufacturer.
(b) A limited quantity of the drug is compounded and
provided to the professional.
(c) The drug is compounded and provided to the
professional as an occasional exception to the normal practice
of dispensing drugs pursuant to patient-specific prescriptions.
(D) "Consult agreement" means an agreement that has been
entered into under section 4729.39 of the Revised Code.
(E) "Drug" means:
(1) Any article recognized in the United States
pharmacopoeia and national formulary, or any supplement to them,
intended for use in the diagnosis, cure, mitigation, treatment,
or prevention of disease in humans or animals;
(2) Any other article intended for use in the diagnosis,
cure, mitigation, treatment, or prevention of disease in humans
or animals;
(3) Any article, other than food, intended to affect the
structure or any function of the body of humans or animals;
(4) Any article intended for use as a component of any
article specified in division (E) (1), (2), or (3) of this
section; but does not include devices or their components,
parts, or accessories.
"Drug" does not include "hemp" or a "hemp product" as
those terms are defined in section 928.01 of the Revised Code.
(F) "Dangerous drug" means any of the following:
(1) Any drug to which either of the following applies:
(a) Under the "Federal Food, Drug, and Cosmetic Act," 52
Stat. 1040 (1938), 21 U.S.C.A. 301, as amended, the drug is
required to bear a label containing the legend "Caution: Federal
law prohibits dispensing without prescription" or "Caution: Federal
law restricts this drug to use by or on the order of a
licensed veterinarian" or any similar restrictive statement, or
the drug may be dispensed only upon a prescription;
(b) Under Chapter 3715. or 3719. of the Revised Code, the
drug may be dispensed only upon a prescription.
(2) Any drug that contains a schedule V controlled
substance and that is exempt from Chapter 3719. of the Revised
Code or to which that chapter does not apply;
(3) Any drug intended for administration by injection into
the human body other than through a natural orifice of the human
body;
(4) Any drug that is a biological product, as defined in
section 3715.01 of the Revised Code.
(G) "Federal drug abuse control laws" has the same meaning
as in section 3719.01 of the Revised Code.
(H) "Prescription" means all of the following:
(1) A written, electronic, or oral order for drugs or
combinations or mixtures of drugs to be used by a particular
individual or for treating a particular animal, issued by a
licensed health professional authorized to prescribe drugs;
(2) For purposes of sections 4723.4810, 4729.282,
4730.432, and 4731.93 of the Revised Code, a written,
electronic, or oral order for a drug to treat chlamydia,
gonorrhea, or trichomoniasis issued to and in the name of a
patient who is not the intended user of the drug but is the
sexual partner of the intended user;
(3) For purposes of sections 3313.7110, 3313.7111,
3314.143, 3326.28, 3328.29, 4723.483, 4729.88, 4730.433,
4731.96, and 5180.26 of the Revised Code, a written, electronic,
or oral order for an epinephrine autoinjector issued to and in
the name of a school, school district, or camp;
(4) For purposes of Chapter 3728. and sections 4723.483,
4729.88, 4730.433, and 4731.96 of the Revised Code, a written,
electronic, or oral order for an epinephrine autoinjector issued
to and in the name of a qualified entity, as defined in section
3728.01 of the Revised Code;
(5) For purposes of sections $3313.7115,3313.7116$,
$3314.147,3326.60,3328.38,4723.4811,4730.437,4731.92$, and
5180.262 of the Revised Code, a written, electronic, or oral
order for injectable or nasally administered glucagon in the
name of a school, school district, or camp.
(I) "Licensed health professional authorized to prescribe
drugs" or "prescriber" means an individual who is authorized by
law to prescribe drugs or dangerous drugs or drug therapy
related devices in the course of the individual's professional
practice, including only the following:
(1) A dentist licensed under Chapter 4715. of the Revised
Code;
(2) A clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner who holds a current, valid
license issued under Chapter 4723. of the Revised Code to
practice nursing as an advanced practice registered nurse;
(3) A certified registered nurse anesthetist who holds a
current, valid license issued under Chapter 4723. of the Revised
Code to practice nursing as an advanced practice registered
nurse, but only to the extent of the nurse's authority under
sections 4723.43 and 4723.434 of the Revised Code;
(4) An optometrist licensed under Chapter 4725. of the
Revised Code to practice optometry;
(5) A physician authorized under Chapter 4731. of the
Revised Code to practice medicine and surgery, osteopathic
medicine and surgery, or podiatric medicine and surgery;
(6) A physician assistant who holds a license to practice
as a physician assistant issued under Chapter 4730. of the
Revised Code, holds a valid prescriber number issued by the
state medical board, and has been granted physician-delegated
prescriptive authority;
(7) A veterinarian licensed under Chapter 4741. of the
Revised Code;
(8) A certified mental health assistant licensed under
Chapter 4772. of the Revised Code who has been granted
physician-delegated prescriptive authority by the physician
supervising the certified mental health assistant;
(9) A pharmacist who prescribes drugs or drug therapy
related devices under section 4729.21 of the Revised Code,
prescribes a tuberculin purified protein derivative product
under section 4729.211 of the Revised Code, or adds a drug to a
patient's drug therapy under section 4729.39 of the Revised
Code.
(J) "Sale" or "sell" includes any transaction made by any
person, whether as principal proprietor, agent, or employee, to
do or offer to do any of the following: deliver, distribute,
broker, exchange, gift or otherwise give away, or transfer,
whether the transfer is by passage of title, physical movement,
or both.
(K) "Wholesale sale" and "sale at wholesale" mean any sale
in which the purpose of the purchaser is to resell the article
purchased or received by the purchaser.
(L) "Retail sale" and "sale at retail" mean any sale other
than a wholesale sale or sale at wholesale.
(M) "Retail seller" means any person that sells any
dangerous drug to consumers without assuming control over and
responsibility for its administration. Mere advice or
instructions regarding administration do not constitute control
or establish responsibility.
(N) "Price information" means the price charged for a
prescription for a particular drug product and, in an easily
understandable manner, all of the following:
(1) The proprietary name of the drug product;
(2) The established (generic) name of the drug product;
(3) The strength of the drug product if the product
contains a single active ingredient or if the drug product
contains more than one active ingredient and a relevant strength
can be associated with the product without indicating each
active ingredient. The established name and quantity of each
active ingredient are required if such a relevant strength
cannot be so associated with a drug product containing more than
one ingredient.
(4) The dosage form;
(5) The price charged for a specific quantity of the drug
product. The stated price shall include all charges to the
consumer, including, but not limited to, the cost of the drug
product, professional fees, handling fees, if any, and a
statement identifying professional services routinely furnished
by the pharmacy. Any mailing fees and delivery fees may be
stated separately without repetition. The information shall not
be false or misleading.
(0) "Wholesale distributor of dangerous drugs" or
"wholesale distributor" means a person engaged in the sale of
dangerous drugs at wholesale and includes any agent or employee
of such a person authorized by the person to engage in the sale
of dangerous drugs at wholesale.
(P) "Manufacturer of dangerous drugs" or "manufacturer"
means a person, other than a pharmacist or prescriber, who
manufactures dangerous drugs and who is engaged in the sale of
those dangerous drugs.
(Q) "Terminal distributor of dangerous drugs" or "terminal
distributor" means a person who is engaged in the sale of
dangerous drugs at retail, or any person, other than a
manufacturer, repackager, outsourcing facility, third-party
logistics provider, wholesale distributor, or pharmacist, who
has possession, custody, or control of dangerous drugs for any
purpose other than for that person's own use and consumption.
"Terminal distributor" includes pharmacies, hospitals, nursing
homes, and laboratories and all other persons who procure
dangerous drugs for sale or other distribution by or under the
supervision of a pharmacist, licensed health professional
authorized to prescribe drugs, or other person authorized by the
state board of pharmacy.
(R) "Promote to the public" means disseminating a
representation to the public in any manner or by any means,
other than by labeling, for the purpose of inducing, or that is
likely to induce, directly or indirectly, the purchase of a
dangerous drug at retail.
(S) "Person" includes any individual, partnership,
association, limited liability company, or corporation, the
state, any political subdivision of the state, and any district,
department, or agency of the state or its political
subdivisions.
(T) (1) "Animal shelter" means a facility operated by a
humane society or any society organized under Chapter 1717. of
the Revised Code or a dog pound operated pursuant to Chapter
955. of the Revised Code.
(2) "County dog warden" means a dog warden or deputy dog
warden appointed or employed under section 955.12 of the Revised
Code.
(U) "Food" has the same meaning as in section 3715.01 of
the Revised Code.
(V) "Pain management clinic" has the same meaning as in
section 4731.054 of the Revised Code.
(W) "Investigational drug or product" means a drug or
product that has successfully completed phase one of the United
States food and drug administration clinical trials and remains
under clinical trial, but has not been approved for general use
by the United States food and drug administration.
"Investigational drug or product" does not include controlled
substances in schedule I, as defined in section 3719.01 of the
Revised Code.
(X) "Product," when used in reference to an
investigational drug or product, means a biological product,
other than a drug, that is made from a natural human, animal, or
microorganism source and is intended to treat a disease or
medical condition.
(Y) "Third-party logistics provider" means a person that
provides or coordinates warehousing or other logistics services
pertaining to dangerous drugs including distribution, on behalf
of a manufacturer, wholesale distributor, or terminal
distributor of dangerous drugs, but does not take ownership of
the drugs or have responsibility to direct the sale or
disposition of the drugs.
(Z) "Repackager of dangerous drugs" or "repackager" means
a person that repacks and relabels dangerous drugs for sale or
distribution.
(AA) "Outsourcing facility" means a facility that is
engaged in the compounding and sale of sterile drugs and is
registered as an outsourcing facility with the United States
food and drug administration.
(BB) "Laboratory" means a laboratory licensed under this
chapter as a terminal distributor of dangerous drugs and
entrusted to have custody of any of the following drugs and to
use the drugs for scientific and clinical purposes and for
purposes of instruction: dangerous drugs that are not controlled
substances, as defined in section 3719.01 of the Revised Code;
dangerous drugs that are controlled substances, as defined in
that section; and controlled substances in schedule I, as
defined in that section.
(CC) "Overdose reversal drug" means both of the following:
(1) Naloxone;
(2) Any other drug that the state board of pharmacy,
through rules adopted in accordance with Chapter 119. of the
Revised Code, designates as a drug that is approved by the
federal food and drug administration for the reversal of a known
or suspected opioid-related overdose.

Sec. 4729.21.

(A) As used in this section and sections
4729.211 and 4729.212 of the Revised Code, "health care
provider" means any of the following:
(1) A physician authorized under Chapter 4731. of the
Revised Code to practice medicine and surgery or osteopathic
medicine and surgery;
(2) An advanced practice registered nurse licensed under
Chapter 4723. of the Revised Code who is designated as a
certified nurse practitioner, certified nurse-midwife, or
clinical nurse specialist;
(3) A physician assistant licensed under Chapter 4730. of
the Revised Code.
(B) In accordance with a protocol that meets the
requirements of division (E) of this section, a pharmacist may
provide treatment and related services to individuals who are
thirteen years of age or older for any of the following health
conditions by engaging in the activities described in division
(C) of this section:
(1) Influenza;
(2) Pharyngitis caused by the bacteria known as "group A
Streptococcus";
(3) COVID;
(4) Bronchitis;
(5) Sinusitis;
(6) Lice;
(7) Skin conditions, including ringworm and athlete's
foot;
(8) Urinary tract infections;
(9) HIV prevention, including pre-exposure and post-
exposure prophylaxis;
(10) Any other minor or generally self-limiting condition
specified in the protocol.
(C) (1) As part of providing treatment or related services
for a health condition under this section, a pharmacist may do
any of the following:
(a) Order or perform the laboratory or diagnostic tests or
screenings described in division (D) of this section;
(b) Evaluate or interpret the results of the tests or
screenings that the pharmacist ordered or performed;
(c) Subject to division (C) (2) of this section, prescribe
drugs and drug therapy related devices, excluding any controlled
substance.
(2) (a) For the treatment of athlete's foot, a pharmacist
may prescribe only a drug that is to be administered topically.
(b) Prior to prescribing drugs and drug therapy related
devices for the treatment of pharyngitis, a pharmacist shall
order or perform a diagnostic test described in division (D) (1)
(a) of this section.
(D) (1) A pharmacist may order or perform any of the
following tests or screenings under this section if the
pharmacist has received appropriate training regarding that test
or screening according to rules adopted under this section:
(a) Any test that may guide clinical decision-making that
qualifies for a waiver under the "Clinical Laboratory
Improvement Amendments of 1988," 42 U.S.C. 263a, or the federal
regulations adopted thereunder, as determined by the United
States centers for medicare and medicaid services;
(b) Any established screening procedure that is specified
in rules adopted under this section.
(2) Notwithstanding any provision of the Revised Code to
the contrary, a pharmacist may delegate technical and
administrative tasks associated with performing a test described
under division (D) (1) (a) of this section to any of the following
who is working under the supervision of the pharmacist: a
pharmacy intern, registered pharmacy technician, or certified
pharmacy technician.
(E) All of the following apply with respect to the
protocol required by division (B) of this section:
(1) The protocol shall be established by a health care
provider who practices primarily within the forty-mile radius of
the pharmacy where the protocol will be implemented. Once the
protocol is established, the health care provider may authorize
one or more pharmacists to use the protocol for the purpose of
treating health conditions under this section.
(2) The protocol shall include particular terms and
conditions imposed by the health care provider regarding the
treatment and related services authorized by this section,
including all of the following:
(a) Specific categories of patients who the pharmacist is
authorized to test or screen;
(b) The health care provider's instructions for obtaining
relevant patient medical history for the purpose of identifying
disqualifying health conditions, adverse reactions, and
contraindications to the approved course of treatment;
(c) The health care provider's instructions for treatment
based on a patient's age, symptoms, and test and screening
results, including negative results;
(d) Requirements related to notifying a patient's primary health care provider of tests and screenings ordered or performed and treatments provided:
(e) A requirement that the pharmacist provide the patient with written information to advise the patient to seek follow-up care from the patient's primary health care provider, or, if the patient does not have a primary health care provider, from the health care provider who established the protocol required by division (B) of this section or another primary care provider:
(f) Any other requirements or limitations established in rules adopted under this section.
(f) A pharmacy in which a pharmacist acts in accordance with this section shall prominently display signage indicating that any patient receiving treatment or related services under this section is advised to seek follow-up care from the patient's primary health care provider, or, if the patient does not have a primary health care provider, from the health care provider who established the protocol required by division (B) of this section or another primary health care provider.
(g) The state board of pharmacy, in consultation with the state medical board and board of nursing, shall adopt rules as necessary to implement this section, including rules regarding training for the performance of tests and screenings. The rules shall be adopted in accordance with Chapter 119 of the Revised Code.
(h) This section is an alternative to the authority granted by sections 4729.39 and 4729.42 of the Revised Code.

Sec. 4729.211.

(A) Notwithstanding any other provision of the Revised Code to the contrary, a pharmacist, acting in good
faith, may prescribe and administer a tuberculin purified ..... 528
protein derivative product approved by the United States food
529
and drug administration to a patient for the purpose of
530
screening for tuberculosis infection, but only if the following
531
conditions are met: ..... 532
(1) Prior to prescribing and administering a tuberculin ..... 533
purified protein derivative product, the pharmacist has ..... 534
successfully completed a course on proper test administration ..... 535
and interpretation of results from the United States centers for ..... 536
disease control and prevention or a comparable course from a ..... 537
provider accredited by the accreditation council for pharmacy ..... 538
education, or a successor organization; ..... 539
(2) The pharmacist agrees to follow the recommendations ..... 540
for Mantoux tuberculin skin testing from the United States ..... 541
centers for disease control and prevention regarding test ..... 542
administration and interpretation of results; ..... 543
(3) The pharmacist maintains documentation of test results ..... 544
in the records of the pharmacy and agrees to make a copy of the ..... 545
results available to the patient upon request. ..... 546
(B) If a patient is found to have a positive test result ..... 547
through a test administered under this section, both of the ..... 548
following apply: ..... 549
(1) The pharmacist shall coordinate a timely referral to ..... 550
the patient's primary health care provider, if applicable, or to ..... 551
a health care provider or clinic located within a forty-mile ..... 552
radius of the patient's residence to coordinate further ..... 553
diagnostics and follow-up care; ..... 554
(2) The pharmacist shall report the confirmed case of ..... 555
tuberculosis in the same manner that a health care provider is ..... 556
required to report under section 339.78 of the Revised Code. ..... 557
Sec. 4729.39. (A) As used in this section: ..... 558
(1) "Certified nurse practitioner," "certified nurse- ..... 559
midwife," "clinical nurse specialist," and "standard care ..... 560
arrangement" have the same meanings as in section 4723.01 of the ..... 561
Revised Code. ..... 562
(2) "Collaborating physician" means a physician who has ..... 563
entered into a standard care arrangement with a clinical nurse ..... 564
specialist, certified nurse-midwife, or certified nurse ..... 565
practitioner. ..... 566
(3) "Physician" means an individual authorized under ..... 567
Chapter 4731. of the Revised Code to practice medicine and ..... 568
surgery or osteopathic medicine and surgery. ..... 569
(4) "Physician assistant" means an individual who is ..... 570
licensed to practice as a physician assistant under Chapter ..... 571
4730. of the Revised Code, holds a valid prescriber number ..... 572
issued by the state medical board, and has been granted ..... 573
physician-delegated prescriptive authority. ..... 574
(5) "Supervising physician" means a physician who has ..... 575
entered into a supervision agreement with a physician assistant ..... 576
under section 4730.19 of the Revised Code. ..... 577
(B) Subject to division (C) of this section, one or more ..... 578
pharmacists may enter into a consult agreement with one or more ..... 579
of the following practitioners: ..... 580
(1) Physicians; ..... 581
(2) Physician assistants, if entering into a consult ..... 582
agreement is authorized by one or more supervising physicians; ..... 583
(3) Clinical nurse specialists, certified nurse-midwives, ..... 584
or certified nurse practitioners, if entering into a consult ..... 585
agreement is authorized by one or more collaborating physicians. ..... 586
(C) Before entering into a consult agreement, all of the ..... 587
following conditions must be met: ..... 588
(1) Each practitioner must have an ongoing practitioner- ..... 589
patient relationship with each patient whose drug therapy is to ..... 590
be managed. ..... 591
(2) The diagnosis for which each patient has been ..... 592
prescribed drug therapy must be within the scope of each ..... 593
practitioner's practice. ..... 594
(3) Each pharmacist must have training and experience ..... 595
related to the particular diagnosis for which drug therapy is to ..... 596
be prescribed. ..... 597
(D) With respect to consult agreements, all of the ..... 598
following apply: ..... 599
(1) Under a consult agreement, a pharmacist is authorized ..... 600
to do both of the following, but only to the extent specified in ..... 601
the agreement, this section, and the rules adopted under this ..... 602
section: ..... 603
(a) Manage drug therapy for treatment of specified ..... 604
diagnoses or diseases for each patient who is subject to the ..... 605
agreement, including all of the following: ..... 606
(i) Changing the duration of treatment for the current ..... 607
drug therapy; ..... 608
(ii) Adjusting a drug's strength, dose, dosage form, ..... 609
frequency of administration, or route of administration; ..... 610
(iii) Discontinuing the use of a drug;
(iv) Administering a drug;
(v) Notwithstanding the definition of "licensed health- 613
professional authorized to prescribe drugs" in section 4729.01- 614
of the Revised Code, adding Adding a drug to the patient's drug 615
therapy.
(b) (i) Order laboratory and diagnostic tests, including 617
blood and urine tests, that are related to the drug therapy 618
being managed, and evaluate the results of the tests that are 619
ordered.
(ii) A pharmacist's authority to evaluate test results 621
under division (D) (1) (b) (i) of this section does not authorize 622
the pharmacist to make a diagnosis.
(2) (a) A consult agreement, or the portion of the 624
agreement that applies to a particular patient, may be 625
terminated by any of the following:
(i) A pharmacist who entered into the agreement;
(ii) A practitioner who entered into the agreement;
(iii) A patient whose drug therapy is being managed;
(iv) An individual who consented to the treatment on 630
behalf of a patient or an individual authorized to act on behalf 631
of a patient.
(b) The pharmacist or practitioner who receives the notice 633
of a patient's termination of the agreement shall provide 634
written notice to every other pharmacist or practitioner who is 635
a party to the agreement. A pharmacist or practitioner who 636
terminates a consult agreement with regard to one or more 637
patients shall provide written notice to all other pharmacists ..... 638
and practitioners who entered into the agreement and to each ..... 639
individual who consented to treatment under the agreement. The ..... 640
termination of a consult agreement with regard to one or more ..... 641
patients shall be recorded by the pharmacist and practitioner in ..... 642
the medical records of each patient to whom the termination ..... 643
applies. ..... 644
(3) A consult agreement shall be made in writing and shall ..... 645
include all of the following: ..... 646
(a) The diagnoses and diseases being managed under the ..... 647
agreement, including whether each disease is primary or ..... 648
comorbid; ..... 649
(b) A description of the drugs or drug categories the ..... 650
agreement involves; ..... 651
(c) A description of the procedures, decision criteria, ..... 652
and plan the pharmacist is to follow in acting under a consult ..... 653
agreement; ..... 654
(d) A description of how the pharmacist is to comply with ..... 655
divisions (D) (5) and (6) of this section. ..... 656
(4) The content of a consult agreement shall be ..... 657
communicated to each patient whose drug therapy is managed under ..... 658
the agreement. ..... 659
(5) A pharmacist acting under a consult agreement shall ..... 660
maintain a record of each action taken for each patient whose ..... 661
drug therapy is managed under the agreement. ..... 662
(6) Communication between a pharmacist and practitioner ..... 663
acting under a consult agreement shall take place at regular ..... 664
intervals specified by the primary practitioner acting under the ..... 665
agreement. The agreement may include a requirement that a ..... 666
pharmacist send a consult report to each consulting ..... 667
practitioner. ..... 668
(7) A consult agreement is effective for two years and may ..... 669
be renewed if the conditions specified in division (C) of this ..... 670
section continue to be met. ..... 671
(8) A consult agreement does not permit a pharmacist to ..... 672
manage drug therapy prescribed by a practitioner who has not ..... 673
entered into the agreement. ..... 674
(E) The state board of pharmacy, state medical board, and ..... 675
board of nursing shall each adopt rules as follows for its ..... 676
license holders establishing standards and procedures for ..... 677
entering into a consult agreement and managing a patient's drug ..... 678
therapy under a consult agreement: ..... 679
(1) The state board of pharmacy, in consultation with the ..... 680
state medical board and board of nursing, shall adopt rules to ..... 681
be followed by pharmacists. ..... 682
(2) The state medical board, in consultation with the ..... 683
state board of pharmacy, shall adopt rules to be followed by ..... 684
physicians and rules to be followed by physician assistants. ..... 685
(3) The board of nursing, in consultation with the state ..... 686
board of pharmacy and state medical board, shall adopt rules to ..... 687
be followed by clinical nurse specialists, certified nurse- ..... 688
midwives, and certified nurse practitioners. ..... 689
The boards shall specify in the rules any categories of ..... 690
drugs or types of diseases for which a consult agreement may not ..... 691
be established. Each board may adopt any other rules it ..... 692
considers necessary for the implementation and administration of ..... 693
this section. All rules adopted under this section shall ..... 694
be adopted in accordance with Chapter 119. of the Revised Code. ..... 695
(F) (1) Subject to division (F) (2) of this section, both of ..... 696
the following apply: ..... 697
(a) A pharmacist acting in accordance with a consult ..... 698
agreement regarding a practitioner's change in a drug for a ..... 699
patient whose drug therapy the pharmacist is managing under the ..... 700
agreement is not liable in damages in a tort or other civil ..... 701
action for injury or loss to person or property allegedly ..... 702
arising from the change. ..... 703
(b) A practitioner acting in accordance with a consult ..... 704
agreement regarding a pharmacist's change in a drug for a ..... 705
patient whose drug therapy the pharmacist is managing under a ..... 706
consult agreement is not liable in damages in a tort or other ..... 707
civil action for injury or loss to person or property allegedly ..... 708
arising from the change unless the practitioner authorized the ..... 709
specific change. ..... 710
(2) Division (F) (1) of this section does not limit a ..... 711
practitioner's or pharmacist's liability in damages in a tort or ..... 712
other civil action for injury or loss to person or property ..... 713
allegedly arising from actions that are not related to the ..... 714
practitioner's or pharmacist's change in a drug for a patient ..... 715
whose drug therapy is being managed under a consult agreement. ..... 716
Section 2. That existing sections 339.78, 339.81, 1751.91, ..... 717
3923.89, 4729.01, and 4729.39 of the Revised Code are hereby ..... 718
repealed. ..... 719
Section 3. Sections 1751.91 and 3923.89 of the Revised ..... 720
Code, as amended by this act, apply to contracts, policies, ..... 721
agreements, and plans that are delivered, issued for delivery, ..... 722
modified, or renewed on or after the effective date of this ..... 723
section. ..... 724
Section 4. This act shall be known as the Pharmacist ..... 725
Prescribing Authority Act. ..... 726