FIRSTREGULARSESSION
HOUSEBILLNO.1188
103RDGENERALASSEMBLY
INTRODUCEDBYREPRESENTATIVEHEWKIN.
2703H.01I JOSEPHENGLER,ChiefClerk
ANACT
Torepealsection338.010,RSMo,andtoenactinlieuthereoftwonewsectionsrelatingtothe
dispensingofinsulin.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Section338.010,RSMo,isrepealedandtwonewsectionsenactedinlieu
2thereof,tobeknownassections338.010and338.740,toreadasfollows:
338.010.1.The"practiceofpharmacy"includes:
2 (1)Theinterpretation,implementation,andevaluationofmedicalprescriptionorders,
3includinganylegenddrugsunder21U.S.C.Section353,andthereceipt,transmission,or
4handlingofsuchordersorfacilitatingthedispensingofsuchorders;
5 (2)Thedesigning,initiating,implementing,andmonitoringofamedication
6therapeuticplaninaccordancewiththeprovisionsofthissection;
7 (3)Thecompounding,dispensing,labeling,andadministrationofdrugsanddevices
8pursuanttomedicalprescriptionorders;
9 (4)TheorderingandadministrationofvaccinesapprovedorauthorizedbytheU.S.
10FoodandDrugAdministration,excludingvaccinesforcholera,monkeypox,Japanese
11encephalitis,typhoid,rabies,yellowfever,tick-borneencephalitis,anthrax,tuberculosis,
12dengue,Hib,polio,rotavirus,smallpox,andanyvaccineapprovedafterJanuary1,2023,to
13personsatleastsevenyearsofageortheagerecommendedbytheCentersforDisease
14ControlandPrevention,whicheverisolder,pursuanttojointpromulgationofrules
15establishedbytheboardofpharmacyandthestateboardofregistrationforthehealingarts
16unlessrulesareestablishedunderastateofemergencyasdescribedinsection44.100;
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 17 (5)Theparticipationindrugselectionaccordingtostatelawandparticipationindrug
18utilizationreviews;
19 (6)Theproperandsafestorageofdrugsanddevicesandthemaintenanceofproper
20recordsthereof;
21 (7)Consultationwithpatientsandotherhealthcarepractitioners,andveterinarians
22andtheirclientsaboutlegenddrugs,aboutthesafeandeffectiveuseofdrugsanddevices;
23 (8)Theprescribinganddispensingofanynicotinereplacementtherapyproductunder
24section338.665;
25 (9)ThedispensingofHIVpostexposureprophylaxispursuanttosection338.730;
26[and]
27 (10)Thedispensingofanemergencysupplyofinsulinundersection338.740;
28and
29 (11)Theofferingorperformingofthoseacts,services,operations,ortransactions
30necessaryintheconduct,operation,managementandcontrolofapharmacy.
31 2.Nopersonshallengageinthepracticeofpharmacyunlessheorsheislicensed
32undertheprovisionsofthischapter.
33 3.Thischaptershallnotbeconstruedtoprohibittheuseofauxiliarypersonnelunder
34thedirectsupervisionofapharmacistfromassistingthepharmacistinanyofhisorherduties.
35Thisassistanceinnowayisintendedtorelievethepharmacistfromhisorherresponsibilities
36forcompliancewiththischapterandheorshewillberesponsiblefortheactionsofthe
37auxiliarypersonnelactinginhisorherassistance.
38 4.Thischaptershallnotbeconstruedtoprohibitorinterferewithanylegally
39registeredpractitionerofmedicine,dentistry,orpodiatry,orveterinarymedicineonlyforuse
40inanimals,orthepracticeofoptometryinaccordancewithandasprovidedinsections
41195.070and336.220inthecompounding,administering,prescribing,ordispensingofhisor
42herownprescriptions.
43 5.Apharmacistwithacertificateofmedicationtherapeuticplanauthoritymay
44providemedicationtherapyservicespursuanttoawrittenprotocolfromaphysicianlicensed
45underchapter334topatientswhohaveestablishedaphysician-patientrelationship,as
46describedinsubdivision(1)ofsubsection1ofsection191.1146,withtheprotocolphysician.
47Thewrittenprotocolauthorizedbythissectionshallcomeonlyfromthephysicianandshall
48notcomefromanurseengagedinacollaborativepracticearrangementundersection
49334.104,orfromaphysicianassistantengagedinacollaborativepracticearrangementunder
50section334.735.
51 6.Nothinginthissectionshallbeconstruedastopreventanyperson,firmor
52corporationfromowningapharmacyregulatedbysections338.210to338.315,providedthat
53alicensedpharmacistisinchargeofsuchpharmacy.
HB1188 2 54 7.Nothinginthissectionshallbeconstruedtoapplytoorinterferewiththesaleof
55nonprescriptiondrugsandtheordinaryhouseholdremediesandsuchdrugsormedicinesas
56arenormallysoldbythoseengagedinthesaleofgeneralmerchandise.
57 8.Nohealthcarrierasdefinedinchapter376shallrequireanyphysicianwithwhich
58theycontracttoenterintoawrittenprotocolwithapharmacistformedicationtherapeutic
59services.
60 9.Thissectionshallnotbeconstruedtoallowapharmacisttodiagnoseor
61independentlyprescribepharmaceuticalsexcepttotheextentdescribedundersection
62338.740.
63 10.Thestateboardofregistrationforthehealingarts,undersection334.125,andthe
64stateboardofpharmacy,undersection338.140,shalljointlypromulgaterulesregulatingthe
65useofprotocolsformedicationtherapyservices.Suchrulesshallrequireprotocolstoinclude
66provisionsallowingfortimelycommunicationbetweenthepharmacistandtheprotocol
67physicianorsimilarbodyauthorizedbythissection,andanyotherpatientprotection
68provisionsdeemedappropriatebybothboards.Inordertotakeeffect,suchrulesshallbe
69approvedbyamajorityvoteofaquorumofeachboard.Neitherboardshallseparately
70promulgaterulesregulatingtheuseofprotocolsformedicationtherapyservices.Anyruleor
71portionofarule,asthattermisdefinedinsection536.010,thatiscreatedundertheauthority
72delegatedinthissectionshallbecomeeffectiveonlyifitcomplieswithandissubjecttoallof
73theprovisionsofchapter536and,ifapplicable,section536.028.Thissectionandchapter
74536arenonseverableandifanyofthepowersvestedwiththegeneralassemblypursuantto
75chapter536toreview,todelaytheeffectivedate,ortodisapproveandannularuleare
76subsequentlyheldunconstitutional,thenthegrantofrulemakingauthorityandanyrule
77proposedoradoptedafterAugust28,2007,shallbeinvalidandvoid.
78 11.Thestateboardofpharmacymaygrantacertificateofmedicationtherapeutic
79planauthoritytoalicensedpharmacistwhosubmitsproofofsuccessfulcompletionofa
80board-approvedcourseofacademicclinicalstudybeyondabachelorofscienceinpharmacy,
81includingbutnotlimitedtoclinicalassessmentskills,fromanationallyaccreditedcollegeor
82university,oracertificationofequivalenceissuedbyanationallyrecognizedprofessional
83organizationandapprovedbytheboardofpharmacy.
84 12.Anypharmacistwhohasreceivedacertificateofmedicationtherapeuticplan
85authoritymayengageinthedesigning,initiating,implementing,andmonitoringofa
86medicationtherapeuticplanasdefinedbyawrittenprotocolfromaphysicianthatmaybe
87specifictoeachpatientforcarebyapharmacist.
88 13.Nothinginthissectionshallbeconstruedtoallowapharmacisttomakea
89therapeuticsubstitutionofapharmaceuticalprescribedbyaphysicianunlessauthorizedby
90thewrittenprotocolorthephysician'sprescriptionorder.
HB1188 3 91 14."Veterinarian","doctorofveterinarymedicine","practitionerofveterinary
92medicine","DVM","VMD","BVSe","BVMS","BSe(VetScience)","VMB","MRCVS",or
93anequivalenttitlemeansapersonwhohasreceivedadoctor'sdegreeinveterinarymedicine
94fromanaccreditedschoolofveterinarymedicineorholdsanEducationalCommissionfor
95ForeignVeterinaryGraduates(EDFVG)certificateissuedbytheAmericanVeterinary
96MedicalAssociation(AVMA).
97 15.Inadditiontootherrequirementsestablishedbythejointpromulgationofrulesby
98theboardofpharmacyandthestateboardofregistrationforthehealingarts:
99 (1)Apharmacistshalladministervaccinesbyprotocolinaccordancewithtreatment
100guidelinesestablishedbytheCentersforDiseaseControlandPrevention(CDC);
101 (2)Apharmacistwhoisadministeringavaccineshallrequestapatienttoremainin
102thepharmacyasafeamountoftimeafteradministeringthevaccinetoobserveanyadverse
103reactions.Suchpharmacistshallhaveadoptedemergencytreatmentprotocols.
104 16.Inadditiontootherrequirementsbytheboard,apharmacistshallreceive
105additionaltrainingasrequiredbytheboardandevidencedbyreceivingacertificatefromthe
106boarduponcompletion,andshalldisplaythecertificationinhisorherpharmacywhere
107vaccinesaredelivered.
108 17.Apharmacistshallinformthepatientthattheadministrationofavaccinewillbe
109enteredintotheShowMeVaxsystem,asadministeredbythedepartmentofhealthandsenior
110services.Thepatientshallattesttotheinclusionofsuchinformationinthesystembysigning
111aformprovidedbythepharmacist.Ifthepatientindicatesthatheorshedoesnotwantsuch
112informationenteredintotheShowMeVaxsystem,thepharmacistshallprovideawritten
113reportwithinfourteendaysofadministrationofavaccinetothepatient'shealthcareprovider,
114ifprovidedbythepatient,containing:
115 (1)Theidentityofthepatient;
116 (2)Theidentityofthevaccineorvaccinesadministered;
117 (3)Therouteofadministration;
118 (4)Theanatomicsiteoftheadministration;
119 (5)Thedoseadministered;and
120 (6)Thedateofadministration.
121 18.Apharmacistlicensedunderthischaptermayorderandadministervaccines
122approvedorauthorizedbytheU.S.FoodandDrugAdministrationtoaddressapublichealth
123need,aslawfullyauthorizedbythestateorfederalgovernment,oradepartmentoragency
124thereof,duringastateorfederallydeclaredpublichealthemergency.
338.740.1.Notwithstandinganyotherprovisionoflaw,apharmacistmay
2dispenseanemergencysupplyofinsulintoapatientwithoutacurrent,valid
3prescriptionif:
HB1188 4 4 (1)Thepharmacistmakeseveryreasonableattemptbutisunabletoobtain
5authorizationtorefilltheprescriptionfromtheprescribinghealthcareprovideror
6anotherhealthcareproviderresponsibleforthepatient'scare;
7 (2)Either:
8 (a)Thepharmacisthasarecordofaprescriptionatthepharmacyorhasbeen
9presentedproofofarecentprescriptionfortheinsulininthenameofthepatientwhois
10requestingtheemergencysupply;or
11 (b)Inthepharmacist'sprofessionaljudgment,therefusaltodispensean
12emergencysupplyoftheinsulinwillendangerthepatient'shealthordisruptessential
13drugtherapyforachronicconditionofthepatient;
14 (3)Theamountofinsulindispenseddoesnotexceedtheamountofthemost
15recentprescriptionorthestandardquantityorunit-of-usepackageofthedrug;and
16 (4)Theprescriberofthedrughasnotindicatedthatnoemergencyrefillsare
17authorized.
18 2.Apharmacist,thepharmacist'semployer,andtheoriginalprescriberofthe
19drugarenotcivillyliableforanactoromissioninconnectionwiththedispensingof
20insulinunderthissectionunlesstheactoromissionconstitutesnegligence,recklessness,
21orwillfulorwantonmisconduct.
22 3.Theboardofpharmacyshalladoptrules,inconsultationwiththestateboard
23ofregistrationforthehealingartsandthestateboardofnursing,toestablishstandard
24proceduresforpharmaciststofollowindispensinginsulinunderthissection.Therules
25adoptedshallincludedocumentationrequirementsforapharmacisttocompletewhen
26dispensinginsulinwithoutacurrentprescription.Anyruleorportionofarule,asthat
27termisdefinedinsection536.010,thatiscreatedundertheauthoritydelegatedinthis
28sectionshallbecomeeffectiveonlyifitcomplieswithandissubjecttoallofthe
29provisionsofchapter536and,ifapplicable,section536.028.Thissectionandchapter
30536arenonseverableandifanyofthepowersvestedwiththegeneralassembly
31pursuanttochapter536toreview,todelaytheeffectivedate,ortodisapproveandannul
32arulearesubsequentlyheldunconstitutional,thenthegrantofrulemakingauthority
33andanyruleproposedoradoptedafterAugust28,2025,shallbeinvalidandvoid.
âś”
HB1188 5