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General Assembly Raised Bill No. 186
February Session, 2022
LCO No. 1677
Referred to Committee on GENERAL LAW
Introduced by:
(GL)
AN ACT CONCERNING COLLABORATIVE DRUG THERAPY
MANAGEMENT AGREEMENTS AND POLICIES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 20-631 of the 2022 supplement to the general 1
statutes is repealed and the following is substituted in lieu thereof 2
(Effective from passage): 3
(a) For the purposes of this section: 4
(1) "Care-giving institution" has the same meaning as provided in 5
section 20-571; 6
(2) "Commissioner" means the Commissioner of Consumer 7
Protection; 8
(3) "Collaborative drug therapy care plan" means a written document 9
memorializing the outcome of the process through which a patient and 10
one or more health care providers discuss, review and agree on an 11
approach to achieve the patient's desired health outcome; 12 Raised Bill No. 186
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(4) "Collaborative drug therapy management agreement" means an 13
agreement between one or more qualified pharmacists and one or more 14
prescribing practitioners to manage the drug therapy of individual 15
patients, or a patient population, based on a written protocol or a 16
collaborative drug therapy care plan; 17
(5) "Collaborative drug therapy management policy" means a written 18
policy adopted by a care-giving institution under which one or more 19
qualified pharmacists manage the drug therapy of individual patients, 20
or a patient population, based on a written protocol or a collaborative 21
drug therapy care plan; 22
(6) "Pharmacist" has the same meaning as provided in section 20-571; 23
(7) "Prescribing practitioner" has the same meaning as provided in 24
section 20-571; 25
(8) "Provider-patient relationship" means a relationship between a 26
prescribing practitioner and a patient in which (A) the patient has made 27
a medical complaint, (B) the patient has provided such patient's medical 28
history, (C) the patient has received a physical examination, and (D) 29
there exists a logical connection between such medical complaint, 30
medical history and physical examination and any drug prescribed for 31
such patient; and 32
(9) "Qualified pharmacist" means a pharmacist who (A) is deemed 33
competent under regulations adopted by the commissioner pursuant to 34
subsection (e) of this section, and (B) has reviewed the latest edition of 35
the "Pharmacists' Patient Care Process" published by the Joint 36
Commission of Pharmacy Practitioners. 37
[(a)] (b) Except as provided in section 20-631b, one or more qualified 38
pharmacists [licensed under this chapter who are determined 39
competent in accordance with regulations adopted pursuant to 40
subsection (d) of this section] may enter into a [written protocol-based] 41
collaborative drug therapy management agreement [with one or more 42
physicians licensed under chapter 370 or advanced practice registered 43 Raised Bill No. 186
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nurses licensed under chapter 378 to] or manage the drug therapy of 44
individual patients or a patient population under a collaborative drug 45
therapy management policy. In order to enter into a [written protocol-46
based] collaborative drug therapy management agreement [, such 47
physician or advanced practice registered nurse shall have established] 48
or collaborative drug therapy care plan, or operate under a collaborative 49
drug therapy management policy, a prescribing practitioner must first 50
establish a provider-patient relationship with the patient or patients 51
who will receive collaborative drug therapy. Each patient's collaborative 52
drug therapy management shall be [governed by a written protocol 53
which may include guideline-directed management established by the 54
treating physician or advanced practice registered nurse in consultation 55
with the pharmacist. For purposes of this subsection, a "provider-patient 56
relationship" is a relationship based on (1) the patient making a medical 57
complaint, (2) the patient providing a medical history, (3) the patient 58
receiving a physical examination, and (4) a logical connection existing 59
between the medical complaint, the medical history, the physical 60
examination and any drug prescribed for the patient] based on a 61
diagnosis made by such patient's prescribing practitioner or a specific 62
test set forth in a collaborative drug therapy management agreement or 63
collaborative drug therapy management policy. 64
[(b)] (c) A collaborative drug therapy management agreement or 65
collaborative drug therapy management policy may authorize a 66
[pharmacist to implement] qualified pharmacist or qualified 67
pharmacists to initiate, modify, continue, discontinue or deprescribe a 68
drug therapy that has been prescribed for a patient, order associated 69
laboratory tests and administer drugs, all in accordance with a patient-70
specific or patient population-specific written protocol [. Such 71
agreement] or collaborative drug therapy care plan, but may not 72
authorize a qualified pharmacist or qualified pharmacists to establish a 73
port to administer parenteral drugs. A collaborative drug therapy 74
management agreement or collaborative drug therapy management 75
policy may specifically address issues that may arise during a 76
medication reconciliation and concerns related to polypharmacy that 77 Raised Bill No. 186
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enable an authorized qualified pharmacist or qualified pharmacists to 78
[implement] initiate, modify, continue, discontinue or deprescribe drug 79
therapy. In instances where drug therapy is discontinued or 80
deprescribed, the qualified pharmacist or qualified pharmacists shall 81
notify the [treating physician or advanced practice registered nurse] 82
prescribing practitioner of such discontinuance or deprescribing [no] 83
not later than twenty-four hours [from the time of such discontinuance 84
or deprescribing] after such drug therapy is discontinued or 85
deprescribed. Each written protocol or collaborative drug therapy care 86
plan developed, pursuant to [the] a collaborative drug therapy 87
management agreement or collaborative drug therapy management 88
policy, shall contain detailed direction concerning the actions that the 89
qualified pharmacist or qualified pharmacists may perform for that 90
patient [. The] or patient population. Such written protocol or 91
collaborative drug therapy care plan shall include, but need not be 92
limited to, (1) the specific drug or drugs, therapeutic class of drug or 93
classes of drugs, or medical devices to be managed by the qualified 94
pharmacist or qualified pharmacists, (2) the terms and conditions under 95
which drug therapy may be [implemented] initiated, modified, 96
continued, discontinued or deprescribed, (3) the conditions and events 97
upon which the qualified pharmacist is, or qualified pharmacists are, 98
required to notify the [physician or advanced practice registered nurse, 99
and] prescribing practitioner, (4) the laboratory tests that may be 100
ordered, and (5) a definition of the patient population included in such 101
written protocol or collaborative drug therapy care plan. All activities 102
performed by the qualified pharmacist or qualified pharmacists in 103
conjunction with the protocol shall be documented in the patient's 104
medical record [. The pharmacist shall report any encounters within the 105
scope of the collaborative drug therapy management agreement within 106
thirty days to the physician or advanced practice registered nurse 107
regarding the patient's drug therapy management or document such 108
information within a shared medical record. The] in accordance with all 109
applicable caregiving institution policies. Each collaborative drug 110
therapy management agreement, [and protocols] collaborative drug 111
therapy management policy, written protocol and collaborative drug 112 Raised Bill No. 186
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therapy care plan shall be available for inspection by the [Departments] 113
Department of Consumer Protection and the Department of Public 114
Health. [and Consumer Protection.] A copy of the protocol shall be filed 115
in the patient's medical record. 116
[(c)] (d) A pharmacist shall be responsible for demonstrating, in 117
accordance with regulations adopted pursuant to subsection [(d)] (e) of 118
this section, the competence necessary for [participation] the pharmacist 119
to participate in each collaborative drug therapy management 120
agreement, [into which such pharmacist enters] collaborative drug 121
therapy management policy and collaborative drug therapy care plan in 122
which such pharmacist seeks to participate by, among other things, 123
demonstrating that such pharmacist has reviewed the latest edition of 124
the "Pharmacists' Patient Care Process" published by the Joint 125
Commission of Pharmacy Practitioners. 126
[(d)] (e) The Commissioner of Consumer Protection, in consultation 127
with the Commissioner of Public Health, shall (1) adopt regulations, in 128
accordance with chapter 54, concerning competency requirements for 129
participation in a [written protocol-based] collaborative drug therapy 130
management agreement, [described in subsection (a) of this section,] the 131
minimum content of the collaborative drug therapy management 132
agreement [and the written protocol] and such other matters said 133
commissioners deem necessary to carry out the purpose of this section, 134
and (2) on or after the effective date of this section, amend such 135
regulations to include competency requirements for participation in a 136
collaborative drug therapy management policy or collaborative drug 137
therapy care plan, the minimum content of collaborative drug therapy 138
management policies, collaborative drug therapy care plans and written 139
protocols governing collaborative drug therapy management. 140
Sec. 2. Section 19a-521d of the general statutes is repealed and the 141
following is substituted in lieu thereof (Effective from passage): 142
A medical director of a nursing home facility, as defined in section 143
19a-521, may establish protocols for a prescription drug formulary 144 Raised Bill No. 186
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system in accordance with guidelines established by the American 145
Society of Health-System Pharmacists and any applicable collaborative 146
drug therapy management agreement or collaborative drug therapy 147
management policy, as [described] defined in section 20-631, as 148
amended by this act. The medical director of a nursing home facility that 149
implements a prescription drug formulary system may make a 150
substitution for a drug prescribed to a patient of the facility in 151
accordance with the provisions of this section. Prior to making any 152
substitution for a drug prescribed to a patient of the facility in 153
accordance with the facility's protocols, the medical director, or the 154
medical director's designee, shall notify the prescribing practitioner of 155
the medical director's intention to make such substitution. If the 156
prescribing practitioner does not authorize the medical director or the 157
medical director's designee to make such substitution or objects to such 158
substitution, the medical director, or the medical director's designee, 159
shall not make the substitution. Notwithstanding the provisions of this 160
section, a facility, when administering prescription drugs to a patient 161
who receives benefits under a medical assistance program administered 162
by the Department of Social Services, shall consider and administer 163
prescription drugs to such patient in accordance with (1) the 164
department's preferred drug list, developed in accordance with section 165
17b-274d, (2) prescription drug formularies under Medicare Part D, or 166
(3) the patient's health insurance policy, as the medical director of the 167
nursing home facility deems appropriate. 168
This act shall take effect as follows and shall amend the following
sections:
Section 1 from passage 20-631
Sec. 2 from passage 19a-521d
Statement of Purpose:
To: (1) Enable care-giving institutions to institute, and certain
pharmacists to operate under, collaborative drug therapy management
policies; (2) provide that prescribing practitioners and pharmacists may
enter into collaborative drug therapy management agreements and Raised Bill No. 186
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operate under collaborative drug therapy management policies; (3)
provide that collaborative drug therapy management agreements and
policies may apply to patient populations; (4) require that written
protocols and collaborative drug therapy care plans (A) be specific to
the patient, patients or patient populations involved, (B) contain
detailed direction concerning the actions pharmacists may perform for
the patient population involved, (C) include the therapeutic class of
drug or classes of drugs, or medical devices, to be managed by
pharmacists, and (D) contain a definition of the patient population
involved; (5) eliminate a reporting requirement concerning encounters
within the scope of collaborative drug therapy man agement
agreements; (6) impose a reporting requirement concerning changes
made to drug therapies within the scope of collaborative drug therapy
management agreements and policies; and (7) require the
Commissioner of Consumer Protection to adopt regulations concerning
collaborative drug therapy management policies.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
underlined.]