FIRST REGULAR SESSION
SENATE BILL NO. 659
102ND GENERAL ASSEMBLY
INTRODUCED BY SENATOR MCCREERY.
2427S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal section 338.010, RSMo, and to enact in lieu thereof two new sections relating to
contraceptives.
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Section A. Section 338.010, RSMo, is repealed and two new 1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 338.720, to read as follows:3
338.010. 1. The "practice of pharmacy" means the 1
interpretation, implementation, and evaluation of medical 2
prescription orders, including any l egend drugs under 21 3
U.S.C. Section 353; the receipt, transmission, or handling 4
of such orders or facilitating the dispensing of such 5
orders; the designing, initiating, implementing, and 6
monitoring of a medication therapeutic plan as defined by 7
the prescription order so long as the prescription order is 8
specific to each patient for care by a pharmacist; the 9
compounding, dispensing, labeling, and administration of 10
drugs and devices pursuant to medical prescription orders 11
and administration of viral influenza, pneumonia, shingles, 12
hepatitis A, hepatitis B, diphtheria, tetanus, pertussis, 13
and meningitis vaccines by written protocol authorized by a 14
physician for persons at least seven years of age or the age 15
recommended by the Centers for Disease Co ntrol and 16
Prevention, whichever is higher, or the administration of 17
pneumonia, shingles, hepatitis A, hepatitis B, diphtheria, 18 SB 659 2
tetanus, pertussis, meningitis, and viral influenza vaccines 19
by written protocol authorized by a physician for a specific 20
patient as authorized by rule; the participation in drug 21
selection according to state law and participation in drug 22
utilization reviews; the proper and safe storage of drugs 23
and devices and the maintenance of proper records thereof; 24
consultation with pat ients and other health care 25
practitioners, and veterinarians and their clients about 26
legend drugs, about the safe and effective use of drugs and 27
devices; the prescribing and dispensing of any nicotine 28
replacement therapy product under section 338.665; the 29
dispensing of HIV postexposure prophylaxis pursuant to 30
section 338.730; the dispensing of self -administered 31
hormonal contraceptives under section 338.720; and the 32
offering or performing of those acts, services, operations, 33
or transactions necessar y in the conduct, operation, 34
management and control of a pharmacy. No person shall 35
engage in the practice of pharmacy unless he or she is 36
licensed under the provisions of this chapter. This chapter 37
shall not be construed to prohibit the use of auxili ary 38
personnel under the direct supervision of a pharmacist from 39
assisting the pharmacist in any of his or her duties. This 40
assistance in no way is intended to relieve the pharmacist 41
from his or her responsibilities for compliance with this 42
chapter and he or she will be responsible for the actions of 43
the auxiliary personnel acting in his or her assistance. 44
This chapter shall also not be construed to prohibit or 45
interfere with any legally registered practitioner of 46
medicine, dentistry, or podiatry, or veterinary medicine 47
only for use in animals, or the practice of optometry in 48
accordance with and as provided in sections 195.070 and 49 SB 659 3
336.220 in the compounding, administering, prescribing, or 50
dispensing of his or her own prescriptions. 51
2. Any pharmacist who accepts a prescription order for 52
a medication therapeutic plan shall have a written protocol 53
from the physician who refers the patient for medication 54
therapy services. The written protocol and the prescription 55
order for a medication th erapeutic plan shall come from the 56
physician only, and shall not come from a nurse engaged in a 57
collaborative practice arrangement under section 334.104, or 58
from a physician assistant engaged in a collaborative 59
practice arrangement under section 334.73 5. 60
3. Nothing in this section shall be construed as to 61
prevent any person, firm or corporation from owning a 62
pharmacy regulated by sections 338.210 to 338.315, provided 63
that a licensed pharmacist is in charge of such pharmacy. 64
4. Nothing in this section shall be construed to apply 65
to or interfere with the sale of nonprescription drugs and 66
the ordinary household remedies and such drugs or medicines 67
as are normally sold by those engaged in the sale of general 68
merchandise. 69
5. No health carrier as defined in chapter 376 shall 70
require any physician with which they contract to enter into 71
a written protocol with a pharmacist for medication 72
therapeutic services. 73
6. This section shall not be construed to allow a 74
pharmacist to diagno se or independently prescribe 75
pharmaceuticals. 76
7. The state board of registration for the healing 77
arts, under section 334.125, and the state board of 78
pharmacy, under section 338.140, shall jointly promulgate 79
rules regulating the use of protocols for prescription 80
orders for medication therapy services and administration of 81 SB 659 4
viral influenza vaccines. Such rules shall require 82
protocols to include provisions allowing for timely 83
communication between the pharmacist and the referring 84
physician, and any other patient protection provisions 85
deemed appropriate by both boards. In order to take effect, 86
such rules shall be approved by a majority vote of a quorum 87
of each board. Neither board shall separately promulgate 88
rules regulating the use of prot ocols for prescription 89
orders for medication therapy services and administration of 90
viral influenza vaccines. Any rule or portion of a rule, as 91
that term is defined in section 536.010, that is created 92
under the authority delegated in this section shal l become 93
effective only if it complies with and is subject to all of 94
the provisions of chapter 536 and, if applicable, section 95
536.028. This section and chapter 536 are nonseverable and 96
if any of the powers vested with the general assembly 97
pursuant to chapter 536 to review, to delay the effective 98
date, or to disapprove and annul a rule are subsequently 99
held unconstitutional, then the grant of rulemaking 100
authority and any rule proposed or adopted after August 28, 101
2007, shall be invalid and void. 102
8. The state board of pharmacy may grant a certificate 103
of medication therapeutic plan authority to a licensed 104
pharmacist who submits proof of successful completion of a 105
board-approved course of academic clinical study beyond a 106
bachelor of science i n pharmacy, including but not limited 107
to clinical assessment skills, from a nationally accredited 108
college or university, or a certification of equivalence 109
issued by a nationally recognized professional organization 110
and approved by the board of pharmacy . 111
9. Any pharmacist who has received a certificate of 112
medication therapeutic plan authority may engage in the 113 SB 659 5
designing, initiating, implementing, and monitoring of a 114
medication therapeutic plan as defined by a prescription 115
order from a physician that is specific to each patient for 116
care by a pharmacist. 117
10. Nothing in this section shall be construed to 118
allow a pharmacist to make a therapeutic substitution of a 119
pharmaceutical prescribed by a physician unless authorized 120
by the written protocol or the physician's prescription 121
order. 122
11. "Veterinarian", "doctor of veterinary medicine", 123
"practitioner of veterinary medicine", "DVM", "VMD", "BVSe", 124
"BVMS", "BSe (Vet Science)", "VMB", "MRCVS", or an 125
equivalent title means a person who has received a doctor's 126
degree in veterinary medicine from an accredited school of 127
veterinary medicine or holds an Educational Commission for 128
Foreign Veterinary Graduates (EDFVG) certificate issued by 129
the American Veterinary Medical Association (AVMA). 130
12. In addition to other requirements established by 131
the joint promulgation of rules by the board of pharmacy and 132
the state board of registration for the healing arts: 133
(1) A pharmacist shall administer vaccines by protocol 134
in accordance with treatment guidelines established by the 135
Centers for Disease Control and Prevention (CDC); 136
(2) A pharmacist who is administering a vaccine shall 137
request a patient to remain in the pharmacy a safe amount of 138
time after administering the vaccine to observe any adverse 139
reactions. Such pharmacist shall have adopted emergency 140
treatment protocols; 141
(3) In addition to other requirements by the board, a 142
pharmacist shall receive additional training as required by 143
the board and evidenced by receivi ng a certificate from the 144 SB 659 6
board upon completion, and shall display the certification 145
in his or her pharmacy where vaccines are delivered. 146
13. A pharmacist shall inform the patient that the 147
administration of the vaccine will be entered into the 148
ShowMeVax system, as administered by the department of 149
health and senior services. The patient shall attest to the 150
inclusion of such information in the system by signing a 151
form provided by the pharmacist. If the patient indicates 152
that he or she does no t want such information entered into 153
the ShowMeVax system, the pharmacist shall provide a written 154
report within fourteen days of administration of a vaccine 155
to the patient's health care provider, if provided by the 156
patient, containing: 157
(1) The identity of the patient; 158
(2) The identity of the vaccine or vaccines 159
administered; 160
(3) The route of administration; 161
(4) The anatomic site of the administration; 162
(5) The dose administered; and 163
(6) The date of administration. 164
338.720. 1. For purposes of this section, "self - 1
administered hormonal contraceptive" shall mean a drug 2
composed of a combination of hormones that is approved by 3
the Food and Drug Administration to prevent pregnancy. 4
2. A pharmacist may dispense self -administered 5
hormonal contraceptives to a person under a prescription 6
order for medication therapy services as described in 7
section 338.010. A prescription order for a self - 8
administered hormonal contraceptive shall have no exp iration 9
date. 10
3. The board of pharmacy, under section 338.140, and 11
the board of registration for the healing arts, under 12 SB 659 7
section 334.125, shall jointly promulgate rules regulating 13
the use of protocols for prescription orders for self - 14
administered hormonal contraceptives. Any rule or portion 15
of a rule, as that term is defined in section 536.010, that 16
is created under the authority delegated in this section 17
shall become effective only if it complies with and is 18
subject to all of the provisions of chapter 536 and, if 19
applicable, section 536.028. This section and chapter 536 20
are nonseverable, and if any of the powers vested with the 21
general assembly pursuant to chapter 536 to review, to delay 22
the effective date, or to disapprove and annul a rule are 23
subsequently held unconstitutional, then the grant of 24
rulemaking authority and any rule proposed or adopted after 25
August 28, 2023, shall be invalid and void. 26
4. The rules adopted under this section shall require 27
a pharmacist to: 28
(1) Complete a training program approved by the board 29
of pharmacy that is related to dispensing self -administered 30
hormonal contraceptives under this section; 31
(2) Provide a self-screening risk assessment tool that 32
the patient shall use prior to the p harmacist's dispensing 33
the self-administered hormonal contraceptive under this 34
section; 35
(3) At least once every twelve months, verbally refer 36
the patient to the health care provider with whom the 37
pharmacist has a prescription order before dispens ing the 38
self-administered hormonal contraceptive to the patient; 39
(4) Provide the patient with a written record of the 40
self-administered hormonal contraceptive dispensed and 41
advise the patient to consult with a health care provider; 42
and 43 SB 659 8
(5) Dispense the self-administered hormonal 44
contraceptive to the patient as soon as practicable. 45
5. All state and federal laws governing insurance 46
coverage of contraceptive drugs, devices, products, and 47
services shall apply to self -administered hormonal 48
contraceptives dispensed by a pharmacist under this section. 49
6. The provisions of this section shall terminate upon 50
the enactment of any laws allowing the provision of hormonal 51
contraceptives from a pharmacist without a prescription. 52
7. Nothing in this section shall be construed to allow 53
a pharmacist to make a therapeutic substitution of a 54
pharmaceutical prescribed by a physician unless authorized 55
by the written protocol or the physician's written 56
prescription order. 57