HOUSE BILL NO. 1852 103RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE HEWKIN.
5325H.01I JOSEPH ENGLER, Chief Clerk
AN ACT To repeal section 338.010, RSMo, and to enact in lieu thereof two new sections relating to the dispensing of insulin.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Section 338.010, RSMo, is repealed and two new sections enacted in lieu 2 thereof, to be known as sections 338.010 and 338.740, to read as follows: 338.010. 1. The "practice of pharmacy" includes: 2 (1) The interpretation, implementation, and evaluation of medical prescription orders, 3 including any legend drugs under 21 U.S.C. Section 353, and the receipt, transmission, or 4 handling of such orders or facilitating the dispensing of such orders; 5 (2) The designing, initiating, implementing, and monitoring of a medication 6 therapeutic plan in accordance with the provisions of this section; 7 (3) The compounding, dispensing, labeling, and administration of drugs and devices 8 pursuant to medical prescription orders; 9 (4) The ordering and administration of vaccines approved or authorized by the U.S. 10 Food and Drug Administration, excluding vaccines for cholera, monkeypox, Japanese 11 encephalitis, typhoid, rabies, yellow fever, tick-borne encephalitis, anthrax, tuberculosis, 12 dengue, Hib, polio, rotavirus, smallpox, and any vaccine approved after January 1, 2023, to 13 persons at least seven years of age or the age recommended by the Centers for Disease 14 Control and Prevention, whichever is older, pursuant to joint promulgation of rules 15 established by the board of pharmacy and the state board of registration for the healing arts 16 unless rules are established under a state of emergency as described in section 44.100;
EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language. HB 1852 2
17 (5) The participation in drug selection according to state law and participation in drug 18 utilization reviews; 19 (6) The proper and safe storage of drugs and devices and the maintenance of proper 20 records thereof; 21 (7) Consultation with patients and other health care practitioners, and veterinarians 22 and their clients about legend drugs, about the safe and effective use of drugs and devices; 23 (8) The prescribing and dispensing of any nicotine replacement therapy product under 24 section 338.665; 25 (9) The dispensing of HIV postexposure prophylaxis pursuant to section 338.730; 26 [and] 27 (10) The dispensing of an emergency supply of insulin under section 338.740; 28 and 29 (11) The offering or performing of those acts, services, operations, or transactions 30 necessary in the conduct, operation, management and control of a pharmacy. 31 2. No person shall engage in the practice of pharmacy unless he or she is licensed 32 under the provisions of this chapter. 33 3. This chapter shall not be construed to prohibit the use of auxiliary personnel under 34 the direct supervision of a pharmacist from assisting the pharmacist in any of his or her duties. 35 This assistance in no way is intended to relieve the pharmacist from his or her responsibilities 36 for compliance with this chapter and he or she will be responsible for the actions of the 37 auxiliary personnel acting in his or her assistance. 38 4. This chapter shall not be construed to prohibit or interfere with any legally 39 registered practitioner of medicine, dentistry, or podiatry, or veterinary medicine only for use 40 in animals, or the practice of optometry in accordance with and as provided in sections 41 195.070 and 336.220 in the compounding, administering, prescribing, or dispensing of his or 42 her own prescriptions. 43 5. A pharmacist with a certificate of medication therapeutic plan authority may 44 provide medication therapy services pursuant to a written protocol from a physician licensed 45 under chapter 334 to patients who have established a physician-patient relationship, as 46 described in subdivision (1) of subsection 1 of section 191.1146, with the protocol physician. 47 The written protocol authorized by this section shall come only from the physician and shall 48 not come from a nurse engaged in a collaborative practice arrangement under section 49 334.104, or from a physician assistant engaged in a collaborative practice arrangement under 50 section 334.735. 51 6. Nothing in this section shall be construed as to prevent any person, firm or 52 corporation from owning a pharmacy regulated by sections 338.210 to 338.315, provided that 53 a licensed pharmacist is in charge of such pharmacy. HB 1852 3
54 7. Nothing in this section shall be construed to apply to or interfere with the sale of 55 nonprescription drugs and the ordinary household remedies and such drugs or medicines as 56 are normally sold by those engaged in the sale of general merchandise. 57 8. No health carrier as defined in chapter 376 shall require any physician with which 58 they contract to enter into a written protocol with a pharmacist for medication therapeutic 59 services. 60 9. This section shall not be construed to allow a pharmacist to diagnose or 61 independently prescribe pharmaceuticals except to the extent described under section 62 338.740. 63 10. The state board of registration for the healing arts, under section 334.125, and the 64 state board of pharmacy, under section 338.140, shall jointly promulgate rules regulating the 65 use of protocols for medication therapy services. Such rules shall require protocols to include 66 provisions allowing for timely communication between the pharmacist and the protocol 67 physician or similar body authorized by this section, and any other patient protection 68 provisions deemed appropriate by both boards. In order to take effect, such rules shall be 69 approved by a majority vote of a quorum of each board. Neither board shall separately 70 promulgate rules regulating the use of protocols for medication therapy services. Any rule or 71 portion of a rule, as that term is defined in section 536.010, that is created under the authority 72 delegated in this section shall become effective only if it complies with and is subject to all of 73 the provisions of chapter 536 and, if applicable, section 536.028. This section and chapter 74 536 are nonseverable and if any of the powers vested with the general assembly pursuant to 75 chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are 76 subsequently held unconstitutional, then the grant of rulemaking authority and any rule 77 proposed or adopted after August 28, 2007, shall be invalid and void. 78 11. The state board of pharmacy may grant a certificate of medication therapeutic 79 plan authority to a licensed pharmacist who submits proof of successful completion of a 80 board-approved course of academic clinical study beyond a bachelor of science in pharmacy, 81 including but not limited to clinical assessment skills, from a nationally accredited college or 82 university, or a certification of equivalence issued by a nationally recognized professional 83 organization and approved by the board of pharmacy. 84 12. Any pharmacist who has received a certificate of medication therapeutic plan 85 authority may engage in the designing, initiating, implementing, and monitoring of a 86 medication therapeutic plan as defined by a written protocol from a physician that may be 87 specific to each patient for care by a pharmacist. 88 13. Nothing in this section shall be construed to allow a pharmacist to make a 89 therapeutic substitution of a pharmaceutical prescribed by a physician unless authorized by 90 the written protocol or the physician's prescription order. HB 1852 4
91 14. "Veterinarian", "doctor of veterinary medicine", "practitioner of veterinary 92 medicine", "DVM", "VMD", "BVSe", "BVMS", "BSe (Vet Science)", "VMB", "MRCVS", or 93 an equivalent title means a person who has received a doctor's degree in veterinary medicine 94 from an accredited school of veterinary medicine or holds an Educational Commission for 95 Foreign Veterinary Graduates (EDFVG) certificate issued by the American Veterinary 96 Medical Association (AVMA). 97 15. In addition to other requirements established by the joint promulgation of rules by 98 the board of pharmacy and the state board of registration for the healing arts: 99 (1) A pharmacist shall administer vaccines by protocol in accordance with treatment 100 guidelines established by the Centers for Disease Control and Prevention (CDC); 101 (2) A pharmacist who is administering a vaccine shall request a patient to remain in 102 the pharmacy a safe amount of time after administering the vaccine to observe any adverse 103 reactions. Such pharmacist shall have adopted emergency treatment protocols. 104 16. In addition to other requirements by the board, a pharmacist shall receive 105 additional training as required by the board and evidenced by receiving a certificate from the 106 board upon completion, and shall display the certification in his or her pharmacy where 107 vaccines are delivered. 108 17. A pharmacist shall inform the patient that the administration of a vaccine will be 109 entered into the ShowMeVax system, as administered by the department of health and senior 110 services. The patient shall attest to the inclusion of such information in the system by signing 111 a form provided by the pharmacist. If the patient indicates that he or she does not want such 112 information entered into the ShowMeVax system, the pharmacist shall provide a written 113 report within fourteen days of administration of a vaccine to the patient's health care provider, 114 if provided by the patient, containing: 115 (1) The identity of the patient; 116 (2) The identity of the vaccine or vaccines administered; 117 (3) The route of administration; 118 (4) The anatomic site of the administration; 119 (5) The dose administered; and 120 (6) The date of administration. 121 18. A pharmacist licensed under this chapter may order and administer vaccines 122 approved or authorized by the U.S. Food and Drug Administration to address a public health 123 need, as lawfully authorized by the state or federal government, or a department or agency 124 thereof, during a state or federally declared public health emergency. 338.740. 1. Notwithstanding any other provision of law, a pharmacist may 2 dispense an emergency supply of insulin to a patient without a current, valid 3 prescription if: HB 1852 5
4 (1) The pharmacist makes every reasonable attempt but is unable to obtain 5 authorization to refill the prescription from the prescribing health care provider or 6 another health care provider responsible for the patient's care; 7 (2) Either: 8 (a) The pharmacist has a record of a prescription at the pharmacy or has been 9 presented proof of a recent prescription for the insulin in the name of the patient who is 10 requesting the emergency supply; or 11 (b) In the pharmacist's professional judgment, the refusal to dispense an 12 emergency supply of the insulin will endanger the patient's health or disrupt essential 13 drug therapy for a chronic condition of the patient; 14 (3) The amount of insulin dispensed does not exceed the amount of the most 15 recent prescription or the standard quantity or unit-of-use package of the drug; and 16 (4) The prescriber of the drug has not indicated that no emergency refills are 17 authorized. 18 2. A pharmacist, the pharmacist's employer, and the original prescriber of the 19 drug are not civilly liable for an act or omission in connection with the dispensing of 20 insulin under this section unless the act or omission constitutes negligence, recklessness, 21 or willful or wanton misconduct. 22 3. The board of pharmacy shall adopt rules, in consultation with the state board 23 of registration for the healing arts and the state board of nursing, to establish standard 24 procedures for pharmacists to follow in dispensing insulin under this section. The rules 25 adopted shall include documentation requirements for a pharmacist to complete when 26 dispensing insulin without a current prescription. Any rule or portion of a rule, as that 27 term is defined in section 536.010, that is created under the authority delegated in this 28 section shall become effective only if it complies with and is subject to all of the 29 provisions of chapter 536 and, if applicable, section 536.028. This section and chapter 30 536 are nonseverable and if any of the powers vested with the general assembly 31 pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul 32 a rule are subsequently held unconstitutional, then the grant of rulemaking authority 33 and any rule proposed or adopted after August 28, 2026, shall be invalid and void. ✔
Statutes affected: