California provider status law effective January 1

SB 493 technically went into effect January 1, but a number of the law's provisions need regulations

The California provider status law (SB 493) technically went into effect January 1, including its important declaration of pharmacists as health care providers. But a number of the law’s provisions need regulations in order to either authorize or clarify them.

The state board of pharmacy intends to begin the rulemaking process on several of those pieces in March, according to Brian Warren, Vice President, Center of Advocacy for the California Pharmacists Association. The process usually takes an average of 9 months to complete depending on how controversial a particular regulation is, so some provisions requiring regulations may be done before the end of 2014; however, the provisions related to the new Advanced Practice Pharmacist recognition may take longer.

In California, bills that pass the legislature generally don’t become effective until the following January 1, but “when the board of pharmacy gets a regulation approved, it becomes effective immediately,” Warren told pharmacist.com. “So the sooner we can get these regulations approved and finalized, then the sooner pharmacists can start exercising the authorities.”

Provisions in effect January 1

Following are provisions of the law that went into true effect on January 1:

  • Declares pharmacists as health care providers who have the authority to provide health care services.
  • Authorizes all licensed pharmacists to:
    • Administer drugs and biologics when ordered by a prescriber. Previously, this was limited to oral and topical administration. SB 493 allows pharmacists to administer drugs via other methods, including by injection.
    • Provide consultation, training, and education about drug therapy, disease management, and disease prevention.
    • Participate in multidisciplinary review of patient progress, including appropriate access to medical records.
    • Furnish travel medications recommended by CDC not requiring a diagnosis.
    • Independently initiate and administer immunizations to patients 3 years of age and older if certain training, certification, recordkeeping, and reporting requirements are met. If a pharmacist wants to provide immunizations to children younger than 3 years, the pharmacist must have a physician protocol.
    • Order and interpret tests for the purpose of monitoring and managing the efficacy and toxicity of drug therapies, in coordination with the patient’s primary care provider or diagnosing prescriber.

Provisions requiring regulations that may be finalized in 2014

Following are provisions of the law that require regulations that may be approved and finalized by the end of 2014:

  • Authorizes all licensed pharmacists to:
    • Furnish self-administered hormonal contraceptives (the pill, the patch, and the ring) pursuant to a statewide protocol. Once a statewide protocol is adopted by the board of pharmacy, it will automatically apply to all pharmacists.
    • Furnish prescription nicotine replacement products for smoking cessation pursuant to a statewide protocol if certain training, certification, and notification requirements are met. Once a statewide protocol is adopted by the board of pharmacy, it will automatically apply to all pharmacists.

Provisions requiring regulations that may be finalized after 2014

Following are provisions of the law that require regulations that may not be finalized until after 2014:

  • Establishes an Advanced Practice Pharmacist (APP) recognition, and authorizes APPs to:
    • Perform patient assessments.
    • Order and interpret drug therapy–related tests in coordination with the patient’s primary care provider or diagnosing prescriber.
    • Refer patients to other health care providers.
    • Initiate, adjust, and discontinue drug therapy pursuant to an order by a patient’s treating prescriber and in accordance with established protocols.
    • Participate in the evaluation and management of diseases and health conditions in collaboration with other health care providers.
  • Requires pharmacists seeking recognition as APPs to complete any two of the following three criteria:
    • Earn certification in a relevant area of practice, such as ambulatory care, critical care, oncology pharmacy, or pharmacotherapy.
    • Complete a postgraduate residency program.
    • Have provided clinical services to patients for 1 year under a collaborative practice agreement or protocol with a physician, APP pharmacist, CDTM pharmacist, or health system.