Read the full stored bill text
SECOND REGULAR SESSION
HOUSE BILL NO. 1976
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE COOK.
5194H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o repeal section 338.010, RSMo, and to enact in lieu thereof one new section relating to the
ordering and administration of vaccines by pharmacists.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Section 338.010, RSMo, is repealed and one new section enacted in lieu
2 thereof, to be known as section 338.010, 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 ]
13 that is jointly excluded by joint rules pr omulgated by the board of pharmacy and the
14 state board of r egistration for the healing arts , to persons at least seven years of age or the
15 age recommended by the Centers for Disease Control and Prevention, whichever is older ,
16 pursuant to joint promulgation of rules established by the board of pharmacy and the state
EXPLANA TION — 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.
17 board of registration for the healing arts unless rules are established under a state of
18 emer gency as described in section 44.100;
19 (5) The participation in drug selection according to state law and participation in drug
20 utilization reviews;
21 (6) The proper and safe storage of drugs and devices and the maintenance of proper
22 records thereof;
23 (7) Consultation with patients and other health care practitioners, and veterinarians
24 and their clients about legend drugs, about the safe and ef fective use of drugs and devices;
25 (8) The prescribing and dispensing of any nicotine replacement therapy product under
26 section 338.665;
27 (9) The dispensing of HIV postexposure prophylaxis pursuant to section 338.730; and
28 (10) The of fering or performing of those acts, services, operations, or transactions
29 necessary in the conduct, operation, management and control of a pharmacy .
30 2. No person shall engage in the practice of pharmacy unless he or she is licensed
31 under the provisions of this chapter .
32 3. This chapter shall not be construed to prohibit the use of auxiliary personnel under
33 the direct supervision of a pharmacist from assisting the pharmacist in any of his or her duties.
34 This assistance in no way is intended to relieve the pharmacist from his or her responsibilities
35 for compliance with this chapter and he or she will be responsible for the actions of the
36 auxiliary personnel acting in his or her assistance.
37 4. This chapter shall not be construed to prohibit or interfere with any legally
38 registered practitioner of medicine, dentistry , or podiatry , or veterinary medicine only for use
39 in animals, or the practice of optometry in accordance with and as provided in sections
40 195.070 and 336.220 in the compounding, administering, prescribing, or dispensing of his or
41 her own prescriptions.
42 5. A pharmacist with a certificate of medication therapeutic plan authority may
43 provide medication therapy services pursuant to a written protocol from a physician licensed
44 under chapter 334 to patients who have established a physician-patient relationship, as
45 described in subdivision (1) of subsection 1 of section 191.1 146, with the protocol physician.
46 The written protocol authorized by this section shall come only from the physician and shall
47 not come from a nurse engaged in a collaborative practice arrangement under section
48 334.104, or from a physician assistant engaged in a collaborative practice arrangement under
49 section 334.735.
50 6. Nothing in this section shall be construed as to prevent any person, firm or
51 corporation from owning a pharmacy regulated by sections 338.210 to 338.315, provided that
52 a licensed pharmacist is in char ge of such pharmacy .
HB 1976 2
53 7. Nothing in this section shall be construed to apply to or interfere with the sale of
54 nonprescription drugs and the ordinary household remedies and such drugs or medicines as
55 are normally sold by those engaged in the sale of general merchandise.
56 8. No health carrier as defined in chapter 376 shall require any physician with which
57 they contract to enter into a written protocol with a pharmacist for medication therapeutic
58 services.
59 9. This section shall not be construed to allow a pharmacist to diagnose or
60 independently prescribe pharmaceuticals.
61 10. The state board of registration for the healing arts, under section 334.125, and the
62 state board of pharmacy , under section 338.140, shall jointly promulgate rules regulating the
63 use of protocols for medication therapy services. Such rules shall require protocols to include
64 provisions allowing for timely communication between the pharmacist and the protocol
65 physician or similar body authorized by this section, and any other patient protection
66 provisions deemed appropriate by both boards. In order to take ef fect, such rules shall be
67 approved by a majority vote of a quorum of each board. Neither board shall separately
68 promulgate rules regulating the use of protocols for medication therapy services. Any rule or
69 portion of a rule, as that term is defined in section 536.010, that is created under the authority
70 delegated in this section shall become effectiv e only if it complies with and is subject to all of
71 the provisions of chapter 536 and, if applicable, section 536.028. This section and chapter
72 536 are nonseverable and if any of the powers vested with the general assembly pursuant to
73 chapter 536 to review , to delay the ef fective date, or to disapprove and annul a rule are
74 subsequently held unconstitutional, then the grant of rulemaking authority and any rule
75 proposed or adopted after August 28, 2007, shall be invalid and void.
76 1 1. The state board of pharmacy may grant a certificate of medication therapeutic
77 plan authority to a licensed pharmacist who submits proof of successful completion of a
78 board-approved course of academic clinical study beyond a bachelor of science in pharmacy ,
79 including but not limited to clinical assessment skills, from a nationally accredited college or
80 university , or a certification of equivalence issued by a nationally recognized professional
81 or ganization and approved by the board of pharmacy .
82 12. Any pharmacist who has received a certificate of medication therapeutic plan
83 authority may engage in the designing, initiating, implementing, and monitoring of a
84 medication therapeutic plan as defined by a written protocol from a physician that may be
85 specific to each patient for care by a pharmacist.
86 13. Nothing in this section shall be construed to allow a pharmacist to make a
87 therapeutic substitution of a pharmaceutical prescribed by a physician unless authorized by
88 the written protocol or the physician's prescription order .
HB 1976 3
89 14. "V eterinarian", "doctor of veterinary medicine", "practitioner of veterinary
90 medicine", "DVM", "VMD", "BVSe", "BVMS", "BSe (V et Science)", "VMB", "MRCVS", or
91 an equivalent title means a person who has received a doctor's degree in veterinary medicine
92 from an accredited school of veterinary medicine or holds an Educational Commission for
93 Foreign V eterinary Graduates (EDFVG) certificate issued by the American V eterinary
94 Medical Association (A VMA).
95 15. In addition to other requirements established by the joint promulgation of rules by
96 the board of pharmacy and the state board of registration for the healing arts:
97 (1) A pharmacist shall administer vaccines by protocol in accordance with treatment
98 guidelines established by the Centers for Disease Control and Prevention (CDC);
99 (2) A pharmacist who is administering a vaccine shall request a patient to remain in
100 the pharmacy a safe amount of time after administering the vaccine to observe any adverse
101 reactions. Such pharmacist shall have adopted emer gency treatment protocols.
102 16. In addition to other requirements by the board, a pharmacist shall receive
103 additional training as required by the board and evidenced by receiving a certificate from the
104 board upon completion, and shall display the certification in his or her pharmacy where
105 vaccines are delivered.
106 17. A pharmacist shall inform the patient that the administration of a vaccine will be
107 entered into the ShowMeV ax system, as administered by the department of health and senior
108 services. The patient shall attest to the inclusion of such information in the system by signing
109 a form provided by the pharmacist. If the patient indicates that he or she does not want such
110 information entered into the ShowMeV ax system, the pharmacist shall provide a written
111 report within fourteen days of administration of a vaccine to the patient's health care provider ,
112 if provided by the patient, containing:
113 (1) The identity of the patient;
114 (2) The identity of the vaccine or vaccines administered;
115 (3) The route of administration;
116 (4) The anatomic site of the administration;
117 (5) The dose administered; and
118 (6) The date of administration.
119 18. A pharmacist licensed under this chapter may order and administer vaccines
120 approved or authorized by the U.S. Food and Drug Administration to address a public health
121 need, as lawfully authorized by the state or federal government, or a department or agency
122 thereof, during a state or federally declared public health emer gency .
✔
HB 1976 4