Bill Text: FL S1094 | 2020 | Regular Session | Comm Sub
Bill Title: Practice of Pharmacy
Spectrum: Slight Partisan Bill (? 2-1)
Status: (Introduced - Dead) 2020-03-10 - Laid on Table, refer to CS/CS/HB 599 [S1094 Detail]
Download: Florida-2020-S1094-Comm_Sub.html
Florida Senate - 2020 CS for CS for SB 1094 By the Committees on Appropriations; and Health Policy; and Senator Diaz 576-04564-20 20201094c2 1 A bill to be entitled 2 An act relating to the practice of pharmacy; amending 3 s. 381.0031, F.S.; requiring certain licensed 4 pharmacists to report specified information relating 5 to public health to the Department of Health; amending 6 s. 465.003, F.S.; revising the definition of the term 7 “practice of the profession of pharmacy”; amending s. 8 465.0125, F.S.; requiring a pharmacist to complete 9 additional training to be licensed as a consultant 10 pharmacist; authorizing a consultant pharmacist to 11 perform specified services under certain circumstances 12 and within the scope of a written collaborative 13 practice agreement with certain health care 14 practitioners; providing requirements for the 15 agreement; prohibiting a consultant pharmacist from 16 modifying or discontinuing medicinal drugs prescribed 17 by a health care practitioner without a written 18 collaborative practice agreement; revising the 19 responsibilities of a consultant pharmacist; requiring 20 written collaborative practice agreements to be made 21 available upon request from or upon inspection by the 22 Department of Health; prohibiting a consultant 23 pharmacist from diagnosing any disease or condition; 24 defining the term “health care facility”; creating s. 25 465.1865, F.S.; defining the terms “collaborative 26 pharmacy practice agreement” and “chronic health 27 condition”; specifying criteria a pharmacist must meet 28 to provide services under a collaborative pharmacy 29 practice agreement; providing requirements for 30 collaborative pharmacy practice agreements; providing 31 for the renewal of such agreements; requiring 32 collaborating pharmacists and physicians to maintain a 33 copy of the collaborative pharmacy practice agreements 34 at their practices and make such agreements available 35 upon request or inspection; requiring pharmacists to 36 submit a copy of the signed collaborative pharmacy 37 practice agreement to the Board of Pharmacy before 38 implementing it; prohibiting pharmacists from engaging 39 in specified activities without a collaborative 40 pharmacy practice agreement; prohibiting pharmacists 41 from entering into collaborative pharmacy practice 42 agreements under certain circumstances; prohibiting 43 collaborating physicians from delegating to 44 pharmacists the authority to initiate or prescribe a 45 controlled substance; providing continuing education 46 requirements for pharmacists practicing under 47 collaborative pharmacy practice agreements; requiring 48 the Board of Medicine in consultation with the Board 49 of Osteopathic Medicine and the Board of Pharmacy to 50 adopt rules; providing an effective date. 51 52 Be It Enacted by the Legislature of the State of Florida: 53 54 Section 1. Subsection (2) of section 381.0031, Florida 55 Statutes, is amended to read: 56 381.0031 Epidemiological research; report of diseases of 57 public health significance to department.— 58 (2) Any practitioner licensed in this state to practice 59 medicine, osteopathic medicine, chiropractic medicine, 60 naturopathy, or veterinary medicine; any licensed pharmacist 61 authorized under a collaborative pharmacy practice agreement, as 62 defined in s. 465.1865, to perform or order and evaluate 63 laboratory and clinical tests; any hospital licensed under part 64 I of chapter 395; or any laboratory appropriately certified by 65 the Centers for Medicare and Medicaid Services under the federal 66 Clinical Laboratory Improvement Amendments and the federal rules 67 adopted thereunder which diagnoses or suspects the existence of 68 a disease of public health significance shall immediately report 69 the fact to the Department of Health. 70 Section 2. Subsection (13) of section 465.003, Florida 71 Statutes, is amended to read: 72 465.003 Definitions.—As used in this chapter, the term: 73 (13) “Practice of the profession of pharmacy” includes 74 compounding, dispensing, and consulting concerning contents, 75 therapeutic values, and uses of any medicinal drug; consulting 76 concerning therapeutic values and interactions of patent or 77 proprietary preparations, whether pursuant to prescriptions or 78 in the absence and entirely independent of such prescriptions or 79 orders; and conducting other pharmaceutical services. For 80 purposes of this subsection, the term “other pharmaceutical 81 services” meansthemonitoringofthe patient’s drug therapy and 82 assisting the patient in the management of his or her drug 83 therapy; reviewing and making recommendations regarding,and84includes review ofthe patient’s drug therapy and health care 85 status in communication with the patient’s prescribing health 86 care provider as licensed under chapter 458, chapter 459, 87 chapter 461, or chapter 466, or a similar statutory provision in 88 another jurisdiction, or such provider’s agent or such other 89 persons as specifically authorized by the patient; and 90 initiating, modifying, or discontinuing drug therapy for a 91 chronic health condition under a collaborative pharmacy practice 92 agreement, regarding the drug therapy.However,Nothing in this 93 subsection may be interpreted to permit an alteration of a 94 prescriber’s directions, the diagnosis or treatment of any 95 disease, the initiation of any drug therapy, the practice of 96 medicine, or the practice of osteopathic medicine, unless 97 otherwise permitted by law or specifically authorized by s. 98 465.1865. The term “Practice of the profession of pharmacy” also 99 includes any other act, service, operation, research, or 100 transaction incidental to, or forming a part of, any of the 101 foregoing acts, requiring, involving, or employing the science 102 or art of any branch of the pharmaceutical profession, study, or 103 training, and shall expressly permit a pharmacist to transmit 104 information from persons authorized to prescribe medicinal drugs 105 to their patients. The practice of the profession of pharmacy 106 also includes the administration of vaccines to adults pursuant 107 to s. 465.189 and the preparation of prepackaged drug products 108 in facilities holding Class III institutional pharmacy permits. 109 The term also includes ordering and evaluating any laboratory or 110 clinical testing; conducting patient assessments; and modifying, 111 discontinuing, or administering medicinal drugs pursuant to s. 112 465.0125 by a consultant pharmacist. 113 Section 3. Section 465.0125, Florida Statutes, is amended 114 to read: 115 465.0125 Consultant pharmacist license; application, 116 renewal, fees; responsibilities; rules.— 117 (1) The department shall issue or renew a consultant 118 pharmacist license upon receipt of an initial or renewal 119 application thatwhichconforms to the requirements for 120 consultant pharmacist initial licensure or renewal as adopted 121promulgatedby the board by rule and a fee set by the board not 122 to exceed $250. To be licensed as a consultant pharmacist, a 123 pharmacist must complete additional training as required by the 124 board. 125 (a) A consultant pharmacist may provide medication 126 management services in a health care facility within the 127 framework of a written collaborative practice agreement between 128 the pharmacist and a health care facility medical director or a 129 physician licensed under chapter 458 or chapter 459, a podiatric 130 physician licensed under chapter 461, or a dentist licensed 131 under chapter 466 who is authorized to prescribe medicinal 132 drugs. A consultant pharmacist may provide medication management 133 services, conduct patient assessments, and order and evaluate 134 laboratory or clinical testing only for patients of the health 135 care practitioner with whom the consultant pharmacist has a 136 written collaborative practice agreement. 137 (b) A written collaborative practice agreement must outline 138 the circumstances under which the consultant pharmacist may: 139 1. Order and evaluate any laboratory or clinical tests to 140 promote and evaluate patient health and wellness, and monitor 141 drug therapy and treatment outcomes. 142 2. Conduct patient assessments as appropriate to evaluate 143 and monitor drug therapy. 144 3. Modify or discontinue medicinal drugs as outlined in the 145 agreed-upon patient-specific order or preapproved treatment 146 protocol under the direction of a physician. However, a 147 consultant pharmacist may not modify or discontinue medicinal 148 drugs prescribed by a health care practitioner who does not have 149 a written collaborative practice agreement with the consultant 150 pharmacist. 151 4. Administer medicinal drugs. 152 (c) ATheconsultant pharmacist shall maintainbe153responsible for maintainingall drug, patient care, and quality 154 assurance records as required by law and, with the collaborating 155 practitioner, maintain written collaborative practice agreements 156 that must be available upon request from or upon inspection by 157 the department. 158 (d) This subsection does not authorize a consultant 159 pharmacist to diagnose any disease or condition. 160 (e) For purposes of this subsection, the term “health care 161 facility” means an ambulatory surgical center or hospital 162 licensed under chapter 395, an alcohol or chemical dependency 163 treatment center licensed under chapter 397, an inpatient 164 hospice licensed under part IV of chapter 400, a nursing home 165 licensed under part II of chapter 400, an ambulatory care center 166 as defined in s. 408.07, or a nursing home component licensed 167 under chapter 400 within a continuing care facility licensed 168 under chapter 651for establishing drug handling procedures for169the safe handling and storage of drugs. The consultant170pharmacist may also be responsible for ordering and evaluating171any laboratory or clinical testing when, in the judgment of the172consultant pharmacist, such activity is necessary for the proper173performance of the consultant pharmacist’s responsibilities.174Such laboratory or clinical testing may be ordered only with175regard to patients residing in a nursing home facility, and then176only when authorized by the medical director of the nursing home177facility. The consultant pharmacist must have completed such178additional training and demonstrate such additional179qualifications in the practice of institutional pharmacy as180shall be required by the board in addition to licensure as a181registered pharmacist. 182 (2) Notwithstandingthe provisions ofsubsection (1), a 183 consultant pharmacist or a doctor of pharmacy licensed in this 184 state may also be responsible for ordering and evaluating any 185 laboratory or clinical testing for persons under the care of a 186 licensed home health agency when, in the judgment of the 187 consultant pharmacist or doctor of pharmacy, such activity is 188 necessary for the proper performance of his or her 189 responsibilities and only when authorized by a practitioner 190 licensed under chapter 458, chapter 459, chapter 461, or chapter 191 466. In order for the consultant pharmacist or doctor of 192 pharmacy to qualify and accept this authority, he or she must 193 receive 3 hours of continuing education relating to laboratory 194 and clinical testing as established by the board. 195 (3) The board shall adoptpromulgaterules necessary to 196 implement and administer this section. 197 Section 4. Section 465.1865, Florida Statutes, is created 198 to read: 199 465.1865 Collaborative pharmacy practice for chronic health 200 conditions.— 201 (1) For purposes of this section, the term: 202 (a) “Collaborative pharmacy practice agreement” means a 203 written agreement between a pharmacist who meets the 204 qualifications of this section and a physician licensed under 205 chapter 458 or chapter 459 in which a collaborating physician 206 authorizes a pharmacist to provide specified patient care 207 services to the collaborating physician′s patients. 208 (b) “Chronic health condition” means: 209 1. Arthritis; 210 2. Asthma; 211 3. Chronic obstructive pulmonary diseases; 212 4. Type 2 diabetes; 213 5. Human immunodeficiency virus or acquired immune 214 deficiency syndrome; or 215 6. Obesity. 216 (2) To provide services under a collaborative pharmacy 217 practice agreement, a pharmacist must be certified according to 218 rules of the Board of Medicine that he or she: 219 (a) Holds an active and unencumbered license to practice 220 pharmacy in the state. 221 (b) Has earned a degree of doctor of pharmacy or has 222 completed 5 years of experience as a licensed pharmacist. 223 (c) Has completed an initial 20-hour course approved by the 224 Board of Medicine in consultation with the Board of Osteopathic 225 Medicine and the Board of Pharmacy which includes, at a minimum, 226 instruction on all of the following: 227 1. Performance of patient assessments. 228 2. Ordering, performing, and interpreting clinical and 229 laboratory tests related to collaborative pharmacy practice. 230 3. Evaluating and managing diseases and health conditions 231 in collaboration with other health care practitioners. 232 4. Any other area required by Board of Medicine rule, 233 adopted in consultation with the Board of Osteopathic Medicine 234 and the Board of Pharmacy. 235 (d) Maintains at least $250,000 of professional liability 236 insurance coverage. However, a pharmacist who maintains 237 professional liability insurance coverage of at least $250,000 238 under a written protocol with a supervising physician for the 239 testing for and treatment of minor nonchronic health conditions 240 satisfies this requirement. 241 (e) Has established a system to maintain records of all 242 patients receiving services under a collaborative pharmacy 243 practice agreement for a period of 5 years. 244 (3) The terms and conditions of the collaborative pharmacy 245 practice agreement must be appropriate to the pharmacist′s 246 education and training and the services delegated to the 247 pharmacist must be within the collaborating physician′s scope of 248 practice. A copy of the certification issued under subsection 249 (2) must be included as an attachment to the collaborative 250 pharmacy practice agreement. 251 (a) A collaborative pharmacy practice agreement must 252 include the following: 253 1. Name of the collaborating physician′s patient or 254 patients for whom a pharmacist may provide services. 255 2. Each chronic health condition to be collaboratively 256 managed. 257 3. Specific medicinal drug or drugs to be managed by the 258 pharmacist. 259 4. Circumstances under which the pharmacist may order or 260 perform and evaluate laboratory or clinical tests. 261 5. Conditions and events upon which the pharmacist must 262 notify the collaborating physician and the manner and timeframe 263 in which such notification must occur. 264 6. Beginning and ending dates for the collaborative 265 pharmacy practice agreement and termination procedures, 266 including procedures for patient notification and medical 267 records transfers. 268 7. A statement that the collaborative pharmacy practice 269 agreement may be terminated, in writing, by either party at any 270 time. 271 (b) A collaborative pharmacy practice agreement must be 272 renewed at least every 2 years. 273 (c) The pharmacist, along with the collaborating physician, 274 must maintain on file the collaborative pharmacy practice 275 agreement at his or her practice location and must make such 276 agreements available upon request or inspection. 277 (d) A pharmacist who enters into a collaborative pharmacy 278 practice agreement must submit a copy of the signed agreement to 279 the Board of Pharmacy before the agreement may be implemented. 280 (4) A pharmacist may not: 281 (a) Modify or discontinue medicinal drugs prescribed by a 282 health care practitioner with whom he or she does not have a 283 collaborative pharmacy practice agreement. 284 (b) Enter into a collaborative pharmacy practice agreement 285 while acting as an employee without the written approval of the 286 owner of the pharmacy. 287 (5) A physician may not delegate to a pharmacist the 288 authority to initiate or prescribe a controlled substance as 289 described in s. 893.03 or 21 U.S.C. s. 812. 290 (6) In addition to the continuing education requirements 291 under s. 465.009, a pharmacist who practices under a 292 collaborative pharmacy practice agreement must, for each 293 biennial licensure renewal, complete an 8-hour continuing 294 education course approved by the Board of Medicine in 295 consultation with the Board of Osteopathic Medicine and the 296 Board of Pharmacy which addresses issues related to the chronic 297 conditions to be collaboratively managed. Such pharmacist must 298 submit confirmation of having completed such course when 299 applying for licensure renewal. A pharmacist who fails to comply 300 with this subsection shall be prohibited from practicing under a 301 collaborative pharmacy practice agreement under this section. 302 (7) The Board of Medicine in consultation with the Board of 303 Osteopathic Medicine and the Board of Pharmacy shall adopt rules 304 pursuant to ss. 120.536(1) and 120.54 to implement this section. 305 Section 5. This act shall take effect July 1, 2020.