Present law specifies that the practice of pharmacy does not include ordering lab tests or prescribing prescription drugs except pursuant to a medical order by the attending prescriber for each patient or pursuant to a collaborative pharmacy practice agreement jointly agreed upon by a pharmacist or pharmacists and a prescriber or prescribers. This bill adds to the definition of the "practice of pharmacy" the prescribing of the following:
(1) Dietary fluoride supplements when prescribed according to the American Dental Association's recommendations for persons whose drinking water is proven to have a fluoride content below the federal department of health and human services' recommended concentration;
(2) Agents for active immunization when prescribed for susceptible individuals who are six years of age or older for the protection from communicable disease;
(3) Opioid antagonists;
(4) Epinephrine auto-injectors;
(5) Tobacco cessation products;
(6) Hormonal contraceptives;
(7) Tuberculin purified protein derivative products; or
(8) Subject to certain conditions specified in the full text of this bill, drugs, drug categories, or devices that are prescribed in accordance with the product's federal FDA-approved labeling.
This bill specifies that it does not authorize a pharmacist to prescribe a controlled drug, compounded drug, or biological product.
This bill also removes specific references to the Tennessee board of pharmacy defining by rule the tasks that may be delegated to a pharmacy intern or pharmacy technician, although the board will retain general rulemaking authority regarding regulation of the practice of pharmacy.
ON MARCH 28, 2024, THE SENATE ADOPTED AMENDMENT #1 AND PASSED SENATE BILL 869, AS AMENDED.
AMENDMENT #1 rewrites the bill to, instead, add to the present law definition of "practice of pharmacy," as described below.
This amendment establishes that the "practice of pharmacy" also includes the issuing of a prescription or medical order of the following drugs, drug categories, or devices, excluding controlled substances, that are issued in accordance with the product's federal FDA-approved labeling or guidelines of the centers for disease control and prevention that are limited to the following:
(1) Antivirals for influenza and COVID-19 that are waived under the federal clinical laboratory improvement amendments of 1988, upon completion of a test that is used to guide diagnosis or clinical decision-making;
(2) Agents for active immunization when prescribed for susceptible persons for the protection from communicable disease for individuals who are 18 and older, and agents for active immunization for influenza and COVID-19 for individuals who are 3 to 17 years old; however, the pharmacists must comply with recordkeeping and reporting requirements, including (i) informing the patient's primary care provider, if the patient identifies a primary care provider; (ii) submitting the required immunization information to this state's vaccine registry; (iii) complying with requirements related to reporting adverse events; and (iv) reviewing the patient's vaccine history, if any, through this state's vaccine registry or other vaccination records prior to administering a vaccine;
(3) Post-exposure prophylaxis for nonoccupational exposure to HIV infection, and the ordering of lab tests in conjunction with initiation of therapy;
(4) Epinephrine auto-injectors for patients with a documented history of allergies or anaphylactic reactions;
(5) Progesterone-only hormonal contraceptives;
(6) Naloxone;
(7) Dietary fluoride supplements for those over seven, when prescribed according to the American Dental Association's recommendations for persons whose drinking water is proven to have a fluoride content below the U.S. department of health and human services' recommended concentration; and
(8) Tuberculin purified protein derivative products in compliance with current statutory reporting requirements.
This amendment establishes that the standard of care for a pharmacist providing the services listed in (1)-(8) above is the same standard of care as a physician ordering or providing the same service.
ON APRIL 16, 2024, THE HOUSE SUBSTITUTED SENATE BILL 869 FOR HOUSE BILL 282, ADOPTED AMENDMENT #1, AND PASSED SENATE BILL 869, AS AMENDED.
AMENDMENT #1 makes the following changes:
(1) Revises the provision that adds to the present law meaning of "practice of pharmacy" to mean the issuing of a prescription or medical order of dietary fluoride supplements for those over seven years of age when prescribed according to the American Dental Association's recommendations for persons whose drinking water is proven to have a fluoride content below the United States department of health and human services' recommended concentration. This amendment revises the above provision by, instead, adding topical fluoride agents when prescribed according to the American Dental Association's recommendations for persons whose drinking water is proven to have a fluoride content below the United States department of health and human services' recommended concentration; and
(2) Clarifies that issuing a prescription or medical order pursuant to the bill is not considered the "practice of medicine."

Statutes affected:
Introduced: 63-10-204, 63-10-204(39)
Amended with SA0842 -- 03/28/2024: 63-10-204, 63-10-204(39)
Amended with SA0842, HA0958 -- 04/17/2024: 63-10-204, 63-10-204(39)