PHARMACIES; OUT-OF-STATE PRESCRIBERS                                                    S.B. 166:

                                                                                 SUMMARY OF INTRODUCED BILL

                                                                                                         IN COMMITTEE

 

 

 

 

 

 

 

 

 

Senate Bill 166 (as introduced 2-24-21)

Sponsor:  Senator Curtis S. VanderWall

Committee:  Health Policy and Human Services

 

Date Completed:  3-4-21

 


CONTENT

 

The bill would amend Article 15 (Occupations) of the Public Health Code to do the following:

 

 --   Allow a pharmacist to dispense a drug or device pursuant to a prescription transmitted by a prescriber in another state or Canada, if the pharmacist determined certain conditions were met.

 --   Allow a pharmacist to dispense a drug or device pursuant to a prescription transmitted by an advanced practice registered nurse prescriber or physician's assistant prescriber in another state or Canada without determining whether the advanced practice registered nurse prescriber or physician's assistant prescriber was authorized under the laws of the other state or Canada to issue the prescription under certain circumstances.

 --   Modify various definitions.

 

Definitions

 

Under Section 16106 of the Code, "license", except as otherwise provided, means an authorization issued under Article 15 to practice where practice would otherwise be unlawful. License includes an authorization to use a designated title which use would otherwise be prohibited under Article 15 and may be used to refer to a health profession subfield license, limited license, or a temporary license. 

 

For purposes of the definition of "prescriber" contained in Section 17708 only, license includes an authorization issued under the laws of another state, or the country of Canada to practice in that state or in the country of Canada, where practice would otherwise be unlawful, and is limited to a licensed doctor of medicine, a licensed doctor of osteopathic medicine and surgery, or another licensed health professional acting under the delegation and using, recording, or otherwise indicating the name of the delegating licensed doctor of medicine or licensed doctor of osteopathic medicine and surgery. The bill would delete this provision.

 

Section 17708 defines "prescriber" as a licensed dentist; a licensed doctor of medicine; a licensed doctor of osteopathic medicine and surgery; a licensed doctor of podiatric medicine and surgery; a licensed physician's assistant; subject to Part 174 (Optometry), a licensed optometrist; subject to Section 17211a, an advanced practice registered nurse; a licensed veterinarian; or another licensed health professional acting under the delegation and using, recording, or otherwise indicating the name of the delegating licensed doctor of medicine or licensed doctor of osteopathic medicine and surgery.

 

Under the bill, as used in the definition of "prescriber", "advanced practice registered nurse" would mean that term as defined in Section 17201 (a registered professional nurse who has been granted a specialty certification under Section 17210 in one of the following health profession specialty fields: a) nurse midwifery, b) nurse practitioner, or c) clinical nurse specialist) and would include a licensed advanced practice registered nurse. "License" would mean that term as defined in Section 16106 (except as otherwise provided, an authorization issued under Article 15 to practice where practice would otherwise be unlawful. License includes an authorization to use a designated title which use would otherwise be prohibited under the article and may be used to refer to a health profession subfield license, limited license, or a temporary license) and includes an authorization issued under the laws of another state or Canada to practice a profession in Section 17708 in that state or Canada where practice would otherwise be unlawful.

 

Under Section 17708, "prescription" means an order by a prescriber to fill, compound, or dispense a drug or device written and signed; written or created in an electronic format, signed, and transmitted by facsimile; or transmitted electronically or by other means of communication. An order transmitted in other than written or hard-copy form must be electronically recorded, printed, or written and immediately dated by the pharmacist, and that record is considered the original prescription. In a health facility or agency licensed under Article 17 or other medical institution, an order for a drug or device in the patient's chart is considered for the purposes of this definition the original prescription. For purposes of Part 177 (Pharmacy Practice and Drug Control), prescription also includes a standing order issued under Section 17744e.

 

Subject to Section 17751, prescription includes an order for a drug, not including a controlled substance except under circumstances described in Section 17763(e), written and signed; written or created in an electronic format, signed, and transmitted by facsimile; or transmitted electronically or by other means of communication by a physician prescriber, dentist prescriber, or veterinarian prescriber who is licensed to practice dentistry, medicine, osteopathic medicine and surgery, or veterinary medicine in another state. The bill would delete reference to "a physician prescriber, dentist prescriber, or veterinarian prescriber who is licensed to practice dentistry, medicine, osteopathic medicine and surgery, or veterinary medicine in another state" and, instead, refer to "a prescriber in another state or Canada".

 

Out-of-State Prescribers

 

The Code prohibits a pharmacist from dispensing a drug requiring a prescription under the Federal Food, Drug, and Cosmetic Act or State law except under authority of an original prescription or an equivalent record of an original prescription approved by the board. A pharmacist may dispense a drug pursuant to an original prescription received at a remote pharmacy if the pharmacist receives, reviews, and verifies an exact digital image of the prescription received at the remote pharmacy before the drug is dispensed at the remote pharmacy.

 

The Code allows a pharmacist to dispense a prescription written and signed; written or created in an electronic format, signed, and transmitted by facsimile; or transmitted electronically or by other means of communication by a physician prescriber, dentist prescriber, or veterinarian prescriber in another state, but not including a prescription for a controlled substance except under circumstances described in Section 17763(e), only if the pharmacist in the exercise of his or her professional judgment determines all of the following:

 

 --    Except as otherwise authorized, if the prescriber is a physician or dentist, that the prescription was issued pursuant to an existing physician-patient or dentist-patient relationship.


 --    That the prescription is authentic.

 --    That the prescribed drug is appropriate and necessary for the treatment of an acute, chronic, or recurrent condition.

 

(Section 17763(e) generally specifies that it is grounds for disciplinary action for a pharmacist licensee to dispense a prescription for a controlled substance unless the prescription is issued by a physician prescriber, dentist prescriber, or veterinarian prescriber in another state, unless the prescription is issued by a physician prescriber, dentist prescriber, or veterinarian prescriber who is authorized under the laws of that state to practice dentistry, medicine, osteopathic medicine and surgery, or veterinary medicine and to prescribe controlled substances.)

 

Instead, under the bill, a pharmacist could dispense a drug or device pursuant to a prescription written and signed; written or created in an electronic format, signed, and transmitted by facsimile; or transmitted electronically or by other means of communication by a prescriber in another state or Canada, but not including a prescription for a controlled substance except under circumstances described in Section 17763(e). Before dispensing a drug or device pursuant to a prescription, the pharmacist, in the exercise of his or her professional judgment, would have to determine all of the following:

 

 --    Except as otherwise authorized, if the prescriber were not a veterinarian, the prescription was issued pursuant to an existing prescriber-patient relationship.

 --    That the prescription was authentic.

 --    That the prescribed drug was appropriate and necessary for the treatment of an acute, chronic, or recurrent condition.

 

The Code requires a pharmacist or a prescriber to dispense a prescription only if the prescription falls within the scope of practice of the prescriber. A pharmacist may not knowingly dispense a prescription after the death of the prescriber or patient. The bill would refer to a drug or device pursuant to a prescription.

 

Additionally, under the bill, notwithstanding any provision of Section 17751, a pharmacist who received a prescription from an advanced practice registered nurse prescriber or physician's assistant prescriber in another state or Canada could dispense the drug or device without determining whether the advanced practice registered nurse prescriber or physician's assistant prescriber was authorized under the laws of the other state or Canada to issue the prescription.

 

MCL 333.16106 et al.                                              Legislative Analyst:  Stephen Jackson

 

FISCAL IMPACT

 

The bill would have no fiscal impact on State or local units of government.

 

                                                                           Fiscal Analyst:  Elizabeth Raczkowski

 

This analysis was prepared by nonpartisan Senate staff for use by the Senate in its deliberations and does not constitute an official statement of legislative intent.