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sb230_02_PS
As Passed by the Senate
136th
General Assembly
Regular
Session
Sub. S. B. No. 230
2025-2026
Senator Romanchuk
Cosponsors: Senators Liston,
Ingram, Antonio, Cirino, Craig, Hicks-Hudson, Reineke, Roegner
To
amend sections 1751.91, 3923.89, 4729.01, 5164.14, and 5167.051 and
to enact
sections
4729.392
and 4729.393
of the Revised Code
to
authorize pharmacists to screen, test, and provide treatment for
certain respiratory health conditions.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section
1.
That
sections 1751.91, 3923.89, 4729.01, 5164.14, and 5167.051 be amended
and
sections
4729.392
and 4729.393
of the Revised Code be enacted to read as follows:
Sec.
1751.91.
A
(A)
Notwithstanding section 3901.71 of the Revised Code, a
health
insuring corporation
may
shall
provide
payment or reimbursement to a pharmacist for providing a health care
service to a patient
if both of the following are the case:
(A)
The pharmacist provided the health care service to the patient in
accordance with
,
in the same manner that it provides payment or reimbursement to any
other health care provider for providing a health care service that
is the equivalent of the pharmacist-provided health care service, as
long as the patient's individual or group health insuring corporation
policy, contract, or agreement includes coverage of that type of
health care service.
(B)
Division (A) of this section applies in the case of any health care
service that a pharmacist is authorized by
Chapter
4729. of the Revised Code
to provide
,
including any of the following
services
:
(1)
Managing drug therapy under a consult agreement pursuant to section
4729.39 of the Revised Code;
(2)
Conducting
screenings, ordering and administering laboratory and diagnostic
tests, evaluating the results of such screenings and tests, and
treating health conditions, to the extent that the foregoing
activities are authorized by section 4729.392 of the Revised Code;
(3)
Administering
immunizations
in
accordance with
pursuant
to
section
4729.41 of the Revised Code;
(3)
(4)
Administering
drugs
in
accordance with
by
injection pursuant to
section
4729.45 of the Revised Code.
(B)
The patient's individual or group health insuring corporation policy,
contract, or agreement provides for payment or reimbursement of the
service.
Sec.
3923.89.
A
(A)
Notwithstanding section 3901.71 of the Revised Code, a
sickness
and accident insurer or public employee benefit plan
may
shall
provide
payment or reimbursement to a pharmacist for providing a health care
service to a patient
if both of the following are the case:
(A)
The pharmacist provided the health care service to the patient in
accordance with
,
in the same manner that it provides payment or reimbursement to any
other health care provider for providing a health care service that
is the equivalent of the pharmacist-provided health care service, as
long as the patient's individual or group sickness and accident
insurance policy or public employee benefit plan includes coverage of
that type of health care service.
(B)
Division (A) of this section applies in the case of any health care
service that a pharmacist is authorized by
Chapter
4729. of the Revised Code
to provide
,
including any of the following
services
:
(1)
Managing drug therapy under a consult agreement pursuant to section
4729.39 of the Revised Code;
(2)
Conducting
screenings, ordering and administering laboratory and diagnostic
tests, evaluating the results of such screenings and tests, and
treating health conditions, to the extent that the foregoing
activities are authorized by section 4729.392 of the Revised Code;
(3)
Administering
immunizations
in
accordance with
pursuant
to
section
4729.41 of the Revised Code;
(3)
(4)
Administering
drugs
in
accordance with
by
injection pursuant to
section
4729.45 of the Revised Code.
(B)
The patient's individual or group policy of sickness and accident
insurance or public employee benefit plan provides for payment or
reimbursement of the service.
Sec.
4729.01.
As
used in this chapter:
(A)
"Pharmacy," except when used in a context that refers to
the practice of pharmacy, means any area, room, rooms, place of
business, department, or portion of any of the foregoing where the
practice of pharmacy is conducted.
(B)
"Practice of pharmacy" means providing pharmacist care
requiring specialized knowledge, judgment, and skill derived from the
principles of biological, chemical, behavioral, social,
pharmaceutical, and clinical sciences. As used in this division,
"pharmacist care" includes the following:
(1)
Interpreting prescriptions;
(2)
Dispensing drugs and drug therapy related devices;
(3)
Compounding drugs;
(4)
Counseling individuals with regard to their drug therapy,
recommending drug therapy related devices, and assisting in the
selection of drugs and appliances for treatment of common diseases
and injuries and providing instruction in the proper use of the drugs
and appliances;
(5)
Performing drug regimen reviews with individuals by discussing all of
the drugs that the individual is taking and explaining the
interactions of the drugs;
(6)
Performing drug utilization reviews with licensed health
professionals authorized to prescribe drugs when the pharmacist
determines that an individual with a prescription has a drug regimen
that warrants additional discussion with the prescriber;
(7)
Advising an individual and the health care professionals treating an
individual with regard to the individual's drug therapy;
(8)
Acting pursuant to a consult agreement, if an agreement has been
established;
(9)
Conducting
screenings, ordering and administering laboratory and diagnostic
tests, evaluating the results of such screenings and tests, and
treating health conditions, to the extent that the foregoing
activities are authorized by section 4729.392 of the Revised Code;
(10)
Engaging
in the administration of immunizations to the extent authorized by
section 4729.41 of the Revised Code;
(10)
(11)
Engaging in the administration
by injection
of drugs
,
to the extent authorized by section 4729.45 of the Revised Code.
(C)
"Compounding" means the preparation, mixing, assembling,
packaging, and labeling of one or more drugs in any of the following
circumstances:
(1)
Pursuant to a prescription issued by a licensed health professional
authorized to prescribe drugs;
(2)
Pursuant to the modification of a prescription made in accordance
with a consult agreement;
(3)
As an incident to research, teaching activities, or chemical
analysis;
(4)
In anticipation of orders for drugs pursuant to prescriptions, based
on routine, regularly observed dispensing patterns;
(5)
Pursuant to a request made by a licensed health professional
authorized to prescribe drugs for a drug that is to be used by the
professional for the purpose of direct administration to patients in
the course of the professional's practice, if all of the following
apply:
(a)
At the time the request is made, the drug is not commercially
available regardless of the reason that the drug is not available,
including the absence of a manufacturer for the drug or the lack of a
readily available supply of the drug from a manufacturer.
(b)
A limited quantity of the drug is compounded and provided to the
professional.
(c)
The drug is compounded and provided to the professional as an
occasional exception to the normal practice of dispensing drugs
pursuant to patient-specific prescriptions.
(D)
"Consult agreement" means an agreement that has been
entered into under section 4729.39 of the Revised Code.
(E)
"Drug" means:
(1)
Any article recognized in the United States pharmacopoeia and
national formulary, or any supplement to them, intended for use in
the diagnosis, cure, mitigation, treatment, or prevention of disease
in humans or animals;
(2)
Any other article intended for use in the diagnosis, cure,
mitigation, treatment, or prevention of disease in humans or animals;
(3)
Any article, other than food, intended to affect the structure or any
function of the body of humans or animals;
(4)
Any article intended for use as a component of any article specified
in division (E)(1), (2), or (3) of this section; but does not include
devices or their components, parts, or accessories.
"Drug"
does not include "hemp" as that term is defined in section
928.01 of the Revised Code.
(F)
"Dangerous drug" means any of the following:
(1)
Any drug to which either of the following applies:
(a)
Under the "Federal Food, Drug, and Cosmetic Act," 52 Stat.
1040 (1938), 21 U.S.C.A. 301, as amended, the drug is required to
bear a label containing the legend "Caution: Federal law
prohibits dispensing without prescription" or "Caution:
Federal law restricts this drug to use by or on the order of a
licensed veterinarian" or any similar restrictive statement, or
the drug may be dispensed only upon a prescription;
(b)
Under Chapter 3715. or 3719. of the Revised Code, the drug may be
dispensed only upon a prescription.
(2)
Any drug that contains a schedule V controlled substance and that is
exempt from Chapter 3719. of the Revised Code or to which that
chapter does not apply;
(3)
Any drug intended for administration by injection into the human body
other than through a natural orifice of the human body;
(4)
Any drug that is a biological product, as defined in section 3715.01
of the Revised Code.
(G)
"Federal drug abuse control laws" has the same meaning as
in section 3719.01 of the Revised Code.
(H)
"Prescription" means all of the following:
(1)
A written, electronic, or oral order for drugs or combinations or
mixtures of drugs to be used by a particular individual or for
treating a particular animal, issued by a licensed health
professional authorized to prescribe drugs;
(2)
For purposes of sections 4723.4810, 4729.282, 4730.432, and 4731.93
of the Revised Code, a written, electronic, or oral order for a drug
to treat chlamydia, gonorrhea, or trichomoniasis issued to and in the
name of a patient who is not the intended user of the drug but is the
sexual partner of the intended user;
(3)
For purposes of sections 3313.7110, 3313.7111, 3314.143, 3326.28,
3328.29, 4723.483, 4729.88, 4730.433, 4731.96, and 5180.26 of the
Revised Code, a written, electronic, or oral order for an epinephrine
autoinjector issued to and in the name of a school, school district,
or camp;
(4)
For purposes of Chapter 3728. and sections 4723.483, 4729.88,
4730.433, and 4731.96 of the Revised Code, a written, electronic, or
oral order for an epinephrine autoinjector issued to and in the name
of a qualified entity, as defined in section 3728.01 of the Revised
Code;
(5)
For purposes of sections 3313.7115, 3313.7116, 3314.147, 3326.60,
3328.38, 4723.4811, 4730.437, 4731.92, and 5180.262 of the Revised
Code, a written, electronic, or oral order for injectable or nasally
administered glucagon in the name of a school, school district, or
camp.
(I)
"Licensed health professional authorized to prescribe drugs"
or "prescriber" means an individual who is authorized by
law to prescribe drugs or dangerous drugs or drug therapy related
devices in the course of the individual's professional practice,
including only the following:
(1)
A dentist licensed under Chapter 4715. of the Revised Code;
(2)
A clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner who holds a current, valid license issued under
Chapter 4723. of the Revised Code to practice nursing as an advanced
practice registered nurse;
(3)
A certified registered nurse anesthetist who holds a current, valid
license issued under Chapter 4723. of the Revised Code to practice
nursing as an advanced practice registered nurse, but only to the
extent of the nurse's authority under section 4723.43 of the Revised
Code;
(4)
An optometrist licensed under Chapter 4725. of the Revised Code to
practice optometry;
(5)
A physician authorized under Chapter 4731. of the Revised Code to
practice medicine and surgery, osteopathic medicine and surgery, or
podiatric medicine and surgery;
(6)
A physician assistant who holds a license to practice as a physician
assistant issued under Chapter 4730. of the Revised Code, holds a
valid prescriber number issued by the state medical board, and has
been granted physician-delegated prescriptive authority;
(7)
A veterinarian licensed under Chapter 4741. of the Revised Code;
(8)
A certified mental health assistant licensed under Chapter 4772. of
the Revised Code who has been granted physician-delegated
prescriptive authority by the physician supervising the certified
mental health assistant.
(J)
"Sale" or "sell" includes any transaction made by
any person, whether as principal proprietor, agent, or employee, to
do or offer to do any of the following: deliver, distribute, broker,
exchange, gift or otherwise give away, or transfer, whether the
transfer is by passage of title, physical movement, or both.
(K)
"Wholesale sale" and "sale at wholesale" mean any
sale in which the purpose of the purchaser is to resell the article
purchased or received by the purchaser.
(L)
"Retail sale" and "sale at retail" mean any sale
other than a wholesale sale or sale at wholesale.
(M)
"Retail seller" means any person that sells any dangerous
drug to consumers without assuming control over and responsibility
for its administration. Mere advice or instructions regarding
administration do not constitute control or establish responsibility.
(N)
"Price information" means the price charged for a
prescription for a particular drug product and, in an easily
understandable manner, all of the following:
(1)
The proprietary name of the drug product;
(2)
The established (generic) name of the drug product;
(3)
The strength of the drug product if the product contains a single
active ingredient or if the drug product contains more than one
active ingredient and a relevant strength can be associated with the
product without indicating each active ingredient. The established
name and quantity of each active ingredient are required if such a
relevant strength cannot be so associated with a drug product
containing more than one ingredient.
(4)
The dosage form;
(5)
The price charged for a specific quantity of the drug product. The
stated price shall include all charges to the consumer, including,
but not limited to, the cost of the drug product, professional fees,
handling fees, if any, and a statement identifying professional
services routinely furnished by the pharmacy. Any mailing fees and
delivery fees may be stated separately without repetition. The
information shall not be false or misleading.
(O)
"Wholesale distributor of dangerous drugs" or "wholesale
distributor" means a person engaged in the sale of dangerous
drugs at wholesale and includes any agent or employee of such a
person authorized by the person to engage in the sale of dangerous
drugs at wholesale.
(P)
"Manufacturer of dangerous drugs" or "manufacturer"
means a person, other than a pharmacist or prescriber, who
manufactures dangerous drugs and who is engaged in the sale of those
dangerous drugs.
(Q)
"Terminal distributor of dangerous drugs" or "terminal
distributor" means a person who is engaged in the sale of
dangerous drugs at retail, or any person, other than a manufacturer,
repackager, outsourcing facility, third-party logistics provider,
wholesale distributor, or pharmacist, who has possession, custody, or
control of dangerous drugs for any purpose other than for that
person's own use and consumption. "Terminal distributor"
includes pharmacies, hospitals, nursing homes, and laboratories and
all other persons who procure dangerous drugs for sale or other
distribution by or under the supervision of a pharmacist, licensed
health professional authorized to prescribe drugs, or other person
authorized by the state board of pharmacy.
(R)
"Promote to the public" means disseminating a
representation to the public in any manner or by any means, other
than by labeling, for the purpose of inducing, or that is likely to
induce, directly or indirectly, the purchase of a dangerous drug at
retail.
(S)
"Person" includes any individual, partnership, association,
limited liability company, or corporation, the state, any political
subdivision of the state, and any district, department, or agency of
the state or its political subdivisions.
(T)(1)
"Animal shelter" means a facility operated by a humane
society or any society organized under Chapter 1717. of the Revised
Code or a dog pound operated pursuant to Chapter 955. of the Revised
Code.
(2)
"County dog warden" means a dog warden or deputy dog warden
appointed or employed under section 955.12 of the Revised Code.
(3)
"Wild animal rehabilitation facility" means a facility that
holds a permit issued by the chief of the division of wildlife for
rehabilitation purposes in accordance with section 1533.08 of the
Revised Code or rules adopted by the chief.
(U)
"Food" has the same meaning as in section 3715.01 of the
Revised Code.
(V)
"Pain management clinic" has the same meaning as in section
4731.054 of the Revised Code.
(W)
"Investigational drug or product" means a drug or product
that has successfully completed phase one of the United States food
and drug administration clinical trials and remains under clinical
trial, but has not been approved for general use by the United States
food and drug administration. "Investigational drug or product"
does not include controlled substances in schedule I, as defined in
section 3719.01 of the Revised Code.
(X)
"Product," when used in reference to an investigational
drug or product, means a biological product, other than a drug, that
is made from a natural human, animal, or microorganism source and is
intended to treat a disease or medical condition.
(Y)
"Third-party logistics provider" means a person that
provides or coordinates warehousing or other logistics services
pertaining to dangerous drugs including distribution, on behalf of a
manufacturer, wholesale distributor, or terminal distributor of
dangerous drugs, but does not take ownership of the drugs or have
responsibility to direct the sale or disposition of the drugs.
(Z)
"Repackager of dangerous drugs" or "repackager"
means a person that repacks and relabels dangerous drugs for sale or
distribution.
(AA)
"Outsourcing facility" means a facility that is engaged in
the compounding and sale of sterile drugs and is registered as an
outsourcing facility with the United States food and drug
administration.
(BB)
"Laboratory" means a laboratory licensed under this chapter
as a terminal distributor of dangerous drugs and entrusted to have
custody of any of the following drugs and to use the drugs for
scientific and clinical purposes and for purposes of instruction:
dangerous drugs that are not controlled substances, as defined in
section 3719.01 of the Revised Code; dangerous drugs that are
controlled substances, as defined in that section; and controlled
substances in schedule I, as defined in that section.
(CC)
"Overdose reversal drug" means both of the following:
(1)
Naloxone;
(2)
Any other drug that the state board of pharmacy, through rules
adopted in accordance with Chapter 119. of the Revised Code,
designates as a drug that is approved by the federal food and drug
administration for the reversal of a known or suspected
opioid-related overdose.
Sec.
4729.392.
(A)
Pursuant to the statewide written protocol developed by the state
board of pharmacy under section 4729.393 of the Revised Code, a
pharmacist may conduct screenings, order and administer laboratory
and diagnostic tests, evaluate the results of the screenings
conducted and tests that are ordered and administered, and provide
treatment to an individual who is five years of age or older for the
following health conditions:
(1)
Influenza;
(2)
Pharyngitis caused by the bacteria known as "group A
Streptococcus";
(3)
COVID-19.
(B)
All of the following apply with respect to a pharmacist's authority
established by this section to conduct screenings and to order and
administer laboratory and diagnostic tests:
(1)
A pharmacist may use any established procedures that can safely be
performed by a pharmacist.
(2)
A pharmacist may use any tests to guide diagnosis or clinical
decision-making that qualify for a waiver under the "Clinical
Laboratory Improvement Amendments of 1988," 42 U.S.C. 263a, or
the federal regulations adopted thereunder, as determined by the
United States centers for medicare and medicaid services.
(3)
Notwithstanding any provision of the Revised Code to the contrary, a
pharmacist may delegate technical and administrative tasks associated
with screening and testing to a pharmacy intern, registered pharmacy
technician, or certified pharmacy technician, as long as the person
to whom the tasks are delegated is acting under the direct
supervision of the pharmacist.
(C)
As part of a pharmacist's authority established by this section to
provide treatment, a pharmacist may initiate drug therapy,
notwithstanding the definition of "licensed health professional
authorized to prescribe drugs" in section 4729.01 of the Revised
Code.
(D)
The state board of pharmacy may adopt rules as it considers necessary
to implement this section. Any rules adopted under this division
shall be adopted in accordance with Chapter 119. of the Revised Code.
(E)
This section is an alternative to the authority granted by sections
4729.39 and 4729.42 of the Revised Code.
Sec.
4729.393.
(A)
The state board of pharmacy shall develop a statewide written
protocol for pharmacists to use when conducting screenings, ordering
and administering laboratory and diagnostic tests, evaluating the
results of the screenings conducted and tests that are ordered and
administered, and providing treatment for health conditions pursuant
to section 4729.392 of the Revised Code. The protocol shall include
all of the following:
(1)
Specific categories of patients a pharmacist is authorized to test or
screen;
(2)
Instructions for obtaining relevant patient medical history
information to identify disqualifying health conditions, adverse
reactions, and contraindications to a treatment;
(3)
Instructions for treatment based on a patient's age, symptoms, and
test and screening results, including negative results;
(4)
Requirements for notifying a patient's primary care provider of the
tests and screenings ordered or performed and the treatment provided;
(5)
Clinical criteria requiring referral to a physician or other health
care provider;
(6)
Dangerous drugs authorized as the approved course of treatment for
specific conditions;
(7)
Any other provisions that the board considers appropriate.
(B)
All of the following procedures apply to the development of a
protocol under this section:
(1)
Before the protocol is finalized, the state board of pharmacy shall
submit a draft protocol to the state medical board for review.
(2)
During the sixty-day period immediately following receipt of the
draft protocol, the state medical board may submit comments to the
state board of pharmacy. Any comments from the state medical board
shall be submitted in writing.
(3)
If no comments are submitted by the state medical board, the state
board of pharmacy shall proceed with finalizing the protocol.
(4)
If comments are submitted by the state medical board, the state board
of pharmacy shall review the comments. If it determines that
revisions will not be made to incorporate or otherwise address the
comments, the state board of pharmacy shall submit to the state
medial board an explanation of the reasons for not making the
revisions. Thereafter, the state board of pharmacy shall proceed with
finalizing the protocol.
(5)
To finalize the protocol, a copy shall be delivered to the president
of the state board of pharmacy for the president's signature. Once
the president has signed the protocol, the protocol is finalized and
remains in effect until any revisions are made under division (C) of
this section.
(C)
The state board of pharmacy shall review the protocol every two years
and shall make revisions as the board considers necessary. If the
board considers revisions to be necessary, the board shall make the
revisions by following the same procedures that are described in
division (B) of this section for developing the protocol.
(D)
The state board of pharmacy, through electronic communication, shall
inform all individuals licensed by the board when the initial
protocol and any revised protocol are finalized. The board shall
maintain on its internet web site a copy of the version of the
protocol that is in effect.
(E)
The state board of pharmacy and state medical board are not liable in
damages in a civil action for injury, death, or loss to person or
property allegedly arising from the use of the protocol, unless an
act or omission by the applicable board in developing, commenting on,
revising, or finalizing the protocol constitutes willful or wanton
misconduct.
Sec.
5164.14.
(A)
The
medicaid program
may
cover a health care service that
shall
provide payment to
a
pharmacist
provides
to
for
providing a health care service to
a
medicaid recipient
in accordance with
,
in the same manner that it provides payment to any other health care
provider for providing a health care service that is the equivalent
of the pharmacist-provided health care service, as long as the
medicaid program covers that type of health care service.
(B)
Division (A) of this section applies in the case of any health care
service that a pharmacist is authorized by
Chapter
4729. of the Revised Code
to provide
,
including any of the following
services
:
(A)
(1)
Managing
drug therapy under a consult agreement pursuant to section 4729.39 of
the Revised Code;
(B)
(2)
Conducting screenings, ordering and administering laboratory and
diagnostic tests, evaluating the results of such screenings and
tests, and treating health conditions, to the extent that the
foregoing activities are authorized by section 4729.392 of the
Revised Code;
(3)
Administering
immunizations
in
accordance with
pursuant
to
section
4729.41 of the Revised Code;
(C)
(4)
Administering
drugs
in
accordance with
by
injection pursuant to
section
4729.45 of the Revised Code.
Sec.
5167.051.
If
the medicaid program covers the pharmacist services described in
Under
the care management system, payments to a pharmacist for providing a
health care service are subject to the same requirements that apply
to medicaid payments under
section
5164.14 of the Revised Code
,
the department of medicaid may include the services in the care
management system
.
Section
2.
That
existing sections 1751.91, 3923.89, 4729.01, 5164.14, and 5167.051 of
the Revised Code are hereby repealed.
Section
3.
Sections
1751.91 and 3923.89 of the Revised Code, as amended by this act,
apply to contracts, policies, agreements, and plans that are
delivered, issued for delivery, modified, or renewed on or after the
effective date of this section.
Section
4.
Section
4729.01 of the Revised Code is presented in this act as a composite
of the section as amended by H.B. 52, H.B. 96, S.B. 56, and S.B. 152,
all of the 136th General Assembly. The General Assembly, applying the
principle stated in division (B) of section 1.52 of the Revised Code
that amendments are to be harmonized if reasonably capable of
simultaneous operation, finds that the composite is the resulting
version of the section in effect prior to the effective date of the
section as presented in this act.