California’s SB 493 implementation: 
Three, two, one … blast-off!

Hub on Provider Status

The wait is almost over for pharmacists to exercise more of the authorities granted under California’s provider status law. The California Board of Pharmacy has completed its work developing the protocols of SB 493 and is now in the process of formalizing the protocols as state regulations—the final piece of the process that will implement more of the state’s landmark law, which was passed in 2013. SB 493 does not address payment.

“We are excited it’s moving through the final stages in the regulatory process so we can get it into practice,” Jon Roth, CAE, CEO of the California Pharmacists Association, told Pharmacy Today. “By next quarter, we will really see pharmacists implementing SB 493—whether that’s the contraceptive piece or initiating smoking cessation or other authorities granted in the legislation.”

Pharmacists are providers

SB 493 declares pharmacists to be health care providers and expands their scope of practice. Many of the law’s provisions required regulations to either authorize or clarify them.

Pharmacists will be able to initiate certain prescriptions, along with providing clinical advice and patient consultation. For example, when ordering self-administered hormonal contraceptives for patients, pharmacists will ask patients to complete a questionnaire, undergo a blood pressure test, and then discuss dosing with them. 

Other provisions in the law allow pharmacists to provide nicotine replacement therapy to patients, prescribe medications for travel abroad, and order tests to monitor and manage the efficacy and toxicity of drug therapies for patients with diabetes, hypertension, and other conditions. 

“Pharmacists are educated to perform these additional duties,” Virginia Herold, Executive Officer of the California Board of Pharmacy, told Today. 

Advanced Practice Pharmacist recognition

SB 493 also includes a new licensure for Advanced Practice Pharmacist recognition. (See sidebar for more information.)

“There was a time when getting a flu shot at a pharmacy was novel. Now this is a standard of care,” Lisa Kroon, PharmD, Professor at the University of California, San Francisco’s (UCSF) School of Pharmacy, told Today. She has been active in the law’s implementation. 

“Imagine a day when a patient goes to get their blood pressure medication, such as an ACE or ARB, at the pharmacy—and the pharmacist assesses the need for any lab tests, and orders electrolytes.”

Electronic health records

She said an important part of the law is that the pharmacist will communicate with the patient’s primary care provider on the patient care services they provide. But to make this more seamless, community pharmacists should be connected with providers through the patient’s electronic health record (EHR). 

“As pharmacists start providing these services, hopefully we will see more integration with these health record systems,” said Kroon. 

In fact, pharmacists at the UCSF Walgreens, which has a formal partnership with UCSF School of Pharmacy, are able to access a read-only version of an EHR and can directly message providers about medication-related problems. This Walgreens pharmacy location will be one of the first to take advantage of SB 493 in California. 

Provisions of the law for which regulations are being finalized

Soon-to-be effective provisions of SB 493 authorize all licensed pharmacists to

  • Furnish self-administered hormonal contraceptives (the pill, the patch, the ring, and Depo-Provera) pursuant to a statewide protocol

  • Furnish prescription nicotine replacement products for tobacco cessation pursuant to a statewide protocol if certain training, certification, and notification requirements are met

  • Furnish prescription travel medications recommended by CDC

  • SB 493 establishes an Advanced Practice Pharmacist (APP) recognition, and authorizes APPs to

  • Perform patient assessments

  • Order and interpret drug therapy–related tests 

  • 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 

SB 493 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