2023 Provider Status End-of-Year Legislative Update

180 bills pertaining to pharmacist scope of practice, payment for pharmacist-provided patient care services, and/or the designation of pharmacists as providers were introduced in 43 states in the 2023 state legislative sessions. Several of the bills focused on addressing public health concerns, including immunization authority, contraceptive prescribing authority, and HIV PrEP and PEP prescribing authority.

As of December 31, 55 bills in 32 states have passed their respective legislatures and been signed into law. Below are highlights of laws that have been enacted.

Vaccine Authority

  • California AB 1286: authorizes a pharmacy technician, under the direct supervision and control of a pharmacist, to prepare and administer influenza and COVID-19 vaccines via injection or intranasally under prescribed conditions
  • Connecticut SB 1102: authorizes pharmacists to administer any vaccine on the CDC adult immunization schedule, or any vaccine not on the schedule provided administration instructions are available on the CDC website, to individuals 18 years and older or 12-17 years old with parent/guardian/legal custodian’s permission or proof of emancipation; or any vaccine pursuant to a verbal or written prescription by a prescribing practitioner for a specific patient; authorizes pharmacy technicians to administer a vaccine to a patient if the managing pharmacist is authorized to administer the vaccine
  • Delaware SB 165: authorizes pharmacists, pharmacy interns, and nationally certified pharmacy technicians to administer vaccines via prescriber order or protocol for patients ages 3 and older
  • Georgia HB 416: authorizes pharmacy technicians to administer vaccines delegated by the supervising pharmacist to patients 18 years of age and older, provided such authorization is included in the vaccine protocol agreement
  • Illinois HB 559: authorizes pharmacists to vaccinate patients 7 and older for COVID-19 or influenza subcutaneously, intramuscularly, or orally under certain conditions; authorizes pharmacy technicians to administer COVID-19 or influenza vaccines under a supervising pharmacist
  • Kansas SB 131: authorizes pharmacy technicians, under pharmacist supervision, to administer influenza vaccines to individuals 6 and older and all other vaccines to individuals 12 and older, pursuant to a vaccination protocol
  • Maryland HB 693: authorizes registered pharmacy technicians to administer COVID-19, influenza, and pneumonia vaccines to individuals 18 and older and RSV and shingles vaccines to individuals 50 and older
  • Maine LD 899: authorizes pharmacy technicians to administer vaccines and reduces training requirements for pharmacists to administer vaccines
  • Maine LD 1151: authorizes pharmacists to administer vaccines licensed by FDA and recommended by CDC ACIP to individuals 18 or older and to individuals ages 3-17 with a valid prescription; also authorizes pharmacists to administer all forms of influenza vaccine to individuals ages 3 and older without a prescription
  • Michigan SB 219: authorizes pharmacists to order and administer vaccines recommended by CDC ACIP to individuals ages 3 and older
  • Montana HB 710: authorizes pharmacists to delegate vaccine administration to pharmacy technicians under a technician utilization plan and pharmacist supervision
  • New Hampshire SB 35: authorizes pharmacists, pharmacy interns, and licensed advanced pharmacy technicians to administer RSV vaccines to individuals 18 or older
  • Nebraska LB 207: authorized certified pharmacy technicians to administer vaccines to individuals 3 years of age or older.
  • Oregon HB 2278: authorizes pharmacists to administer influenza vaccine to individuals six months of age or older
  • Oregon HB 2486: authorizes pharmacy technicians to administer vaccines under the supervision of a pharmacist
  • West Virginia HB 2754: authorizes pharmacists, pharmacy interns, and pharmacy technicians to administer vaccines including but not limited to those on the CDC immunization schedules for adults, children, and adolescents to individuals ages 3 and older

Point-of-Care Testing and Treatment Authority

  • California AB 1286: authorizes a pharmacy technician, under the direct supervision and control of a pharmacist, to perform specimen collection for specified tests under prescribed conditions
  • California AB 1341: authorizes pharmacists, until January 1, 2025, to furnish COVID-19 oral therapeutics following a positive test for SARS-CoV-2
  • Colorado SB 23-162: authorizes pharmacy technicians to perform point-of-care testing as delegated by a supervising pharmacist
  • Connecticut SB 1102: authorizes pharmacists to order and administer COVID-19, influenza, and HIV-related tests for individuals 18 years and older or 12-17 years old with parent/guardian/legal custodian’s permission or proof of emancipation
  • Hawaii HB 602: authorizes pharmacists to order, perform, and report the results of CLIA-waived tests for blood glucose, hemoglobin A1c, hepatitis C, HIV, influenza, RSV, SAR-COV-2, or streptococcal pharyngitis
  • Illinois HB 559: authorizes pharmacists to order and administer tests and screenings for influenza, SARS-CoV-2, and health conditions identified by a statewide public health emergency; also authorizes pharmacists to order and administer COVID-19 therapeutics subcutaneously, intramuscularly, or orally; authorizes pharmacist to delegate performing the test or the administration of a COVID-19 therapeutic to a pharmacy technician
  • Michigan SB 219: authorizes pharmacists to order and administer CLIA-waived tests for COVID-19, influenza, or other respiratory infections; also authorizes pharmacists to dispense an appropriate antiviral based on the results of an administered COVID-19 or influenza test without a prescription
  • North Carolina SB 206: authorizes pharmacists to administer all ACIP-recommended vaccines under written protocol to individuals 18 and older and COVID-19 and influenza vaccines to individuals ages 7-17 with written consent of a parent or legal guardian; also authorizes pharmacy technicians to administer vaccines under supervision of an immunizing pharmacist
  • New Mexico SB 92: authorizes pharmacists, pursuant to a board-approved protocol, to order, test, screen, treat, and provide preventive services for influenza, group A streptococcus pharyngitis, SARS-COV-2, uncomplicated UTI, HIV PrEP and PEP, and other emerging and existing public health threats identified during civil or public health emergencies; also authorizes pharmacists to delegate performing CLIA-waived tests to pharmacy technicians
  • Virginia HB 2274/SB 948: authorizes pharmacists, via statewide protocol, to initiate treatment for group A streptococcus bacteria infection, influenza virus infection, COVID-19 virus infection, and urinary tract infection

HIV PrEP/PEP Prescribing Authority

  • Arkansas HB 1007: authorizes pharmacists, under statewide protocol, to initiate therapy and administer or dispense, or both, HIV PrEP and PEP
  • Connecticut SB 1102: authorizes pharmacists to order and administer HIV-related tests for individuals 18 years and older or 12-17 years old with parent/guardian/legal custodian’s permission or proof of emancipation; and, if administered test is negative, to prescribe and dispense any HIV-related prophylaxis
  • Illinois SB 1344: authorizes pharmacists to provide patients with HIV PrEP or PEP via standing order by the state Department of Public Health
  • Rhode Island SB 563: authorizes pharmacists to order laboratory testing for HIV infection as necessary, and to prescribe, dispense, and administer HIV PrEP and PEP drugs pursuant to a standing order, collaborative practice agreement, or to protocols developed by the board

Contraceptive Prescribing Authority

  • Connecticut HB 6768: authorizes pharmacists to prescribe, in good faith, an emergency contraceptive or hormonal contraceptive to a patient subject to certain conditions
  • Indiana HB 1568: authorizes pharmacists to prescribe and dispense hormonal contraceptive patches and self-administered hormonal contraceptives to a woman who is at least 18 years of age, regardless of whether the woman has evidence of a previous prescription; requires the state health commissioner or designated public health authority to issue a standing order concerning standard procedures for this prescribing authority until the board adopts rules
  • Maine LD 351: authorizes pharmacists to prescribe, dispense or administer a self-administered hormonal contraceptive or injectable hormonal contraceptive in accordance with the specified requirements
  • New York A 1060: authorizes pharmacists to dispense self-administered hormonal contraceptives based on a non-patient-specific order from a physician or certified nurse practitioner
  • Rhode Island SB 103: authorizes pharmacists to prescribe and dispense short-term, FDA-approved hormonal contraceptives
  • Vermont S 37: authorizes pharmacists to prescribe emergency contraception

Opioid Antagonist and OUD Authority

  • California AB 1341: authorizes pharmacists, when acting under the direction of a physician and surgeon, to administer a narcotic controlled substance in the treatment of a person with substance use disorder for addiction to a controlled substance, regardless of dosage form (previously limited to oral administration)
  • Maine LD 1728: expands pharmacist authority to prescribe and dispense naloxone to include other opioid overdose-reversing medications
  • Nevada AB 256: authorizes pharmacists to prescribe and dispense drugs for medication-assisted treatment of opioid use disorder and perform certain assessments under certain conditions
  • Oklahoma HB 2424: expands pharmacist authority to prescribe and dispense naloxone to prescribing and dispensing any FDA-approved opioid antagonist
  • Oregon HB 2395: expands pharmacist authority to distribute and administer naloxone to distributing and administering short-acting opioid antagonists

Collaborative Practice Authority

  • Delaware SB 165: authorizes one or more pharmacists to enter into collaborative pharmacy practice agreements with one or more practitioners to provide patient care and drug therapy management services not otherwise permitted to be performed

Broad Prescribing Authority

  • Montana SB 112: authorizes pharmacists to prescribe a drug or device for a legitimate medical purpose for a person with whom the pharmacist has a patient-prescriber relationship; a pharmacist may prescribe for conditions that do not require a new diagnosis, are minor and generally self-limiting, are diagnosed by or for which clinical decisions are made using CLIA-waived tests, or are patient emergencies

Additional Authorities to Address Public Health Issues

  • Alaska HB 112: authorizes pharmacists to prescribe epinephrine auto-injectors and administer epinephrine to a patient
  • California AB 1286: authorizes a pharmacy technician, under the direct supervision and control of a pharmacist, to prepare and administer epinephrine, receive prescription transfers, and accept clarification on prescriptions under prescribed conditions
  • Colorado SB 23-162: authorizes pharmacy technicians to perform patient care technical tasks as specifically trained for and delegated by a supervising pharmacist, as well as other activities authorized and defined by the board of pharmacy by rule

Provider Designation and Payment for Services

  • California AB 317: requires a health care services plan and certain disability insurers that offer coverage for a service that is within a pharmacist’s scope of practice to pay or reimburse the cost of services provided by a pharmacist at an in-network pharmacy or by a pharmacist at an out-of-network pharmacy if the health care service plan or insurer has an out-of-network pharmacy benefit
  • Colorado SB 23-162: allows reimbursement under the state medical assistance program for pharmacists or pharmacies that dispense or administer vaccines to children under 19 years of age pursuant to the CDC childhood immunization schedule; authorizes reimbursement under either pharmacy or medical benefit, provided the pharmacist or pharmacy is enrolled in good standing with the Vaccines for Children program
  • Illinois HB 559: requires a group or individual policy of accident or health insurance or managed care plan, after January 1, 2025, to provide coverage for health care or patient care services provided by a pharmacist if the service is within the pharmacist’s scope of practice, the health plan provides coverage for the same service by a licensed physician, APRN, or PA, the pharmacist is in the plan’s network of participating providers, and reimbursement has been successfully negotiated in good faith between the pharmacist and the plan
  • Indiana HB 1568: requires the state to submit an application to HHS to amend the state plan to reimburse a pharmacist for eligible services and prescriptions provided to an eligible Medicaid recipient
  • Maryland HB 1151/SB 678: requires the Maryland Medical Assistance Program, Maryland Children’s Health Program, and certain insurers, nonprofit health service plans, and health maintenance organizations to provide coverage for all services rendered by a licensed pharmacist within their scope of practice, to the same extent as services rendered by any other health care practitioner, and provides that reimbursement may not be conditioned on whether the pharmacist is employed by a physician, pharmacy, or facility, or acting under a physician’s orders
  • North Dakota HB 1095: defines comprehensive medication management and requires health carriers to provide coverage for licensed pharmacists to provide comprehensive medication management to eligible enrollees who elect to participate
  • Nevada AB 256: requires public and private health plans, Medicaid and Medicaid managed care organizations, and health plans for state and local government employees to cover FDA-approved drugs for medicated-assisted treatment and to reimburse assessment, prescribing, and dispensing by a pharmacist at a rate equal to that provided by a physician, PA, or APRN for similar services
  • Virginia SB 1538: requires reimbursement by Medicaid and Medicaid managed care organizations for services by a pharmacist, pharmacy technician, or pharmacy intern performed under the terms of a collaborative agreement or independently per scope of practice when consistent with the terms of a managed care contractor provider contract or the state plan