2022 Provider Status End-of-Year Legislative Update
178 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 38 states in the 2022 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 22, 44 bills in 26 states have passed their respective legislatures and been signed into law, and 8 bills in 6 states are awaiting a governor’s signature. Below are highlights of laws that have been enacted.
Vaccine Authority
- Authorizes pharmacists to independently prescribe and administer a vaccine and related emergency medication and an opioid overdose drug after approved training requirements are met.
- Authorizes pharmacy technicians to administer vaccines or related emergency medication under immediate supervision of a pharmacist.
- Authorizes pharmacists to order and administer ACIP recommended vaccines to a person who is at least 6 years of age; for international travel to a person who is at least 18 years of age; and for influenza to a person who is at least 3 years of age.
- Authorizes pharmacists to order and administer emergency medication to manage an acute allergic reaction to an immunization, vaccine or medication in accordance with ACIP guidelines.
- Updates reporting requirements of immunizations for pharmacists.
- Authorizes pharmacists to administer the influenza vaccine to any person between the ages of 12-17, with the consent of a parent or guardian.
- Authorizes registered pharmacy technicians to administer vaccines under supervision of a certified pharmacist and after board certified immunization-related training/continuing education.
- Revises reference for immunizations or vaccines that certified pharmacists, interns, and registered pharmacy technicians may administer.
- Authorizes registered nurses to practice under the order of a pharmacist to assist in the administration of vaccines and immunizations and the utilization of statewide protocols without obtaining registration from the board
- Updates eligible vaccines and coverage/reimbursement for pharmacists.
- Authorizes a qualified pharmacy technician to administer immunizations (beyond influenza and COVID-19) that are delegated by the pharmacist.
- Authorizes pharmacists to administer injectable medications, biologicals and immunizations to persons who are more than eighteen years of age and influenza and COVID-19 immunizations by injectable or needle-free delivery methods to persons five years of age and older.
- Authorizes a pharmacy technician to perform tasks delegated by the pharmacist, including participation in drug, dietary supplement and device selection, storage, distribution, and administration, if the delegated tasks are consistent with the pharmacy technician’s education, training, and experience.
- Authorizes pharmacists and pharmacy technicians under supervision of a pharmacist to initiate treatment with and dispense/administer vaccines for COVID-19, nicotine replacement and other tobacco cessation therapies, and tests for COVID-19.
- Authorizes pharmacists and pharmacy technicians under supervision of a pharmacist to initiate treatment with and dispense/administer certain drugs, devices and tests in accordance with a statewide protocol.
- Allows the Commissioner of Health to authorize persons who are not authorized by law to administer or dispense drugs or devices to do so in accordance with established protocols when the board has made an emergency order for the limited purpose of administering vaccines.
- Authorizes pharmacy technicians and pharmacy interns to administer immunizations to individuals 13 and older and repeals the requirements for direct supervision (supervision is still required) of a pharmacy technician or intern by a licensed pharmacist.
Collaborative Practice Authority
- Expands pharmacist practice authority under collaborative practice agreements
- Updates definitions of “practice of pharmacy”, “prescription order”, and “collaborative practice agreement”
- Authorizes pharmacists to enter into a CPA with a provider to initiate, monitor, and modify drug therapy or provide disease management assistance under specific requirements
- Defines collaborative drug therapy care plan, collaborative drug therapy management agreement, and management policy
- Expands authority for pharmacists to initiate therapy for drug therapy and initiate, continue or discontinue use of, or deprescribe, a device under an agreement or policy
- Allows agreements and policies to cover patient populations in addition to individual patients
- Revises definitions for “collaborative pharmacy practice” and “practice of pharmacy”
- Revises definition of collaborative pharmacy practice agreement.
- Authorizes pharmacist to perform collaborative drug therapy management with physicians in certain settings.
- Revises definition for collaborative pharmacy practice agreements and the requirements/prohibitions related to them.
Point-of-Care Testing and Treatment Authority
- Authorizes pharmacists to independently provide patient care services related to a condition that has a CLIA-waived test that is used to guide diagnosis or clinical decision-making
- Defines patient care services as “medical care services given in exchange for compensation intended to achieve outcomes related to the cure or prevention of a disease, elimination or reduction of a patient’s symptoms, or arresting or slowing of a disease process”
- Authorizes pharmacists to order, test, screen, and treat influenza, group A streptococcal pharyngitis, COVID and other respiratory illnesses, lice, skin conditions (including ringworm and athlete’s foot), and for other emerging and existing public health threats if permitted by the Division of Public Health, pursuant to a statewide protocol.
- Authorizes pharmacists to initiate therapy within the framework of new statewide protocols for the following health conditions: influenza, streptococcal pharyngitis, or urinary tract infection.
- Authorizes pharmacists to direct limited service labs and order/administer COVID-19 and influenza tests.
Contraceptive Prescribing Authority
- Authorizes the issuance of a statewide standing order to authorize the dispensing of emergency contraception by a licensed pharmacist
- Authorizes pharmacies to administer and dispense certain hormonal contraception to patients pursuant to a standing order and in accordance with a written joint protocol issued by the board.
Opioid Antagonist and OUD Authority
- Expands the language in existing law authorizing pharmacists to furnish naloxone to include any opioid antagonist approved by the FDA
- Expands the language in existing law authorizing pharmacists to dispense naloxone pursuant to a standing order to include any opioid antagonist approved by the FDA
- Authorizes pharmacists to order and dispense an emergency opioid antagonist pursuant to a pharmacist’s order or to a nonpatient-specific standing order.
- Added “addiction mitigation medication” terminology to sections relating to opioid addiction treatment.
Additional Authorities to Address Public Health Issues
- Authorizes pharmacists to independently provide patient care services for general health and wellness, disease prevention, or conditions meeting certain criteria
- Revises definitions for “collaborative pharmacy practice” and “practice of pharmacy”
- Authorizes pharmacists to provide patient care services for HIV PrEP/PEP to a patient after satisfying specified requirements.
- Authorizes pharmacists to administer a maintenance injectable medication or an injectable medication for treatment of a sexually transmitted infection that is not a biological product to a patient, if not the initial dose.
- Authorizes pharmacists to prescribe and dispense nicotine replacement therapy medications for the purpose of aiding in tobacco cessation of smoking cessation.
- Changed the Emergency Administration of Opiate Antagonist Act to Emergency Administration of Medical Treatment Act, so it could include epinephrine auto injector for treatment of anaphylaxis.
Provider Designation and Payment for Services
- Adds pharmacists to the list of providers in the insurance statutes.
- Updates coverage/reimbursement for pharmacists related to eligible vaccines.
- Revised the definition of “health care provider” to include pharmacists.
- Requires payment/coverage for the administration of a maintenance injectable medication or an injectable medication for treatment of a sexually transmitted infection by the pharmacist.