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An Act
ENROLLED HOUSE
BILL NO. 4431 By: Hilbert of the House
and
Rosino of the Senate
An Act relating to professions and occupations;
amending 59 O.S. 2021, Section 353.1, as last amended
by Section 5, Chapter 340, O.S.L. 2025 (59 O.S. Supp.
2025, Section 353.1), which relates to definitions
within the Oklahoma Pharmacy Act; modifying
references; amending 59 O.S. 2021, Section 353.1a, as
amended by Section 6, Chapter 340, O.S.L. 2025 (59
O.S. Supp. 2025, Section 353.1a), which relates to
prescribing authority for Advanced Practice
Registered Nurse, Certified Nurse Practitioner,
Clinical Nurse Specialist, Certified Midwife;
modifying references; amending 59 O.S. 2021, Section
519.3, as amended by Section 4, Chapter 343, O.S.L.
2025 (59 O.S. Supp. 2025, Section 519.3), which
relates to the Physician Assistant Committee;
modifying procedures with respect to license
applications; amending 59 O.S. 2021, Section 519.4,
as amended by Section 7, Chapter 350, O.S.L. 2025 (59
O.S. Supp. 2025, Section 519.4), which relates to
physician assistant licensure; modifying requirements
related to jurisprudence examinations; repealing 59
O.S. 2021, Section 353.1, as last amended by Section
1, Chapter 343, O.S.L. 2025 (59 O.S. Supp. 2025,
Section 353.1), which relates to a duplicate section;
repealing 59 O.S. 2021, Section 353.1a, as amended by
Section 2, Chapter 343, O.S.L. 2025 (59 O.S. Supp.
2025, Section 353.1a), which relates to a duplicate
section; and providing an effective date.
SUBJECT: Professions and occupations
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
ENR. H. B. NO. 4431 Page 2
SECTION 1. AMENDATORY 59 O.S. 2021, Section 353.1, as
last amended by Section 5, Chapter 340, O.S.L. 2025 (59 O.S. Supp.
2025, Section 353.1), is amended to read as follows:
Section 353.1. For the purposes of the Oklahoma Pharmacy Act:
1. "Accredited program" means those seminars, classes,
meetings, work projects, and other educational courses approved by
the State Board of Pharmacy for purposes of continuing professional
education;
2. "Act" means the Oklahoma Pharmacy Act;
3. "Administer" means the direct application of a drug, whether
by injection, inhalation, ingestion, or any other means, to the body
of a patient;
4. "Assistant pharmacist" means any person presently licensed
as an assistant pharmacist in this state by the Board pursuant to
Section 353.10 of this title and for the purposes of the Oklahoma
Pharmacy Act shall be considered the same as a pharmacist, except
where otherwise specified;
5. "Board" or "State Board" means the State Board of Pharmacy;
6. "Certify" or "certification of a prescription" means the
review of a filled prescription by a licensed pharmacist or a
licensed practitioner with dispensing authority to confirm that the
medication, labeling, and packaging of the filled prescription are
accurate and meet all requirements prescribed by state and federal
law. For the purposes of this paragraph, "licensed practitioner"
shall not include optometrists with dispensing authority;
7. "Chemical" means any medicinal substance, whether simple or
compound or obtained through the process of the science and art of
chemistry, whether of organic or inorganic origin;
8. "Compounding" means the combining, admixing, mixing,
diluting, pooling, reconstituting, or otherwise altering of a drug
or bulk drug substance to create a drug. Compounding includes the
preparation of drugs or devices in anticipation of prescription drug
orders based on routine, regularly observed prescribing patterns;
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9. "Continuing professional education" means professional,
pharmaceutical education in the general areas of the socioeconomic
and legal aspects of health care; the properties and actions of
drugs and dosage forms; and the etiology, characteristics, and
therapeutics of the diseased state;
10. "Dangerous drug", "legend drug", "prescription drug", or
"Rx Only" means a drug:
a. for human use subject to 21 U.S.C., Section 353(b)(1),
or
b. is labeled "Prescription Only", or labeled with the
following statement: "Caution: Federal law restricts
this drug to use by or on the order of a licensed
veterinarian.";
11. "Director" means the Executive Director of the State Board
of Pharmacy unless context clearly indicates otherwise;
12. "Dispense" or "dispensing" means the interpretation,
evaluation, and implementation of a prescription drug order
including the preparation and delivery of a drug or device to a
patient or a patient's agent in a suitable container appropriately
labeled for subsequent administration to, or use by, a patient.
Dispense includes sell, distribute, leave with, give away, dispose
of, deliver, or supply;
13. "Dispenser" means a retail pharmacy, hospital pharmacy, a
group of chain pharmacies under common ownership and control that do
not act as a wholesale distributor, or any other person authorized
by law to dispense or administer prescription drugs, and the
affiliated warehouses or distributions of such entities under common
ownership and control that do not act as a wholesale distributor.
For the purposes of this paragraph, dispenser does not mean a person
who dispenses only products to be used in animals in accordance with
21 U.S.C., Section 360b(a)(5);
14. "Distribute" or "distribution" means the sale, purchase,
trade, delivery, handling, storage, or receipt of a product, and
does not include the dispensing of a product pursuant to a
prescription executed in accordance with 21 U.S.C., Section
353(b)(1) or the dispensing of a product approved under 21 U.S.C.,
Section 360b(b); provided, taking actual physical possession of a
product or title shall not be required;
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15. "Doctor of Pharmacy" means a person licensed by the Board
to engage in the practice of pharmacy. The terms "pharmacist",
"D.Ph.", and "Doctor of Pharmacy" shall be interchangeable and shall
have the same meaning wherever they appear in the Oklahoma Statutes
and the rules promulgated by the Board;
16. "Drug outlet" means all manufacturers, repackagers,
outsourcing facilities, wholesale distributors, third-party
logistics providers, pharmacies, and all other facilities which are
engaged in dispensing, delivery, distribution, or storage of
dangerous drugs;
17. "Drugs" means all medicinal substances and preparations
recognized by the United States Pharmacopeia and National Formulary,
or any revision thereof, and all substances and preparations
intended for external and/or internal use in the cure, diagnosis,
mitigation, treatment, or prevention of disease in humans or animals
and all substances and preparations, other than food, intended to
affect the structure or any function of the body of a human or
animals;
18. "Drug sample" means a unit of a prescription drug packaged
under the authority and responsibility of the manufacturer that is
not intended to be sold and is intended to promote the sale of the
drug;
19. "Durable medical equipment" has the same meaning as
provided by Section 375.2 of this title;
20. "Filled prescription" means a packaged prescription
medication to which a label has been affixed which contains such
information as is required by the Oklahoma Pharmacy Act;
21. "Hospital" means any institution licensed as a hospital by
this state for the care and treatment of patients, or a pharmacy
operated by the Oklahoma Department of Veterans Affairs;
22. "Licensed practitioner" means:
a. an allopathic physician,
b. an osteopathic physician,
c. a podiatric physician,
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d. a dentist,
e. a veterinarian,
f. an optometrist, or
g. an Advanced Practice Registered Nurse, or
h. a physician assistant
licensed to practice and authorized to prescribe dangerous drugs
within the scope of practice of such practitioner;
23. "Manufacturer" or "virtual manufacturer" means with respect
to a product:
a. a person that holds an application approved under 21
U.S.C., Section 355 or a license issued under 42
U.S.C., Section 262 for such product, or if such
product is not the subject of an approved application
or license, the person who manufactured the product,
b. a co-licensed partner of the person described in
subparagraph a of this paragraph that obtains the
product directly from a person described in this
subparagraph or subparagraph a of this paragraph,
c. an affiliate of a person described in subparagraph a
or b of this paragraph who receives the product
directly from a person described in this subparagraph
or in subparagraph a or b of this paragraph, or
d. a person who contracts with another to manufacture a
product;
24. "Manufacturing" means the production, preparation,
propagation, compounding, conversion, or processing of a device or a
drug, either directly or indirectly by extraction from substances of
natural origin or independently by means of chemical or biological
synthesis and includes any packaging or repackaging of the
substances or labeling or relabeling of its container, and the
promotion and marketing of such drugs or devices. The term
manufacturing also includes the preparation and promotion of
ENR. H. B. NO. 4431 Page 6
commercially available products from bulk compounds for resale by
licensed pharmacies, licensed practitioners, or other persons;
25. "Medical gas" means those gases including those in liquid
state upon which the manufacturer or distributor has placed one of
several cautions, such as "Rx Only", in compliance with federal law;
26. "Medical gas order" means an order for medical gas issued
by a licensed prescriber;
27. "Medical gas distributor" means a person licensed to
distribute, transfer, wholesale, deliver, or sell medical gases on
drug orders to suppliers or other entities licensed to use,
administer, or distribute medical gas and may also include a patient
or ultimate user;
28. "Medical gas supplier" means a person who dispenses medical
gases on drug orders only to a patient or ultimate user;
29. "Medicine" means any drug or combination of drugs which has
the property of curing, preventing, treating, diagnosing, or
mitigating diseases, or which is used for that purpose;
30. "Nonprescription drugs" means medicines or drugs which are
sold without a prescription and which are prepackaged for use by the
consumer and labeled in accordance with the requirements of the
statutes and regulations of this state and the federal government.
Such items shall also include medical and dental supplies and
bottled or nonbulk chemicals which are sold or offered for sale to
the general public if such articles or preparations meet the
requirements of the Federal Food, Drug, and Cosmetic Act, 21
U.S.C.A., Section 321 et seq.;
31. "Outsourcing facility" including "virtual outsourcing
facility" means a facility at one geographic location or address
that:
a. is engaged in the compounding of sterile drugs,
b. has elected to register as an outsourcing facility,
and
c. complies with all requirements of 21 U.S.C., Section
353b;
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32. "Package" means the smallest individual saleable unit of
product for distribution by a manufacturer or repackager that is
intended by the manufacturer for ultimate sale to the dispenser of
such product. For the purposes of this paragraph, "individual
saleable unit" means the smallest container of a product introduced
into commerce by the manufacturer or repackager that is intended by
the manufacturer or repackager for individual sale to a dispenser;
33. "Person" means an individual, partnership, limited
liability company, corporation, or association, unless the context
otherwise requires;
34. "Pharmacist-in-charge" or "PIC" means the pharmacist
licensed in this state responsible for the management control of a
pharmacy and all other aspects of the practice of pharmacy in a
licensed pharmacy as provided by Section 353.18 of this title;
35. "Pharmacy" means a place regularly licensed by the State
Board of Pharmacy in which prescriptions, drugs, medicines,
chemicals, and poisons are compounded or dispensed or such place
where pharmacists practice the profession of pharmacy, or a pharmacy
operated by the Oklahoma Department of Veterans Affairs;
36. "Pharmacy technician", "technician", "Rx tech", or "tech"
means a person issued a technician permit by the State Board of
Pharmacy to assist the pharmacist and perform nonjudgmental,
technical, manipulative, non-discretionary functions in the
prescription department under the immediate and direct supervision
of a pharmacist;
37. "Poison" means any substance which when introduced into the
body, either directly or by absorption, produces violent, morbid, or
fatal changes, or which destroys living tissue with which such
substance comes into contact;
38. "Practice of pharmacy" means:
a. the interpretation and evaluation of prescription
orders,
b. the compounding, dispensing, administering, and
labeling of drugs and devices, except labeling by a
manufacturer, repackager, or distributor of
nonprescription drugs and commercially packaged legend
drugs and devices,
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c. the participation in drug selection and drug
utilization reviews,
d. the proper and safe storage of drugs and devices and
the maintenance of proper records thereof,
e. the responsibility for advising by counseling and
providing information, where professionally necessary
or where regulated, of therapeutic values, content,
hazards, and use of drugs and devices,
f. the offering or performing of those acts, services,
operations, or transactions necessary in the conduct,
operation, management, and control of a pharmacy, or
g. the provision of those acts or services that are
necessary to provide pharmaceutical care;
39. "Preparation" means an article which may or may not contain
sterile products compounded in a licensed pharmacy pursuant to the
order of a licensed prescriber;
40. "Prescriber" means a person licensed in this state who is
authorized to prescribe dangerous drugs within the scope of practice
of the person's profession;
41. "Prescription" means and includes any order for drug or
medical supplies written or signed, or transmitted by word of mouth,
telephone, or other means of communication:
a. by a licensed prescriber, including:
(1) a Certified Nurse Practitioner, Clinical Nurse
Specialist, or Certified Nurse-Midwife licensed
in the state who has obtained independent
prescriptive authority under Section 567.4c of
Title 59 of the Oklahoma Statutes, and
(2) a physician assistant entitled to practice
without the supervision of a delegating physician
under Section 519.6 of Title 59 of the Oklahoma
Statutes;
ENR. H. B. NO. 4431 Page 9
b. by a physician assistant pursuant to a practice
agreement,
c. (1) under the supervision of a supervising physician,
by a Certified Nurse Practitioner, Clinical Nurse
Specialist, or Certified Nurse-Midwife licensed
in this state who has not obtained independent
prescriptive authority under Section 1 of this
act Section 567.4c of Title 59 of the Oklahoma
Statutes under the supervision of a supervising
physician, or
(2) by a Certified Nurse Practitioner, Clinical Nurse
Specialist, or Certified Nurse-Midwife licensed
in this state who has obtained independent
prescriptive authority under Section 1 of this
act, or
d. by an Oklahoma licensed wholesaler or distributor as
authorized in Section 353.29.1 of this title;
42. "Product" means a prescription drug in a finished dosage
form for administration to a patient without substantial further
manufacturing, such as capsules, tablets, and lyophilized products
before reconstitution. Product does not include blood components
intended for transfusion, radioactive drugs or biologics and medical
gas;
43. "Repackager", including "virtual repackager", means a
person who owns or operates an establishment that repacks and
relabels a product or package for further sale or distribution
without further transaction;
44. "Sterile drug" means a drug that is intended for parenteral
administration, an ophthalmic or oral inhalation drug in aqueous
format, or a drug that is required to be sterile under state and
federal law;
45. "Supervising physician" means an individual holding a
current license to practice as a physician from the State Board of
Medical Licensure and Supervision, pursuant to the provisions of the
Oklahoma Allopathic Medical and Surgical Licensure and Supervision
Act, or the State Board of Osteopathic Examiners, pursuant to the
provisions of the Oklahoma Osteopathic Medicine Act, who supervises
a Certified Nurse Practitioner, Clinical Nurse Specialist, or
ENR. H. B. NO. 4431 Page 10
Certified Nurse-Midwife as defined in Section 567.3a of this title
who has not obtained independent prescriptive authority under
Section 1 of this act 567.4c of this title, and who is not in
training as an intern, resident, or fellow. The supervising
physician shall remain in compliance with the rules promulgated by
the State Board of Medical Licensure and Supervision or the State
Board of Osteopathic Examiners;
46. "Supportive personnel" means technicians and auxiliary
supportive persons who are regularly paid employees of a pharmacy
who work and perform tasks in the pharmacy as authorized by Section
353.18A of this title;
47. "Third-party logistics provider" including "virtual third-
party logistics provider" means an entity that provides or
coordinates warehousing, or other logistics services of a product in
interstate commerce on behalf of a manufacturer, wholesale
distributor, or dispenser of a product but does not take ownership
of the product, nor have responsibility to direct the sale or
disposition of the product. For the purposes of this paragraph,
third-party logistics provider does not include shippers and the
United States Postal Service;
48. "Wholesale distributor" including "virtual wholesale
distributor" means a person other than a manufacturer, a
manufacturer's co-licensed partner, a third-party logistics
provider, or repackager engaged in wholesale distribution as defined
by 21 U.S.C., Section 353(e)(4) as amended by the Drug Supply Chain
Security Act;
49. "County jail" means a facility operated by a county for the
physical detention and correction of persons charged with, or
convicted of, criminal offenses or ordinance violations or persons
found guilty of civil or criminal contempt;
50. "State correctional facility" means a facility or
institution that houses a prisoner population under the jurisdiction
of the Department of Corrections;
51. "Unit dose package" means a package that contains a single
dose drug with the name, strength, control number, and expiration
date of that drug on the label; and
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52. "Unit of issue package" means a package that provides
multiple doses of the same drug, but each drug is individually
separated and includes the name, lot number, and expiration date.
SECTION 2. AMENDATORY 59 O.S. 2021, Section 353.1a, as
amended by Section 6, Chapter 340, O.S.L. 2025 (59 O.S. Supp. 2025,
Section 353.1a), is amended to read as follows:
Section 353.1a. A. Prescriptive authority for certain licensed
Advanced Practice Registered Nurses:
1. Prescriptive authority shall be allowed, under a current
supervision agreement with a supervising physician, for a licensed
Advanced Practice Registered Nurse recognized by the Oklahoma Board
of Nursing as a Certified Nurse Practitioner, Clinical Nurse
Specialist, or Certified Nurse-Midwife who has not obtained
independent prescriptive authority under Section 1 of this act.
pursuant to Section 567.4c of Title 59 of the Oklahoma Statutes; and
2. Prescriptive authority shall be allowed, independent of a
current supervision agreement with a supervising physician, for a
licensed Advanced Practice Registered Nurse recognized by the
Oklahoma Board of Nursing as a Certified Nurse Practitioner,
Clinical Nurse Specialist, or Certified Nurse-Midwife who has
obtained independent prescriptive authority under Section 1 of this
act pursuant to Section 567.4c of Title 59 of the Oklahoma Statutes.
B. Prescriptive authority for physician assistants:
1. Prescriptive authority shall be allowed, pursuant to a
practice agreement, for a physician assistant required to practice
under supervision of a delegating physician; and
2. Prescriptive authority shall be allowed for a physician
assistant not required to practice under supervision of a delegating
physician.
C. The An Advanced Practice Registered Nurse may write or sign,
or transmit by word of mouth, telephone, or other means of
communication an order for drugs or medical supplies that is
intended to be filled, compounded, or dispensed by a pharmacist.
The supervising physician, if applicable, and the prescribing
Advanced Practice Registered Nurse shall be identified at the time
of origination of the prescription and the name of the prescribing
ENR. H. B. NO. 4431 Page 12
Advanced Practice Registered Nurse shall be printed on the
prescription label.
C. D. Pharmacists may dispense prescriptions for non-controlled
prescription drugs authorized by an Advanced Practice Registered
Nurse or physician assistant, not located in this state, provided
that they are licensed in the state in which they are actively
prescribing.
D. 1. E. Pharmacists may only dispense prescriptions for
controlled dangerous substances prescribed by:
1. an An Advanced Practice Registered Nurse licensed in this
state who meets the criteria in paragraph 1 or 2 of subsection A of
this section.
2. Pharmacists may only dispense prescriptions for controlled
dangerous substances prescribed by a A physician assistant licensed
in this state pursuant to a practice agreement.
F. Pharmacies and pharmacists may rely on the Board of Medical
Licensure and Supervision list of physician assistants who have
reported completion of six thousand two hundred forty (6,240) or
more postgraduate clinical experience hours and are thus entitled to
prescribe without a practice agreement.
SECTION 3. AMENDATORY 59 O.S. 2021, Section 519.3, as
amended by Section 4, Chapter 343, O.S.L. 2025 (59 O.S. Supp. 2025,
Section 519.3), is amended to read as follows:
Section 519.3. A. There is hereby created the Physician
Assistant Committee, which shall be composed of nine (9) members.
Five members of the Committee shall be physician assistants
appointed by the State Board of Medical Licensure and Supervision
from a list of qualified individuals submitted by the Oklahoma
Academy of Physician Assistants. One member shall be a physician
appointed by the Board from its membership. One member shall be a
physician appointed by the Board from a list of qualified
individuals submitted by the Oklahoma State Medical Association and
who is not a member of the Board. One member shall be a physician
appointed by the State Board of Osteopathic Examiners from its
membership. One member shall be a physician appointed by the State
Board of Osteopathic Examiners from a list of qualified individuals
submitted by the Oklahoma Osteopathic Association and who is not a
member of said board.
ENR. H. B. NO. 4431 Page 13
B. The term of office for each member of the Committee shall be
five (5) years.
C. The Committee shall meet at least quarterly. At the initial
meeting of each calendar year, the Committee members shall elect a
chair from the physician assistant members. The chair or his or her
designee shall represent the Committee at all meetings of the Board.
Five members shall constitute a quorum for the purpose of conducting
official business of the Committee.
D. The State Board of Medical Licensure and Supervision is
hereby granted the power and authority to promulgate rules, which
are in accordance with the provisions of Section 519.1 et seq. of
this title, governing the requirements for licensure as a physician
assistant, as well as to establish standards for training, approve
institutions for training, and regulate the standards of practice of
a physician assistant after licensure, including the power of
revocation of a license.
E. The State Board of Medical Licensure and Supervision is
hereby granted the power and authority to investigate all
complaints, hold hearings, subpoena witnesses and initiate
prosecution concerning violations of Section 519.1 et seq. of this
title. When such complaints involve physicians licensed by the
State Board of Osteopathic Examiners, the State Board of Osteopathic
Examiners shall be officially notified of such complaints.
F. 1. The Committee shall advise the Board on all matters
pertaining to the practice of physician assistants.
2. The Committee shall review and make recommendations to the
Board for approval of or other action on all applications for
licensure as a physician assistant and all applications to practice
which shall be approved by the Board. When considering applicants
for licensure, to establish standards of training or approve
institutions for training, the Committee shall include the Director,
or designee, of all Physician Assistant educational programs
conducted by institutions of higher education in the state as
members.
3. The Committee shall assist and advise the Board in all
hearings involving physician assistants who are deemed to be in
violation of Section 519.1 et seq. of this title or the rules of the
Board.
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SECTION 4. AMENDATORY 59 O.S. 2021, Section 519.4, as
amended by Section 7, Chapter 350, O.S.L. 2025 (59 O.S. Supp. 2025,
Section 519.4), is amended to read as follows:
Section 519.4. To be eligible for licensure as a physician
assistant pursuant to the provisions of Section 519.1 et seq. of
this title an applicant shall:
1. Have graduated from an accredited physician assistant
program recognized by the State Board of Medical Licensure and
Supervision;
2. Successfully pass an examination for physician assistants
recognized by the Board; and
3. Obtain a national criminal history background check; and
4. Successfully complete the jurisprudence examination of the
Board, in accordance with rules promulgated by the Board, upon
initial licensure or upon application to reenter practice.
SECTION 5. REPEALER 59 O.S. 2021, Section 353.1, as last
amended by Section 1, Chapter 343, O.S.L. 2025 (59 O.S. Supp. 2025,
Section 353.1), is hereby repealed.
SECTION 6. REPEALER 59 O.S. 2021, Section 353.1a, as
amended by Section 2, Chapter 343, O.S.L. 2025 (59 O.S. Supp. 2025,
Section 353.1a), is hereby repealed.
SECTION 7. This act shall become effective November 1, 2026.
ENR. H. B. NO. 4431 Page 15
Passed the House of Representatives the 6th day of May, 2026.
Presiding Officer of the House
of Representatives
Passed the Senate the 29th day of April, 2026.
Presiding Officer of the Senate
OFFICE OF THE GOVERNOR
Received by the Office of the Governor this ____________________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________
Approved by the Governor of the State of Oklahoma this _________
day of ___________________, 20_______, at _______ o'clock _______ M.
_________________________________
Governor of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary of State this __________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________