Connecticut 2022 Regular Session

Connecticut Senate Bill SB00186 Compare Versions

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7	7		General Assembly Substitute Bill No. 186
8	8		February Session, 2022
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12	12		AN ACT CONCERNING COLLABORATIVE DRUG THERAPY
13	13		MANAGEMENT AGREEMENTS AND POLICIES.
14	14		Be it enacted by the Senate and House of Representatives in General
15	15		Assembly convened:
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17	17		Section 1. Section 20-631 of the 2022 supplement to the general 1
18	18		statutes is repealed and the following is substituted in lieu thereof 2
19	19		(Effective from passage): 3
20	20		(a) For the purposes of this section: 4
21	21		(1) "Care-giving institution" has the same meaning as provided in 5
22	22		section 20-571; 6
23	23		(2) "Commissioner" means the Commissioner of Consumer 7
24	24		Protection; 8
25	25		(3) "Collaborative drug therapy care plan" means a written document 9
26	26		memorializing the outcome of the process through which a patient and 10
27	27		one or more health care providers discuss, review and agree on an 11
28	28		approach to achieve the patient's desired health outcome; 12
29	29		(4) "Collaborative drug therapy management agreement" means an 13
30	30		agreement between one or more qualified pharmacists and one or more 14
31	31		prescribing practitioners to manage the drug therapy of individual 15
32	32		patients, or a patient population, based on a written protocol or a 16
33	33		collaborative drug therapy care plan; 17 Substitute Bill No. 186
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40	40		(5) "Collaborative drug therapy management policy" means a written 18
41	41		policy adopted by a care-giving institution under which one or more 19
42	42		qualified pharmacists manage the drug therapy of individual patients, 20
43	43		or a patient population, based on a written protocol or a collaborative 21
44	44		drug therapy care plan; 22
45	45		(6) "Pharmacist" has the same meaning as provided in section 20-571; 23
46	46		(7) "Prescribing practitioner" has the same meaning as provided in 24
47	47		section 20-571; 25
48	48		(8) "Provider-patient relationship" means a relationship between a 26
49	49		prescribing practitioner and a patient in which (A) the patient has made 27
50	50		a medical complaint, (B) the patient has provided such patient's medical 28
51	51		history, (C) the patient has received a physical examination, and (D) 29
52	52		there exists a logical connection between such medical complaint, 30
53	53		medical history and physical examination and any drug prescribed for 31
54	54		such patient; and 32
55	55		(9) "Qualified pharmacist" means a pharmacist who (A) is deemed 33
56	56		competent under regulations adopted by the commissioner pursuant to 34
57	57		subsection (e) of this section, and (B) has reviewed the latest edition of 35
58	58		the "Pharmacists' Patient Care Process" published by the Joint 36
59	59		Commission of Pharmacy Practitioners. 37
60	60		[(a)] (b) Except as provided in section 20-631b, one or more qualified 38
61	61		pharmacists [licensed under this chapter who are determined 39
62	62		competent in accordance with regulations adopted pursuant to 40
63	63		subsection (d) of this section] may enter into a [written protocol-based] 41
64	64		collaborative drug therapy management agreement [with one or more 42
65	65		physicians licensed under chapter 370 or advanced practice registered 43
66	66		nurses licensed under chapter 378 to] or manage the drug therapy of 44
67	67		individual patients, or a patient population, under a collaborative drug 45
68	68		therapy management policy. In order to enter into a [written protocol-46
69	69		based] collaborative drug therapy management agreement [, such 47
70	70		physician or advanced practice registered nurse shall have established] 48 Substitute Bill No. 186
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77	77		or collaborative drug therapy care plan, or operate under a collaborative 49
78	78		drug therapy management policy, a prescribing practitioner must first 50
79	79		establish a provider-patient relationship with the patient or patients 51
80	80		who will receive collaborative drug therapy. Each patient's collaborative 52
81	81		drug therapy management shall be [governed by a written protocol 53
82	82		which may include guideline-directed management established by the 54
83	83		treating physician or advanced practice registered nurse in consultation 55
84	84		with the pharmacist. For purposes of this subsection, a "provider-patient 56
85	85		relationship" is a relationship based on (1) the patient making a medical 57
86	86		complaint, (2) the patient providing a medical history, (3) the patient 58
87	87		receiving a physical examination, and (4) a logical connection existing 59
88	88		between the medical complaint, the medical history, the physical 60
89	89		examination and any drug prescribed for the patient] based on a 61
90	90		diagnosis made by such patient's prescribing practitioner or a specific 62
91	91		test set forth in a collaborative drug therapy management agreement or 63
92	92		collaborative drug therapy management policy. 64
93	93		[(b)] (c) A collaborative drug therapy management agreement or 65
94	94		collaborative drug therapy management policy may authorize a 66
95	95		[pharmacist to implement] qualified pharmacist or qualified 67
96	96		pharmacists to initiate, modify, continue, discontinue or deprescribe a 68
97	97		drug therapy that has been prescribed for a patient, order associated 69
98	98		laboratory tests and administer drugs, all in accordance with a patient-70
99	99		specific or patient population-specific written protocol [. Such 71
100	100		agreement] or collaborative drug therapy care plan, but may not 72
101	101		authorize a qualified pharmacist or qualified pharmacists to establish a 73
102	102		port to administer parenteral drugs. A collaborative drug therapy 74
103	103		management agreement or collaborative drug therapy management 75
104	104		policy may specifically address issues that may arise during a 76
105	105		medication reconciliation and concerns related to polypharmacy that 77
106	106		enable an authorized qualified pharmacist or qualified pharmacists to 78
107	107		[implement] initiate, modify, continue, discontinue or deprescribe drug 79
108	108		therapy. In instances where drug therapy is discontinued or 80
109	109		deprescribed, the qualified pharmacist or qualified pharmacists shall 81
110	110		notify the [treating physician or advanced practice registered nurse] 82 Substitute Bill No. 186
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117	117		prescribing practitioner of such discontinuance or deprescribing [no] 83
118	118		not later than twenty-four hours [from the time of such discontinuance 84
119	119		or deprescribing] after such drug therapy is discontinued or 85
120	120		deprescribed. Each written protocol or collaborative drug therapy care 86
121	121		plan developed, pursuant to [the] a collaborative drug therapy 87
122	122		management agreement or collaborative drug therapy management 88
123	123		policy, shall contain detailed direction concerning the actions that the 89
124	124		qualified pharmacist or qualified pharmacists may perform for [that] the 90
125	125		patient [. The] or patient population. Such written protocol or 91
126	126		collaborative drug therapy care plan shall include, but need not be 92
127	127		limited to, (1) the specific drug or drugs, therapeutic class of drug or 93
128	128		classes of drugs, or medical devices to be managed by the qualified 94
129	129		pharmacist or qualified pharmacists, (2) the terms and conditions under 95
130	130		which drug therapy may be [implemented] initiated, modified, 96
131	131		continued, discontinued or deprescribed, (3) the conditions and events 97
132	132		upon which the qualified pharmacist is, or qualified pharmacists are, 98
133	133		required to notify the [physician or advanced practice registered nurse, 99
134	134		and] prescribing practitioner, (4) the laboratory tests that may be 100
135	135		ordered, and (5) a definition of the patient population included in such 101
136	136		written protocol or collaborative drug therapy care plan. All activities 102
137	137		performed by the qualified pharmacist or qualified pharmacists in 103
138	138		conjunction with the protocol shall be documented in the patient's 104
139	139		medical record [. The pharmacist shall report any encounters within the 105
140	140		scope of the collaborative drug therapy management agreement within 106
141	141		thirty days to the physician or advanced practice registered nurse 107
142	142		regarding the patient's drug therapy management or document such 108
143	143		information within a shared medical record. The] in accordance with all 109
144	144		applicable care-giving institution policies. Each collaborative drug 110
145	145		therapy management agreement, [and protocols] collaborative drug 111
146	146		therapy management policy, written protocol and collaborative drug 112
147	147		therapy care plan shall be available for inspection by the [Departments] 113
148	148		Department of Consumer Protection and the Department of Public 114
149	149		Health. [and Consumer Protection.] A copy of the protocol shall be filed 115
150	150		in the patient's medical record. 116 Substitute Bill No. 186
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157	157		[(c)] (d) A pharmacist shall be responsible for demonstrating, in 117
158	158		accordance with regulations adopted pursuant to subsection [(d)] (e) of 118
159	159		this section, the competence necessary for [participation] the pharmacist 119
160	160		to participate in each collaborative drug therapy management 120
161	161		agreement, [into which such pharmacist enters] collaborative drug 121
162	162		therapy management policy and collaborative drug therapy care plan in 122
163	163		which such pharmacist seeks to participate by, among other things, 123
164	164		demonstrating that such pharmacist has reviewed the latest edition of 124
165	165		the "Pharmacists' Patient Care Process" published by the Joint 125
166	166		Commission of Pharmacy Practitioners. 126
167	167		[(d)] (e) The Commissioner of Consumer Protection, in consultation 127
168	168		with the Commissioner of Public Health, shall (1) adopt regulations, in 128
169	169		accordance with chapter 54, concerning competency requirements for 129
170	170		participation in a [written protocol-based] collaborative drug therapy 130
171	171		management agreement, [described in subsection (a) of this section,] the 131
172	172		minimum content of the collaborative drug therapy management 132
173	173		agreement [and the written protocol] and such other matters said 133
174	174		commissioners deem necessary to carry out the purpose of this section, 134
175	175		and (2) on or after the effective date of this section, amend such 135
176	176		regulations to include competency requirements for participation in a 136
177	177		collaborative drug therapy management policy or collaborative drug 137
178	178		therapy care plan and the minimum content of collaborative drug 138
179	179		therapy management policies, collaborative drug therapy care plans 139
180	180		and written protocols governing collaborative drug therapy 140
181	181		management. 141
182	182		Sec. 2. Section 19a-521d of the general statutes is repealed and the 142
183	183		following is substituted in lieu thereof (Effective from passage): 143
184	184		A medical director of a nursing home facility, as defined in section 144
185	185		19a-521, may establish protocols for a prescription drug formulary 145
186	186		system in accordance with guidelines established by the American 146
187	187		Society of Health-System Pharmacists and any applicable collaborative 147
188	188		drug therapy management agreement or collaborative drug therapy 148
189	189		management policy, as [described] defined in section 20-631, as 149 Substitute Bill No. 186
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196	196		amended by this act. The medical director of a nursing home facility that 150
197	197		implements a prescription drug formulary system may make a 151
198	198		substitution for a drug prescribed to a patient of the facility in 152
199	199		accordance with the provisions of this section. Prior to making any 153
200	200		substitution for a drug prescribed to a patient of the facility in 154
201	201		accordance with the facility's protocols, the medical director, or the 155
202	202		medical director's designee, shall notify the prescribing practitioner of 156
203	203		the medical director's intention to make such substitution. If the 157
204	204		prescribing practitioner does not authorize the medical director or the 158
205	205		medical director's designee to make such substitution or objects to such 159
206	206		substitution, the medical director, or the medical director's designee, 160
207	207		shall not make the substitution. Notwithstanding the provisions of this 161
208	208		section, a facility, when administering prescription drugs to a patient 162
209	209		who receives benefits under a medical assistance program administered 163
210	210		by the Department of Social Services, shall consider and administer 164
211	211		prescription drugs to such patient in accordance with (1) the 165
212	212		department's preferred drug list, developed in accordance with section 166
213	213		17b-274d, (2) prescription drug formularies under Medicare Part D, or 167
214	214		(3) the patient's health insurance policy, as the medical director of the 168
215	215		nursing home facility deems appropriate. 169
216	216		This act shall take effect as follows and shall amend the following
217	217		sections:
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219	219		Section 1 from passage 20-631
220	220		Sec. 2 from passage 19a-521d
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	222	+	Statement of Legislative Commissioners:
	223	+	In Section 1(b), "patients or a patient population" was changed to
	224	+	"patients, or a patient population," for clarity; in Section 1(c), "that" was
	225	+	bracketed and "the" was inserted after the closing bracket, and
	226	+	"caregiving institution" was changed to "care-giving institution", for
	227	+	consistency; and in Section 1(e)(2), "and" was inserted before "the
	228	+	minimum" for clarity.
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223	230		GL Joint Favorable Subst. -LCO
224		-	APP Joint Favorable
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