IMPROVING ACCESS TO PATIENT CARE.

View NCGA Bill Details2019-2020 Session
House Bill 659 (Public) Filed Tuesday, April 9, 2019
AN ACT TO IMPROVE ACCESS TO PATIENT CARE SERVICES VIA COLLABORATION BETWEEN PHYSICIANS AND PHARMACISTS.
Intro. by Sasser.

Status: Ref to the Com on Health, if favorable, Rules, Calendar, and Operations of the House (House action) (Apr 10 2019)
H 659

Bill Summaries:

  • Summary date: Apr 10 2019 - More information

    Amends GS 90-18 to revise the acts identified which constitute the practice of medicine or surgery, thereby triggering a requirement for licensure under Article 1. Makes the following changes to subdivision (c)(3a). Defines collaborative care services to mean patient care services authorized by a physician and delegated to a pharmacist for the purpose of drug therapy and disease management. Now requires the provision of patient care services by a licensed pharmacist under a collaborative practice agreement with one or more physicians to be performed in accordance with the rules developed by the NC Medical Board and the NC Board of Pharmacy and approved by both Boards. Authorizes a supervising physician to delegate to a licensed pharmacist, under a collaborative practice agreement, any patient care services that the supervising physician deems appropriate. Eliminates existing provisions of subdivision (c)(3a) that included the provision of drug therapy management, defined to include implementing drug therapy and ordering tests by a licensed pharmacist engaged in the practice of pharmacy pursuant to an agreement that is physician, pharmacist, patient and disease specific when performed in accordance with the Boards' rules and approved by the Boards).

    Makes conforming changes to GS 90-18.4 concerning clinical pharmacist practitioners. Modifies the conditions to which clinical pharmacist practitioners authorized by physicians to provide patient care in accordance with GS 90-18(c)(3a) and GS 90-18.4A are subject. Now requires the Boards to have adopted rules developed by a joint subcommittee governing the use and oversight of collaborative practice in patient care settings that the Boards have determined to be in the best interest of patient health and safety. Additionally requires clinical pharmacist practitioners to register with the Board of Pharmacy and maintain annual requirements as a clinical pharmacist practitioner (previously only required current approval from both Boards), and requires the clinical pharmacist practitioner's unique identification number to be shown on any prescriptions he or she writes (previously required the Medical Board to assign an ID number to be written on prescriptions written by him or her). Eliminates the condition which required the agreement to prohibit the substitution of chemically dissimilar drug products without explicit consent of the physician and to provide for periodic review by the physician of the drugs modified. Adds a new subsection to require the supervising physician to evaluate the provision of collaborative care services by the clinical pharmacist practitioner in accordance with rules adopted by the Boards. Requires the physician to conduct periodic review and evaluation of the clinical pharmacist practitioner as stated in their agreement. Authorizes the physician to collaborate with and supervise as many clinical pharmacist practitioners as the physician deems safe and effective. Repeals subdivisions (c)(1)-(4) regarding conditions for certain clinical pharmacist practitioners working in hospitals and other facilities to order medications and tests from the facility's prescription drug formulary or other lists of drugs to be utilized in the facility. Recodifies subdivision (c)(5) as subsection (c1) and modifies it to now provide as follows. Requires any drug therapy order medications, tests, or devices written by a clinical pharmacist practitioner to be deemed authorized by the collaborating physician. Requires orders written by a clinical pharmacist practitioner to be documented to inform the collaborating physician or advanced practice provider for the patient. Requires the supervising physician to conduct periodic review and evaluation of the clinical pharmacist practitioner's prescribing patterns. Adds new subsection (c2) to allow institutional and group practices to implement an institution-wide, multiprovider collaborative practice agreement for the care of their patients under a policy for oversight and evaluation of clinical pharmacist practitioners by an appointed supervising physician. Repeals subsection (d), which authorized any registered nurse or licensed practical nurse who receives a drug therapy order from a clinical pharmacist practitioner for medications or tests to perform that order in the same manner as if the order was received from a licensed physician.

    Amends GS 90-8.2 to allow rather than mandate the Medical Board to appoint and maintain a subcommittee to work with a subcommittee of the Pharmacy Board to develop rules to govern the performance of patient care services by clinical pharmacist practitioners. Authorizes the Pharmacy Board to determine reasonable fees to accompany the registry application not to exceed $50 and annual renewal of registration not to exceed $50 (previously required of the Medical Board with an initial application fee of $100 and renewal of $50). Requires rules recommended by the joint subcommittee to be made and adopted compliant with GS Chapter 150B (APA) by both Boards within six months of any approved statutory changes (was not effective until adopted by both Boards). Now places the responsibility to ensure compliance with collaborative practice rules with the Pharmacy Board rather than the Medical Board.

    Enacts GS 90-18.4A (substantively similar to GS 90-18.4(b)(4), as repealed) to permit a collaborative practice agreement to include a statement of authorization regarding the clinical pharmacist practitioner's authority to conduct drug substitutions within the same therapeutic class. Requires documentation of any substitutions and notification of the physician. Requires the agreement to include a policy for periodic review by the physician regarding therapeutic substitutions made. Allows physicians to add advanced practice providers to an agreement if supervised in a manner separate from the collaborative practice agreement, so long as evaluation and supervision of the clinical pharmacist practitioner remains with the supervising physician.

    Amends GS 90-85.3(b2), under the NC Pharmacy Act, Article 4A, to now define a clinical pharmacist practitioner as a licensed pharmacist who (1) provides collaborative care under a written collaborative practice agreement with one or more physicians, (2) has registered with the Pharmacy Board, (3) meets and maintains required annual professional development requirements, (4) maintains good standing with the Pharmacy Board, and (5) practices in accordance with GS 90-18.4, as amended, and rules established by the joint subcommittee of the Boards. Also defines collaborative care services as it is defined in GS 90-18(c)(3a), as amended.

    Enacts GS 90-85.11B to direct the Pharmacy Board to maintain a registry of all pharmacists engaged in collaborative practice and to issue and track numbers unique to each participating pharmacist. 

    Applies to licenses granted or renewed on or after October 1, 2019.


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