H.B. 512
GENERAL ASSEMBLY OF NORTH CAROLINA
Apr 8, 2021
SESSION 2021 HOUSE PRINCIPAL CLERK
H D
HOUSE BILL DRH50010-NB-116A
Short Title: Pharmacists Improve Public Health Needs. (Public)
Sponsors: Representative Sasser.
Referred to:
1 A BILL TO BE ENTITLED
2 AN ACT TO AUTHORIZE CLINICAL PHARMACIST PRACTITIONERS AND
3 IMMUNIZING PHARMACISTS TO PRESCRIBE, DISPENSE, AND ADMINISTER
4 CERTAIN TREATMENT AND MEDICATIONS.
5 Whereas, it is the intention of the North Carolina General Assembly to improve access
6 to care and health outcomes for its citizens; and
7 Whereas, North Carolina's public health ranking is in the bottom one-half to one-third
8 of the nation; and
9 Whereas, one-third of our nation's states have authorized pharmacists to help with
10 access to care related to public health needs beyond immunizations; and
11 Whereas, North Carolinians need and deserve better accessibility to care; Now,
12 therefore,
13 The General Assembly of North Carolina enacts:
14 SECTION 1.(a) G.S. 90-12.7 reads as rewritten:
15 "§ 90-12.7. Treatment of overdose with opioid antagonist; immunity.
16 (a) As used in this section, "opioid antagonist" means naloxone hydrochloride that is
17 approved by the federal Food and Drug Administration for the treatment of a drug overdose.
18 (b) The following individuals may prescribe an opioid antagonist in the manner
19 prescribed by this subsection:
20 (1) A practitioner practitioner, an immunizing pharmacist, as defined in
21 G.S. 90-85.3, or a clinical pharmacist practitioner, as defined in G.S. 90-85.3,
22 acting in good faith and exercising reasonable care may directly or by standing
23 order prescribe an opioid antagonist to (i) a person at risk of experiencing an
24 opiate-related overdose or (ii) a family member, friend, or other person in a
25 position to assist a person at risk of experiencing an opiate-related overdose.
26 As an indicator of good faith, the practitioner, prior to prescribing an opioid
27 under this subsection, may require receipt of a written communication that
28 provides a factual basis for a reasonable conclusion as to either of the
29 following:
30 a. The person seeking the opioid antagonist is at risk of experiencing an
31 opiate-related overdose.
32 b. The person other than the person who is at risk of experiencing an
33 opiate-related overdose, and who is seeking the opioid antagonist, is
34 in relation to the person at risk of experiencing an opiate-related
35 overdose:
36 1. A family member, friend, or other person.
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1 2. In the position to assist a person at risk of experiencing an
2 opiate-related overdose.
3 (2) The State Health Director or a designee may prescribe an opioid antagonist
4 pursuant to subdivision (1) of this subsection by means of a statewide standing
5 order.
6 (3) A practitioner acting in good faith and exercising reasonable care may directly
7 or by standing order prescribe an opioid antagonist to any governmental or
8 nongovernmental organization, including a local health department, a law
9 enforcement agency, or an organization that promotes scientifically proven
10 ways of mitigating health risks associated with substance use disorders and
11 other high-risk behaviors, for the purpose of distributing, through its agents,
12 the opioid antagonist to (i) a person at risk of experiencing an opiate-related
13 overdose or (ii) a family member, friend, or other person in a position to assist
14 a person at risk of experiencing an opiate-related overdose.
15 (c) A pharmacist may dispense an opioid antagonist to a person or organization pursuant
16 to a prescription issued in accordance with subsection (b) of this section. For purposes of this
17 section, the term "pharmacist" is as defined in G.S. 90-85.3.
18 …."
19 SECTION 1.(b) G.S. 90-85.15B reads as rewritten:
20 "§ 90-85.15B. Immunizing pharmacists.
21 (a) Except as provided in subsection (b) and (c) of this section, an immunizing pharmacist
22 may administer vaccinations or immunizations only if the vaccinations or immunizations are
23 recommended or required by the Centers for Disease Control and Prevention and administered
24 to persons at least 18 years of age pursuant to a specific prescription order.
25 (b) An immunizing pharmacist may administer the vaccinations or immunizations listed
26 in subdivisions (1) through (7) of this subsection to persons at least 18 years of age if the
27 vaccinations or immunizations are administered under written protocols as defined in 21 NCAC
28 46. 2507(b)(12) and 21 NCAC 32U. 0101(b)(12) and in accordance with the supervising
29 physician's responsibilities as defined in 21 NCAC 46. 2507(e) and 21 NCAC 32U. 0101(e), and
30 the physician is licensed in and has a practice physically located in North Carolina:
31 (1) Pneumococcal polysaccharide or pneumococcal conjugate vaccines.
32 (2) Herpes zoster vaccine.
33 (3) Hepatitis B vaccine.
34 (4) Meningococcal polysaccharide or meningococcal conjugate vaccines and
35 Serogroup B meningococcal vaccines.
36 (5) Tetanus-diphtheria, tetanus and diphtheria toxoids and pertussis, tetanus and
37 diphtheria toxoids and acellular pertussis, or tetanus toxoid vaccines.
38 However, a pharmacist shall not administer any of these vaccines if the patient
39 discloses that the patient has an open wound, puncture, or tissue tear.
40 (6) Human Papillomavirus vaccine.
41 (7) Hepatitis A vaccine.
42 (c) An immunizing pharmacist may administer the influenza vaccine to persons at least
43 10 years of age pursuant to 21 NCAC 46. 2507 and 21 NCAC 32U. 0101. An immunizing
44 pharmacist may administer an influenza vaccine and any other vaccinations approved by the
45 United States Food and Drug Administration in accordance with the protocols established by the
46 Advisory Committee on Immunization Practices to persons at least six years of age pursuant to
47 a specific prescription order initiated by a prescriber following a physical examination of the
48 patient by the prescriber.
49 (c1) An immunizing pharmacist may administer a long-acting injectable medication to
50 persons at least 18 years of age pursuant to a specific prescription order initiated by a prescriber
51 following a physical examination of the patient by the prescriber. An immunizing pharmacist
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1 who administers a long-acting injectable medication pursuant to this section shall do all of the
2 following:
3 (1) Maintain a record of any administration of a long-acting injectable performed
4 by the immunizing pharmacist to the patient in a patient profile or record.
5 (2) Within 72 hours after the administration of the long-acting injectable
6 performed by the immunizing pharmacist to the patient, notify the prescriber
7 regarding which medication and dosage was administered to the patient.
8 (c2) An immunizing pharmacist may prescribe and dispense the following medications:
9 (1) Naloxone or other opioid antagonist and any drug delivery paraphernalia
10 necessary to administer the opioid antagonist in accordance with G.S. 90-12.7.
11 (2) Tobacco cessation medications that are approved by the United States Food
12 and Drug Administration.
13 (3) Epinephrine or other anaphylaxis management medication, including
14 self-administered formulations for the management of severe allergic
15 reaction.
16 (4) Glucagon or other self-administered formulations for the management of
17 hypoglycemia.
18 (5) Short-acting bronchodilators, for patients with an established diagnosis of
19 asthma.
20 (6) Hormonal contraceptives, injectable or self-administered, after the patient
21 completes an assessment consistent with the Centers for Disease Control and
22 Prevention's United States Medical Eligibility Criteria (USMEC) for
23 Contraceptive Use.
24 (7) Prenatal vitamins.
25 (8) Controlled substances for the prevention of human immunodeficiency virus,
26 including controlled substances prescribed for pre-exposure and
27 post-exposure prophylaxis pursuant to guidelines and recommendations of the
28 Centers for Disease Control and Prevention.
29 (9) Dietary fluoride supplements, in accordance with recommendations of the
30 American Dental Association for prescribing of such supplements for persons
31 whose drinking water has a fluoride content below the concentration
32 recommended by the U.S. Department of Health and Human Services.
33 (10) Prescription medications, not requiring a diagnosis, that are recommended by
34 the Centers for Disease Control and Prevention for individuals traveling
35 outside the United States.
36 (d) An immunizing pharmacist who administers a vaccine or immunization to any patient
37 pursuant to this section or prescribes and dispenses a medication listed in subsection (c2) of this
38 section to a patient shall do all of the following:
39 (1) Maintain a record of any vaccine or immunization administered to the patient
40 in a patient profile.profile for a period of five years from the patient's most
41 recent provision of service.
42 (2) Within 72 hours after administration of the vaccine or immunization, or
43 medication listed in subsection (c2) of this section, notify any primary care
44 provider identified by the patient. If the patient does not identify a primary
45 care provider, the immunizing pharmacist shall direct the patient to
46 information describing the benefits to a patient of having a primary care
47 physician, including information about federally qualified health centers, free
48 clinics, and local health departments, prepared by any of the following: North
49 Carolina Medical Board, North Carolina Academy of Family Physicians,
50 North Carolina Medical Society, or Community Care of North Carolina.
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1 (3) Except for influenza vaccines administered under G.S. 90-85.15B(c), access
2 the North Carolina Immunization Registry prior to administering the vaccine
3 or immunization and record any vaccine or immunization administered to the
4 patient in the registry within 72 hours after the administration. In the event the
5 registry is not operable, an immunizing pharmacist shall report as soon as
6 reasonably possible.
7 (4) Furnish patient records to the patient upon the patient's request.
8 (5) Furnish patient records to the primary care provider identified by the patient
9 upon the primary care provider's request.
10 (6) If the immunizing pharmacist has administered or dispensed a hormonal
11 contraceptive to the patient, the immunizing pharmacist shall counsel the
12 patient about preventative care, including well-woman visits, sexually
13 transmitted infection testing information, and Pap smear testing.
14 (e) An immunizing pharmacist may test or screen for and treat minor, nonchronic health
15 conditions. An immunizing pharmacist may use tests waived under the federal Clinical
16 Laboratory Improvement Amendments of 1988, or applicable federal rules and regulations that
17 are approved for performance by pharmacists. For the purposes of this subsection, a "minor,
18 nonchronic health condition" is a short-term condition that is generally managed with minimal
19 treatment or self-care. An immunizing pharmacist that tests or screens for and treats a minor,
20 nonchronic health condition must do all of the following:
21 (1) Maintain a record of any vaccine or immunization administered to the patient
22 in a patient profile for a period of five years from the patient's most recent
23 provision of service.
24 (2) Furnish patient records to the patient upon the patient's request.
25 (3) Furnish patient records to the primary care provider identified by the patient
26 upon the primary care provider's request.
27 (f) An immunizing pharmacist that prescribes and dispenses the medications listed in
28 subsection (c2) of this section shall comply with the following conditions:
29 (1) The North Carolina Medical Board and the North Carolina Board of Pharmacy
30 have adopted rules developed by a joint subcommittee governing the approval
31 of the individual immunizing pharmacist to administer, prescribe, and
32 dispense the medications with limitations that the Boards determine to be in
33 the best interest of patient health and safety.
34 (2) The immunizing pharmacist has current approval from both Boards.
35 (3) The North Carolina Medical Board has assigned an identification number to
36 the immunizing pharmacist which is shown on written prescriptions written
37 by the immunizing pharmacist."
38 SECTION 1.(c) G.S. 90-18.4 reads as rewritten:
39 "§ 90-18.4. Limitations on clinical pharmacist practitioners.
40 (a) Any pharmacist who is approved under the provisions of G.S. 90-18(c)(3a) to perform
41 medical acts, tasks, and functions may use the title "clinical pharmacist practitioner". Any other
42 person who uses the title in any form or holds himself or herself out to be a clinical pharmacist
43 practitioner or to be so licensed shall be deemed to be in violation of this Article.
44 (b) Clinical pharmacist practitioners are authorized to implement predetermined drug
45 therapy, which includes diagnosis and product selection by the patient's physician, modify
46 prescribed drug dosages, dosage forms, and dosage schedules, and to order laboratory tests
47 pursuant to a drug therapy management agreement that is physician, pharmacist, patient, and
48 disease specific under the following conditions:
49 (1) The North Carolina Medical Board and the North Carolina Board of Pharmacy
50 have adopted rules developed by a joint subcommittee governing the approval
51 of individual clinical pharmacist practitioners to practice drug therapy
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1 management with such limitations that the Boards determine to be in the best
2 interest of patient health and safety.
3 (2) The clinical pharmacist practitioner has current approval from both Boards.
4 (3) The North Carolina Medical Board has assigned an identification number to
5 the clinical pharmacist practitioner which is shown on written prescriptions
6 written by the clinical pharmacist practitioner.
7 (4) The drug therapy management agreement prohibits the substitution of a
8 chemically dissimilar drug product by the pharmacist for the product
9 prescribed by the physician without the explicit consent of the physician and
10 includes a policy for periodic review by the physician of the drugs modified
11 pursuant to the agreement or