1 STATE OF OKLAHOMA
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2 1st Session of the 59th Legislature (2023)
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3 SENATE BILL 458 By: Stanley
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6 AS INTRODUCED
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7 An Act relating to the practice of nursing; providing
7 for independent prescriptive authority of Advanced
8 Practice Registered Nurses who meet certain
8 requirements; stating application criteria;
9 specifying duration of authority; authorizing
9 supervision by Advanced Practice Registered Nurse
10 with independent prescriptive authority who meets
10 certain requirements; authorizing Oklahoma Board of
11 Nursing to prescribe additional qualifications;
11 providing for application approval, denial,
12 reapplication, fees, and independent prescriptive
12 authority revocation; amending 59 O.S. 2021, Section
13 353.1, as amended by Section 6, Chapter 288, O.S.L.
13 2022 (59 O.S. Supp. 2022, Section 353.1), which
14 relates to definitions used in the Oklahoma Pharmacy
14 Act; modifying and adding definitions; amending 59
15 O.S. 2021, Section 353.1a, which relates to
15 prescriptive authority of Advanced Practice
16 Registered Nurses; modifying prescriptive authority
16 of certain Advanced Practice Registered Nurses;
17 amending 59 O.S. 2021, Section 567.3a, which relates
17 to definitions used in the Oklahoma Nursing Practice
18 Act; modifying and adding definitions; amending 59
18 O.S. 2021, Section 567.4a, which relates to
19 prescriptive authority; directing the Board to
19 promulgate certain rules; amending 59 O.S. 2021,
20 Section 567.5a, which relates to Advanced Practice
20 Registered Nurse license; providing for independent
21 prescriptive authority by endorsement; amending 63
21 O.S. 2021, Section 2-312, as amended by Section 2,
22 Chapter 184, O.S.L. 2022 (63 O.S. Supp. 2022, Section
22 2-312), which relates to controlled dangerous
23 substances; authorizing Certified Nurse Practitioner
23 or Clinical Nurse Specialist to prescribe and
24 administer certain controlled dangerous substances;
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 1 providing for codification; and providing an
1 effective date.
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4 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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5 SECTION 1. NEW LAW A new section of law to be codified
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6 in the Oklahoma Statutes as Section 567.4c of Title 59, unless there
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7 is created a duplication in numbering, reads as follows:
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8 A. 1. An Advanced Practice Registered Nurse recognized by the
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9 Oklahoma Board of Nursing as a Certified Nurse Practitioner or
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10 Clinical Nurse Specialist who has completed a minimum of two
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11 thousand (2,000) hours of practice with prescriptive authority
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12 supervised by a physician or a supervising Advanced Practice
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13 Registered Nurse may apply to the Oklahoma Board of Nursing for
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14 authority to prescribe and order independent of supervision.
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15 2. The application for independent prescriptive authority shall
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16 include proof that the Certified Nurse Practitioner or Clinical
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17 Nurse Specialist:
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18 a. has satisfied the educational requirements stated in
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19 Section 567.5a of Title 59 of the Oklahoma Statutes,
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20 b. has successfully passed a national certification
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21 examination recognized by the Board that measures the
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22 Advanced Practice Registered Nurse role and specialty
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23 competencies,
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 1 c. holds a valid, current license in the appropriate
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2 Advanced Practice Registered Nurse role issued by the
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3 Board and is in good standing with the Board, and
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4 d. has completed a minimum of two thousand (2,000) hours
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5 of practice with prescriptive authority supervised by
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6 a physician or supervising Advanced Practice
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7 Registered Nurse.
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8 3. Independent prescriptive authority granted under this
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9 subsection shall be valid until the expiration of the current
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10 license to practice and may be renewed upon application to the Board
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11 at the same time and for the same period as the renewal of the
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12 license to practice.
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13 B. 1. A Certified Nurse Practitioner or Clinical Nurse
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14 Specialist who has obtained independent prescriptive authority under
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15 subsection A of this section and who has completed a minimum of
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16 eight thousand (8,000) hours of practice with independent
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17 prescriptive authority may serve as a supervising Advanced Practice
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18 Registered Nurse.
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19 2. Notwithstanding paragraph 1 of this subsection, an Advanced
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20 Practice Registered Nurse who has been licensed and in practice for
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21 a minimum of five (5) years as of the effective date of this act
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22 without a lapse of work, upon obtainment of independent prescriptive
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23 authority under subsection A of this section, may serve as a
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24 supervising Advanced Practice Registered Nurse.
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 1 3. The Board may at its discretion prescribe by rule additional
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2 qualifications for supervising Advanced Practice Registered Nurses
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3 including, but not limited to, qualifications pertaining to the
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4 Advanced Practice Registered Nurse role or specialty.
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5 C. The Board shall review any application submitted under this
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6 section and shall approve or deny the application, stating the
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7 reason or reasons for denial, if denied. The Board shall mail the
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8 approval or denial letter to the applicant within fourteen (14)
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9 calendar days of receipt of the application. If denied, the
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10 applicant may reapply using the process prescribed by subsection A
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11 of this section.
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12 D. The Board may suspend or revoke independent prescriptive
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13 authority granted under this section for good cause at any time.
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14 E. The Board may establish a fee for the review of initial and
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15 renewal applications under the provisions of this section.
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16 SECTION 2. AMENDATORY 59 O.S. 2021, Section 353.1, as
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17 amended by Section 6, Chapter 288, O.S.L. 2022 (59 O.S. Supp. 2022,
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18 Section 353.1), is amended to read as follows:
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19 Section 353.1. For the purposes of the Oklahoma Pharmacy Act:
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20 1. “Accredited program” means those seminars, classes,
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21 meetings, work projects, and other educational courses approved by
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22 the Board State Board of Pharmacy for purposes of continuing
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23 professional education;
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24 2. “Act” means the Oklahoma Pharmacy Act;
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 1 3. “Administer” means the direct application of a drug, whether
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2 by injection, inhalation, ingestion or any other means, to the body
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3 of a patient;
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4 4. “Assistant pharmacist” means any person presently licensed
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5 as an assistant pharmacist in the State of Oklahoma by the Board
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6 pursuant to Section 353.10 of this title and for the purposes of the
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7 Oklahoma Pharmacy Act shall be considered the same as a pharmacist,
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8 except where otherwise specified;
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9 5. “Board” or “State Board” means the State Board of Pharmacy;
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10 6. “Certify” or “certification of a prescription” means the
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11 review of a filled prescription by a licensed pharmacist or a
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12 licensed practitioner with dispensing authority to confirm that the
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13 medication, labeling and packaging of the filled prescription are
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14 accurate and meet all requirements prescribed by state and federal
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15 law. For the purposes of this paragraph, “licensed practitioner”
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16 shall not include optometrists with dispensing authority;
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17 7. “Chemical” means any medicinal substance, whether simple or
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18 compound or obtained through the process of the science and art of
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19 chemistry, whether of organic or inorganic origin;
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20 8. “Compounding” means the combining, admixing, mixing,
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21 diluting, pooling, reconstituting or otherwise altering of a drug or
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22 bulk drug substance to create a drug. Compounding includes the
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23 preparation of drugs or devices in anticipation of prescription drug
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24 orders based on routine, regularly observed prescribing patterns;
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 1 9. “Continuing professional education” means professional,
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2 pharmaceutical education in the general areas of the socioeconomic
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3 and legal aspects of health care; the properties and actions of
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4 drugs and dosage forms; and the etiology, characteristics and
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5 therapeutics of the diseased state;
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6 10. “Dangerous drug”, “legend drug”, “prescription drug” or “Rx
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7 Only” means a drug:
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8 a. for human use subject to 21 U.S.C. 353(b)(1), or
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9 b. is labeled “Prescription Only”, or labeled with the
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10 following statement: “Caution: Federal law restricts
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11 this drug except for use by or on the order of a
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12 licensed veterinarian.”;
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13 11. “Director” means the Executive Director of the State Board
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14 of Pharmacy unless context clearly indicates otherwise;
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15 12. “Dispense” or “dispensing” means the interpretation,
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16 evaluation, and implementation of a prescription drug order
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17 including the preparation and delivery of a drug or device to a
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18 patient or a patient’s agent in a suitable container appropriately
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19 labeled for subsequent administration to, or use by, a patient.
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20 Dispense includes sell, distribute, leave with, give away, dispose
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21 of, deliver or supply;
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22 13. “Dispenser” means a retail pharmacy, hospital pharmacy, a
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23 group of chain pharmacies under common ownership and control that do
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24 not act as a wholesale distributor, or any other person authorized
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 1 by law to dispense or administer prescription drugs, and the
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2 affiliated warehouses or distributions of such entities under common
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3 ownership and control that do not act as a wholesale distributor.
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4 For the purposes of this paragraph, “dispenser” does not mean a
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5 person who dispenses only products to be used in animals in
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6 accordance with 21 U.S.C. 360b(a)(5);
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7 14. “Distribute” or “distribution” means the sale, purchase,
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8 trade, delivery, handling, storage, or receipt of a product, and
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9 does not include the dispensing of a product pursuant to a
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10 prescription executed in accordance with 21 U.S.C. 353(b)(1) or the
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11 dispensing of a product approved under 21 U.S.C. 360b(b); provided,
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12 taking actual physical possession of a product or title shall not be
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13 required;
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14 15. “Doctor of Pharmacy” means a person licensed by the Board
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15 to engage in the practice of pharmacy. The terms “pharmacist”,
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16 “D.Ph.”, and “Doctor of Pharmacy” shall be interchangeable and shall
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17 have the same meaning wherever they appear in the Oklahoma Statutes
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18 and the rules promulgated by the Board;
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19 16. “Drug outlet” means all manufacturers, repackagers,
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20 outsourcing facilities, wholesale distributors, third-party
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21 logistics providers, pharmacies, and all other facilities which are
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22 engaged in dispensing, delivery, distribution or storage of
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23 dangerous drugs;
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 1 17. “Drugs” means all medicinal substances and preparations
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2 recognized by the United States Pharmacopoeia and National
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3 Formulary, or any revision thereof, and all substances and
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4 preparations intended for external and/or internal use in the cure,
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5 diagnosis, mitigation, treatment or prevention of disease in humans
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6 or animals and all substances and preparations, other than food,
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7 intended to affect the structure or any function of the body of a
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8 human or animals;
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9 18. “Drug sample” means a unit of a prescription drug packaged
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10 under the authority and responsibility of the manufacturer that is
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11 not intended to be sold and is intended to promote the sale of the
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12 drug;
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13 19. “Durable medical equipment” has the same meaning as
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14 provided by Section 2 of this act;
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15 20. “Filled prescription” means a packaged prescription
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16 medication to which a label has been affixed which contains such
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17 information as is required by the Oklahoma Pharmacy Act;
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18 21. “Hospital” means any institution licensed as a hospital by
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19 this state for the care and treatment of patients, or a pharmacy
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20 operated by the Oklahoma Department of Veterans Affairs;
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21 22. “Licensed practitioner” means:
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22 a. an allopathic physician,
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23 b. an osteopathic physician,
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24 c. a podiatric physician,
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 1 d. a dentist,
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2 e. a veterinarian or,
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3 f. an optometrist, or
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4 g. a Certified Nurse Practitioner or Clinical Nurse
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5 Specialist who has obtained independent prescriptive
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6 authority under Section 1 of this act,
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7 licensed to practice and authorized to prescribe dangerous drugs
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8 within the scope of practice of such practitioner;
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9 23. “Manufacturer” or “virtual manufacturer” means with respect
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10 to a product:
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11 a. a person that holds an application approved under 21
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12 U.S.C. 355 or a license issued under 42 U.S.C. 262 for
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13 such product, or if such product is not the subject of
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14 an approved application or license, the person who
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15 manufactured the product,
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16 b. a co-licensed partner of the person described in
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17 subparagraph a that obtains the product directly from
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18 a person described in this subparagraph or
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19 subparagraph a of this paragraph,
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20 c. an affiliate of a person described in subparagraph a
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21 or b who receives the product directly from a person
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22 described in this subparagraph or in subparagraph a or
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23 b of this paragraph, or
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 1 d. a person who contracts with another to manufacture a
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2 product;
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3 24. “Manufacturing” means the production, preparation,
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4 propagation, compounding, conversion or processing of a device or a
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5 drug, either directly or indirectly by extraction from substances of
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6 natural origin or independently by means of chemical or biological
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7 synthesis and includes any packaging or repackaging of the
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8 substances or labeling or relabeling of its container, and the
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9 promotion and marketing of such drugs or devices. The term
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10 “manufacturing” also includes the preparation and promotion of
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11 commercially available products from bulk compounds for resale by
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12 licensed pharmacies, licensed practitioners or other persons;
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13 25. “Medical gas” means those gases including those in liquid
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14 state upon which the manufacturer or distributor has placed one of
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15 several cautions, such as “Rx Only”, in compliance with federal law;
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16 26. “Medical gas order” means an order for medical gas issued
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17 by a licensed prescriber;
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18 27. “Medical gas distributor” means a person licensed to
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19 distribute, transfer, wholesale, deliver or sell medical gases on
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20 drug orders to suppliers or other entities licensed to use,
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21 administer or distribute medical gas and may also include a patient
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22 or ultimate