 |
ARIZONA STATE SENATE
Fifty-Seventh Legislature, Second Regular Session
AMENDED
AHCCCS;
procurement; contracting
(NOW: independent testing; treatment; pharmacists)
As passed by the Senate, S.B. 1713 established the Arizona hybrid procurement model as the exclusive performance-based contracting framework for Arizona Health Care Cost Containment System managed care programs.
The House of Representatives adopted a strike-everything amendment that does the following:
Purpose
Background
Pharmacists in Arizona are licensed and regulated by the Board and are authorized to provide specified health care services, including but not limited to interpreting and dispensing prescription orders, compounding drugs, drug therapy management, providing patient counseling, providing patient care services under a collaborative practice agreement with a provider and initiating and administering immunizations or vaccines (A.R.S. §§ 32-1901 and 32-1904).
All facilities in the United States that perform laboratory testing on human specimens for health assessment or the diagnosis, prevention or treatment of disease are regulated under the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA). Waived tests include test systems cleared by the U.S. Food and Drug Administration (FDA) for home use and those tests approved for waiver under CLIA criteria. CLIA requires that waived tests must be simple and have a low risk for erroneous results (CDC).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
Independent Testing and Treatment
1. Allows a pharmacist, under a statewide written protocol (protocol) approved by the Board, to independently order, perform and interpret tests authorized by the FDA and waived under CLIA.
2. Allows a pharmacist to independently initiate treatment to eligible persons at least 12 years old or the age authorized by the treatment, whichever is older, who test positive for:
a) influenza;
b) group A streptococcus pharyngitis;
c) COVID-19 or any other coronavirus respiratory illnesses; or
d) a condition related to an emerging or existing public health threat identified by the Department of Health Services for which a statewide standing order, rule or executive order is issued.
3. Requires the Board's protocol to address, at a minimum, the following:
a) documentation;
b) records retention;
c) referrals;
d) patient screening requirements and obtaining relevant medical history;
e) exclusion criteria;
f) treatment instructions based on the patient's age and medical history;
g) follow up maintenance and care plans; and
h) pharmacist training and certification requirements.
4. Requires a pharmacist who orders, conducts testing or treats a health condition to use any test that may guide clinical decision-making for which a waiver has been obtained under CLIA or federal law or any screening procedure that is established by the protocol.
5. Directs pharmacists to use evidence-based clinical guidelines published by the Center for Disease Control and Prevention, the Infectious Diseases Society of America, the American Academy of Pediatrics Committee on Infectious Disease or other clinically recognized recommendation that aligns with the standards of care in providing patient treatment.
6. Requires an eligible person to meet criteria for treatment based on the protocol that specify:
a) patient inclusion and exclusion criteria; and
b) explicit medical referral criteria.
7. Requires a pharmacist to refer a patient to the patient's primary care provider, if one is identified, or recommend follow up with a primary provider, if the patient:
a) is not eligible for treatment by a pharmacist under state law and presents with symptoms; or
b) does not respond to the initial treatment provided by the pharmacist.
8. Directs a pharmacist who initiates treatment of a patient to:
a) notify the patient's primary care provider, if one is identified, within 72 hours after initiating treatment, including notice of the patient's name and method and date of treatment;
b) make a reasonable effort to identify the patient's primary care provider by checking pharmacy records or requesting the information from the patient or patient's parent or guardian, if applicable;
c) maintain, for at least seven years, a record of any testing or screening results, including a summary of the visit, patient assessment information, history of illness, examination findings, vitals and plan of care;
d) notify the patient's primary care provider, if one is identified, within 48 hours after an adverse reaction is reported to or witnessed by the pharmacist as a result of treatment; and
e) provide informational materials to the patient or patient's parent or guardian, if applicable, about the importance of pediatric preventive health care visits as recommended by the American Academy of Pediatrics.
9. Allows a patient's treatment information to be submitted to the patient's primary care provider through an electronic health record or by phone, fax, mail or email.
10. Allows a pharmacist to delegate the task of performing a test waived by CLIA to a licensed member of the pharmacy staff who is under the supervision of the pharmacist, except that the pharmacist:
a) may not delegate any tasks that include clinical judgment or treatment; and
b) may delegate only ancillary duties permitted by the rules of the Board.
11. Specifies that a pharmacist is not required to provide independent testing or treatment.
12. Prohibits an employer from overruling a pharmacist's decision to not provide independent testing or treatment.
13. Specifies that a pharmacist's ability to test and treat outlined conditions 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 treatment initiated by the pharmacist.
14. Prohibits a pharmacist from independently initiating treatment using opioids for a patient.
15. Prohibits a pharmacist from independently ordering a test or screening or treating a minor without consent of the minor's parent or guardian.
16. Requires a pharmacy to display a notice and include in a patient's consent paperwork that the testing and treatment being performed is being performed by a pharmacist without consultation with or oversight by a physician and that the patient should consult with a primary care provider if symptoms continue.
17. Requires each pharmacy providing testing and treatment services to ensure there is a private area available to perform services.
18. Requires a pharmacist who provides independent testing or treatment to maintain professional liability insurance.
Advisory Committee
19. Directs the Board to establish an Independent Testing and Treatment Advisory Committee (Committee) to assist in developing the state's protocols relating to pharmacists' independent authority to order testing and initiate treatments.
20. Requires the Committee to make recommendations to the Board regarding the protocols.
21. Requires the Committee to include at least the following:
a) two licensed pharmacists, appointed by the Board;
b) two licensed physicians, one of whom specializes in primary care and one of whom practices in an emergency medicine setting, appointed by the Arizona Medical Board or the Arizona Board of Osteopathic Examiners in Medicine and Surgery;
c) one representative from a nonprofit patient advocacy program, appointed by the Governor; and
d) one licensed nurse practitioner who specializes in primary care or emergency medicine and is able to prescribe medication, appointed by the Arizona State Board of Nursing.
22. Requires at least one of the physician members of the Committee to have a patient population that is substantially composed of children and adolescents.
23. Requires all Committee members to be appointed within 60 days after the effective date.
24. Stipulates that, if any members are not appointed within 60 days after the effective date, the other Committee members may meet and make recommendations to the Board.
25. Specifies that Committee members are ineligible to receive compensation or reimbursement of expenses.
26. Requires the Committee to review the protocols annually and update when necessary.
27. Directs the Board to provide a copy of the protocols to the chairpersons of the Health and Human Services Committees of the Senate and House of Representatives, or their successor committees, and to post the protocols on the Board's public website.
HIV Preexposure and Postexposure Prophylaxis
28. Allows a licensed pharmacist to initiate and dispense HIV preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) under the protocols.
29. Requires a pharmacist, before initiating PrEP, to:
a) conduct or obtain a clinical laboratory improvement amendments-waived HIV test and confirm a negative test result; and
b) assess the patient for contraindications, drug interactions and clinical eligibility consistent with current U.S. Centers for Disease Control and Prevention (CDC) guidelines.
30. Requires a pharmacist, before initiating PEP, to:
a) determine that the patient presents within 72 hours after a potential exposure to HIV;
b) conduct or obtain an HIV test if feasible; and
c) assess the patient for contraindications, drug interactions and clinical eligibility consistent with current CDC guidelines.
31. Allows a pharmacist to dispense a complete 28-day course of PEP but no more than a 30-day supply of PrEP.
32. Requires a pharmacist initiating PrEP or PEP therapy to:
a) provide counseling regarding medication adherence, potential side effects and prevention measures;
b) provide the patient with a written referral to a primary care provider or other appropriate provider for follow-up care; and
c) notify the patient's primary care provider of the services provided, if the patient consents.
33. Requires the Board's protocol to address, at a minimum:
a) minimum training requirements for pharmacists who initiate PrEP or PEP therapy;
b) documentation and records retention requirements; and
c) protocol standards consistent with the current guidelines of the U.S. Centers for Disease Control and Prevention, the Infectious Diseases Society of America or another clinically recognized recommendation.
Miscellaneous
34. Defines terms.
35. Becomes effective on the general effective date.
Amendments Adopted by the House of Representatives
· Adopted the strike-everything amendment relating to independent testing and treatment initiated by pharmacists.
House Action
HHS 3/26/26 W/D
APPROP 3/31/26 DPA/SE 10-7-1-1
3rd Read 6/11/26 37-18-5
Prepared by Senate Research
June 12, 2026
MM/hk