EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
FIRST REGULAR SESSION
[PERFECTED]
SENATE SUBSTITUTE FOR
SENATE COMMITTEE SUBSTITUTE FOR
SENATE BILL NO. 41
102ND GENERAL ASSEMBLY
INTRODUCED BY SENATOR THOMPSON REHDER.
0719S.04P KRISTINA MARTIN, Secretary
AN ACT
To repeal section 338.010, RSMo, and to enact in lieu thereof two new sections relating to the
administration of medications by pharmacists.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Section 338.010, RSMo, is repealed and two new 1
sections enacted in lieu thereof, to be known as sections 2
338.010 and 338.012, to read as follows:3
338.010. 1. The "practice of pharmacy" [means] 1
includes: 2
(1) The interpretation, implementation, and evaluation 3
of medical prescription orders, in cluding any legend drugs 4
under 21 U.S.C. Section 353 [;], and the receipt, 5
transmission, or handling of such orders or facilitating the 6
dispensing of such orders; 7
(2) The designing, initiating, implementing, and 8
monitoring of a medication therapeu tic plan [as defined by 9
the prescription order so long as the prescription order is 10
specific to each patient for care by a pharmacist ] in 11
accordance with the provisions of this section ; 12
(3) The compounding, dispensing, labeling, and 13
administration of drugs and devices pursuant to medical 14 SS SCS SB 41 2
prescription orders [and administration of viral influenza, 15
pneumonia, shingles, hepatitis A, hepatitis B, diphtheria, 16
tetanus, pertussis, and meningitis vaccines by written 17
protocol authorized by a physician for persons at least 18
seven years of age or the age recommended by the Centers for 19
Disease Control and Prevention, whichever is higher, or the 20
administration of pneumonia, shingles, hepatitis A, 21
hepatitis B, diphtheria, tetanus, pertussis, meningitis, a nd 22
viral influenza vaccines by written protocol authorized by a 23
physician for a specific patient as authorized by rule ]; 24
(4) The ordering and administration of vaccines 25
approved or authorized by the U.S. Food and Drug 26
Administration, excluding va ccines for cholera, monkeypox, 27
Japanese encephalitis, typhoid, rabies, yellow fever, tick - 28
borne encephalitis, anthrax, tuberculosis, dengue, Hib, 29
polio, rotavirus, smallpox, and any vaccine approved after 30
January 1, 2023, to persons at least seven year s of age or 31
the age recommended by the Centers for Disease Control and 32
Prevention, whichever is older, pursuant to joint 33
promulgation of rules established by the board of pharmacy 34
and the state board of registration for the healing arts 35
unless rules are established under a state of emergency as 36
described in section 44.100; 37
(5) The participation in drug selection according to 38
state law and participation in drug utilization reviews; 39
(6) The proper and safe storage of drugs and devices 40
and the maintenance of proper records thereof; 41
(7) Consultation with patients and other health care 42
practitioners, and veterinarians and their clients about 43
legend drugs, about the safe and effective use of drugs and 44
devices; 45 SS SCS SB 41 3
(8) The prescribing and dispensing of any nicotine 46
replacement therapy product under section 338.665; 47
(9) The dispensing of HIV postexposure prophylaxis 48
pursuant to section 338.730; and 49
(10) The offering or performing of those acts, 50
services, operations, or tr ansactions necessary in the 51
conduct, operation, management and control of a pharmacy. 52
2. No person shall engage in the practice of pharmacy 53
unless he or she is licensed under the provisions of this 54
chapter. 55
3. This chapter shall not be const rued to prohibit the 56
use of auxiliary personnel under the direct supervision of a 57
pharmacist from assisting the pharmacist in any of his or 58
her duties. This assistance in no way is intended to 59
relieve the pharmacist from his or her responsibilities fo r 60
compliance with this chapter and he or she will be 61
responsible for the actions of the auxiliary personnel 62
acting in his or her assistance. 63
4. This chapter shall [also] not be construed to 64
prohibit or interfere with any legally registered 65
practitioner of medicine, dentistry, or podiatry, or 66
veterinary medicine only for use in animals, or the practice 67
of optometry in accordance with and as provided in sections 68
195.070 and 336.220 in the compounding, administering, 69
prescribing, or dispensing o f his or her own prescriptions. 70
[2. Any pharmacist who accepts a prescription order 71
for a medication therapeutic plan shall have a written 72
protocol from the physician who refers the patient for 73
medication therapy services. ] 5. A pharmacist with a 74
certificate of medication therapeutic plan authority may 75
provide medication therapy services pursuant to a written 76
protocol from a physician licensed under chapter 334 to 77 SS SCS SB 41 4
patients who have established a physician -patient 78
relationship, as described in subdivision (1) of subsection 79
1 of section 191.1146, with the protocol physician. The 80
written protocol [and the prescription order for a 81
medication therapeutic plan ] authorized by this section 82
shall come only from the physician [only,] and shall not 83
come from a nurse engaged in a collaborative practice 84
arrangement under section 334.104, or from a physician 85
assistant engaged in a collaborative practice arrangement 86
under section 334.735. 87
[3.] 6. Nothing in this section shall be construed as 88
to prevent any person, firm or corporation from owning a 89
pharmacy regulated by sections 338.210 to 338.315, provided 90
that a licensed pharmacist is in charge of such pharmacy. 91
[4.] 7. Nothing in this section shall be construed to 92
apply to or interfere with the sale of nonprescription drugs 93
and the ordinary household remedies and such drugs or 94
medicines as are normally sold by those engaged in the sale 95
of general merchandise. 96
[5.] 8. No health carrier as defined in chapter 376 97
shall require any physician with which they contract to 98
enter into a written protocol with a pharmacist for 99
medication therapeutic services. 100
[6.] 9. This section shall not be construed to allow a 101
pharmacist to diagnose or independently prescribe 102
pharmaceuticals. 103
[7.] 10. The state board of registration for the 104
healing arts, under section 334.125, and the state board of 105
pharmacy, under section 338.140, shall jointly promulgate 106
rules regulating the use of protocols [for prescription 107
orders] for medication therapy services [and administration 108
of viral influenza vaccines ]. Such rules shall require 109 SS SCS SB 41 5
protocols to include provisions allowing for timely 110
communication between the pharmacist and the [referring] 111
protocol physician or similar body authorized b y this 112
section, and any other patient protection provisions deemed 113
appropriate by both boards. In order to take effect, such 114
rules shall be approved by a majority vote of a quorum of 115
each board. Neither board shall separately promulgate rules 116
regulating the use of protocols for [prescription orders 117
for] medication therapy services [and administration of 118
viral influenza vaccines ]. Any rule or portion of a rule, 119
as that term is defined in section 536.010, that is created 120
under the authority delega ted in this section shall become 121
effective only if it complies with and is subject to all of 122
the provisions of chapter 536 and, if applicable, section 123
536.028. This section and chapter 536 are nonseverable and 124
if any of the powers vested with the gene ral assembly 125
pursuant to chapter 536 to review, to delay the effective 126
date, or to disapprove and annul a rule are subsequently 127
held unconstitutional, then the grant of rulemaking 128
authority and any rule proposed or adopted after August 28, 129
2007, shall be invalid and void. 130
[8.] 11. The state board of pharmacy may grant a 131
certificate of medication therapeutic plan authority to a 132
licensed pharmacist who submits proof of successful 133
completion of a board -approved course of academic clinical 134
study beyond a bachelor of science in pharmacy, including 135
but not limited to clinical assessment skills, from a 136
nationally accredited college or university, or a 137
certification of equivalence issued by a nationally 138
recognized professional organization and app roved by the 139
board of pharmacy. 140 SS SCS SB 41 6
[9.] 12. Any pharmacist who has received a certificate 141
of medication therapeutic plan authority may engage in the 142
designing, initiating, implementing, and monitoring of a 143
medication therapeutic plan as defined by a [prescription 144
order] written protocol from a physician that [is] may be 145
specific to each patient for care by a pharmacist. 146
[10.] 13. Nothing in this section shall be construed 147
to allow a pharmacist to make a therapeutic substitution of 148
a pharmaceutical prescribed by a physician unless authorized 149
by the written protocol or the physician's prescription 150
order. 151
[11.] 14. "Veterinarian", "doctor of veterinary 152
medicine", "practitioner of veterinary medicine", "DVM", 153
"VMD", "BVSe", "BVMS", "BS e (Vet Science)", "VMB", "MRCVS", 154
or an equivalent title means a person who has received a 155
doctor's degree in veterinary medicine from an accredited 156
school of veterinary medicine or holds an Educational 157
Commission for Foreign Veterinary Graduates (EDFV G) 158
certificate issued by the American Veterinary Medical 159
Association (AVMA). 160
[12.] 15. In addition to other requirements 161
established by the joint promulgation of rules by the board 162
of pharmacy and the state board of registration for the 163
healing arts: 164
(1) A pharmacist shall administer vaccines by protocol 165
in accordance with treatment guidelines established by the 166
Centers for Disease Control and Prevention (CDC); 167
(2) A pharmacist who is administering a vaccine shall 168
request a patient to remain in the pharmacy a safe amount of 169
time after administering the vaccine to observe any adverse 170
reactions. Such pharmacist shall have adopted emergency 171
treatment protocols; 172 SS SCS SB 41 7
[(3)] 16. In addition to other requirements by the 173
board, a pharmacist shall receive additional training as 174
required by the board and evidenced by receiving a 175
certificate from the board upon completion, and shall 176
display the certification in his or her pharmacy where 177
vaccines are delivered. 178
[13.] 17. A pharmacist shall inform the patient that 179
the administration of [the] a vaccine will be entered into 180
the ShowMeVax system, as administered by the department of 181
health and senior services. The patient shall attest to the 182
inclusion of such information in the s ystem by signing a 183
form provided by the pharmacist. If the patient indicates 184
that he or she does not want such information entered into 185
the ShowMeVax system, the pharmacist shall provide a written 186
report within fourteen days of administration of a vac cine 187
to the patient's health care provider, if provided by the 188
patient, containing: 189
(1) The identity of the patient; 190
(2) The identity of the vaccine or vaccines 191
administered; 192
(3) The route of administration; 193
(4) The anatomic site of the administration; 194
(5) The dose administered; and 195
(6) The date of administration. 196
18. A pharmacist licensed under this chapter may order 197
and administer vaccines approved or authorized by the U.S. 198
Food and Drug Administration to add ress a public health 199
need, as lawfully authorized by the state or federal 200
government, or a department or agency thereof, during a 201
state or federally declared public health emergency. 202
338.012. 1. A pharmacist with a certificate of 1
medication therapeutic plan authority may provide influenza, 2 SS SCS SB 41 8
group A streptococcus, and COVID -19 medication therapy 3
services pursuant to a statewide standing order issued by 4
the director or chief medical officer of the department of 5
health and senior se rvices if that person is a licensed 6
physician, or a licensed physician designated by the 7
department of health and senior services. 8
2. The state board of registration for the healing 9
arts, pursuant to section 334.125, and the state board of 10
pharmacy, pursuant to section 338.140, shall jointly 11
promulgate rules to implement the provisions of this 12
section. Any rule or portion of a rule, as that term is 13
defined in section 536.010, that is created under the 14
authority delegated in this section shall become effective 15
only if it complies with and is subject to all of the 16
provisions of chapter 536 and, if applicable, section 17
536.028. This section and chapter 536 are nonseverable and 18
if any of the powers vested with the general assembly 19
pursuant to chapter 536 to review, to delay the effective 20
date, or to disapprove and annul a rule are subsequently 21
held unconstitutional, then the grant of rulemaking 22
authority and any rule proposed or adopted after August 28, 23
2023, shall be invalid and void. 24