Chapter 0103 - 501R - S Ver of SB1298

Be it enacted by the Legislature of the State of Arizona:

Section 1. Section 32-1970, Arizona Revised Statutes, is amended to read:

START_STATUTE32-1970. Implementing, monitoring and modifying drug therapy and use; conditions; definitions

A. A pharmacist licensed pursuant to this chapter may implement, monitor and modify drug therapy and use only under the following circumstances:

1. The patient's drug therapy and use are pursuant to a diagnosis by a physician licensed pursuant to chapter 13 or 17 of this title in an inpatient setting except for health care provided pursuant to paragraph 4, subdivisions (b) and (d) of this subsection provider.

2. The pharmacist complies with rules adopted by the state board of pharmacy that have been approved by the Arizona medical board and the board of osteopathic examiners in medicine and surgery.

3. The pharmacist follows the written drug therapy management protocols prescribed by the physician provider who made the diagnosis and implements, monitors or modifies a person's drug therapy and use only pursuant to those protocols. Each protocol developed pursuant to the drug therapy agreement shall contain detailed directions concerning the actions that the pharmacist may perform for that patient. The protocol shall specify, at a minimum, the specific drug or drugs to be managed by the pharmacist, the conditions and events for which the pharmacist must notify the provider and the laboratory tests that may be ordered. A provider who enters into a protocol-based drug therapy agreement must have a legitimate provider-patient relationship.

4. The pharmacist implements, monitors or modifies a person's drug therapy and use only in the following health care institutions:

(a) A hospital as defined in section 32‑1901.

(b) A staff model of a health care services organization.

(c) A nursing care institution that has a contractual relationship between a limited service pharmacy or a long‑term care consultant pharmacist or has an on‑site pharmacy.

(d) A qualifying community health center as defined in section 32‑1921 that has an on‑site pharmacy.

5. The pharmacist includes the approved guidelines and protocols in the patient's chart or file and makes the chart or file available for review by the patient's other health care providers.

B. A licensee who violates this section commits an act of unprofessional conduct.

C. A pharmacist is responsible for the pharmacist's negligent acts that are the result of the pharmacist's change of medication or that relate to patient drug usage pursuant to drug therapy management protocols. This subsection does not limit a physician's provider's liability for negligent acts that are not related to a pharmacist's change of medication pursuant to the protocols.

D. For the purposes of this section:

1. "Implement, monitor and modify" means that a pharmacist may perform specific acts as authorized by a physician provider pursuant to written guidelines and protocols. This does not include the selection of drug products not prescribed by the physician provider unless selection of the specific drug product is authorized by the written guidelines and protocols.

2. "Long‑term care consultant pharmacist" means a pharmacist providing consulting services to a long‑term care facility.

3. 2. "Protocol" means a physician's provider's written order, written standing medical order or other written order of protocol as defined by rules adopted by the Arizona medical board and the board of osteopathic examiners in medicine and surgery and that are patient, physician provider and pharmacist specific for prescriptions or orders given by the physician provider authorizing the written protocol.

4. "Staff model of a health care services organization" means an organization that is licensed pursuant to title 20 and that employs its health care providers.

3. "Provider" means a physician who is licensed pursuant to chapter 13 or 17 of this title or a registered nurse practitioner who is licensed pursuant to chapter 15 of this title and who acts as a primary care practitioner. END_STATUTE

Sec. 2. Section 32-1974, Arizona Revised Statutes, is amended to read:

START_STATUTE32-1974. Pharmacists; administration of immunizations, vaccines and emergency medications; certification; reporting requirements; advisory committee; definition

A. Except as prescribed pursuant to subsection G I of this section, a pharmacist who is licensed pursuant to this chapter and who meets the requirements of this section may administer the following to adults without a prescription order pursuant to rules and protocols adopted by the board pursuant to this section:

1. Immunizations or vaccines listed in the United States centers for disease control and prevention's recommended adult immunization schedule.

2. Immunizations or vaccines recommended by the United States centers for disease control and prevention's health information for international travel.

b. A pharmacist who is licensed pursuant to this chapter and who meets the requirements of this section may administer the following to a person who is at least six years of age but under eighteen years of age without a prescription order pursuant to rules and protocols adopted by the board pursuant to this section:

1. Immunizations or vaccines for influenza.

2. Immunizations or vaccines in response to a public health emergency declared by the governor pursuant to section 36-787.

C. Pursuant to a prescription order, a pharmacist who is licensed pursuant to this chapter and who meets the requirements of this section may administer immunizations and vaccines to a person who is at least six years of age but under eighteen years of age pursuant to rules and protocols adopted by the board pursuant to this section.

B. D. A pharmacist who wishes to administer immunizations and vaccines pursuant to subsection A of this section must be certified to do so by the board. The board shall issue a certificate to a pharmacist who meets board requirements for certification as prescribed by the board by rule.

C. E. A pharmacist who is certified to administer immunizations and vaccines pursuant to this section may administer emergency medication to manage an acute allergic reaction to an immunization or vaccine.

D. F. A pharmacist who administers an immunization, vaccine or emergency medication pursuant to this section must:

1. Report the administration to the person's primary care provider or physician, if the primary care provider or physician is available, within forty-eight hours after administering the immunization, vaccine or emergency medication and as prescribed by the board by rule.

2. Report information to any adult immunization information system or vaccine registry established by the department of health services.

3. Maintain a record of the immunization pursuant to title 12, chapter 13, article 7.1 and as prescribed by the board by rule.

4. Participate in any federal vaccine adverse event reporting system or successor database.

E. G. Nothing in This section creates does not establish a cause of action against a patient's primary care provider for any adverse reaction, complication or negative outcome arising from the administration of any immunization, vaccine or emergency medication by a pharmacist to a patient pursuant to this section if it is administered without a prescription written by the patient's primary care provider.

F. H. The board shall adopt rules for the administration of vaccines or immunizations pursuant to this section regarding:

1. Protocols that are based on protocols approved by the United States centers for disease control and prevention and any advisory committee appointed by the board for the purpose of recommending protocols.

2. Record keeping and reporting requirements.

3. Requirements and qualifications for pharmacist certification pursuant to this section.

4. Vaccine information and educational materials for those requesting vaccines and immunizations.

5. The administration of emergency medication pursuant to this section.

G. I. The department of health services, by rule, shall establish and maintain a list of immunizations or vaccines that may be administered to adults by a pharmacist only pursuant to a prescription order. In adopting and maintaining this list, the department is exempt from the rule making requirements of title 41, chapter 6. The department shall adopt its initial rules within six months after receipt of the recommendations of the advisory committee appointed by the board and shall hold one public hearing before implementing the rules and any amendments to the rules. The list shall include those immunizations or vaccines listed in the United States centers for disease control and prevention's recommended adult immunization schedule or recommended by the United States centers for disease control and prevention's health information for international travel that have adverse reactions that could cause significant harm to a patient's health. A pharmacist may not administer immunizations or vaccines without a prescription order pursuant to this section before the department has established the list pursuant to this subsection. The board may not authorize a pharmacist to administer new immunizations or vaccines without a prescription order pursuant to this section until the department reviews the new immunizations and vaccines to determine if they should be added to the list established pursuant to this subsection.

H. J. The board may appoint an advisory committee to assist the board in adopting and amending rules and developing protocols relating to the administration of immunizations, vaccines and emergency medications and certification requirements.

K. A pharmacy intern who is certified by the board to administer immunizations and vaccines pursuant to this section may do so only in the presence and under the immediate personal supervision of a pharmacist certified as prescribed in this section.

L. This section does not prevent a pharmacist who administers an immunization or vaccine from participating in the federal vaccines for children program.

M. A pharmacist may not administer an immunization or vaccine to a minor pursuant to subsection b or c of this section without the consent of the minor's parent or guardian.

I. N. For the purposes of this section, "emergency medication" means emergency epinephrine and diphenhydramine. END_STATUTE

Sec. 3. Scope of statutory change

Section 32-1974, subsection C, Arizona Revised Statutes, as amended by this act, is intended to allow families greater access to immunizations and vaccinations and to enhance collaboration between pharmacist and primary care providers by allowing immunization trained pharmacists to administer immunizations and vaccinations to children when presented with a valid prescription order. This coordination recognizes efficiencies and improved outcomes in a model of health care delivery for children, such as prescriptions for immunizations and vaccinations, delivered through a primary care provider.