| 1 | 1 | | FIRSTREGULARSESSION |
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| 2 | 2 | | HOUSEBILLNO.471 |
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| 3 | 3 | | 103RDGENERALASSEMBLY |
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| 4 | 4 | | INTRODUCEDBYREPRESENTATIVEDOLL. |
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| 5 | 5 | | 1610H.01I DANARADEMANMILLER,ChiefClerk |
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| 6 | 6 | | ANACT |
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| 7 | 7 | | Torepealsection338.010,RSMo,andtoenactinlieuthereoftwonewsectionsrelatingtothe |
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| 8 | 8 | | dispensingofinsulin. |
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| 9 | 9 | | BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows: |
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| 10 | 10 | | SectionA.Section338.010,RSMo,isrepealedandtwonewsectionsenactedinlieu |
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| 11 | 11 | | 2thereof,tobeknownassections338.010and338.740,toreadasfollows: |
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| 12 | 12 | | 338.010.1.The"practiceofpharmacy"includes: |
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| 13 | 13 | | 2 (1)Theinterpretation,implementation,andevaluationofmedicalprescriptionorders, |
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| 14 | 14 | | 3includinganylegenddrugsunder21U.S.C.Section353,andthereceipt,transmission,or |
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| 15 | 15 | | 4handlingofsuchordersorfacilitatingthedispensingofsuchorders; |
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| 16 | 16 | | 5 (2)Thedesigning,initiating,implementing,andmonitoringofamedication |
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| 17 | 17 | | 6therapeuticplaninaccordancewiththeprovisionsofthissection; |
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| 18 | 18 | | 7 (3)Thecompounding,dispensing,labeling,andadministrationofdrugsanddevices |
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| 19 | 19 | | 8pursuanttomedicalprescriptionorders; |
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| 20 | 20 | | 9 (4)TheorderingandadministrationofvaccinesapprovedorauthorizedbytheU.S. |
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| 21 | 21 | | 10FoodandDrugAdministration,excludingvaccinesforcholera,monkeypox,Japanese |
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| 22 | 22 | | 11encephalitis,typhoid,rabies,yellowfever,tick-borneencephalitis,anthrax,tuberculosis, |
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| 23 | 23 | | 12dengue,Hib,polio,rotavirus,smallpox,andanyvaccineapprovedafterJanuary1,2023,to |
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| 24 | 24 | | 13personsatleastsevenyearsofageortheagerecommendedbytheCentersforDisease |
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| 25 | 25 | | 14ControlandPrevention,whicheverisolder,pursuanttojointpromulgationofrules |
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| 26 | 26 | | 15establishedbytheboardofpharmacyandthestateboardofregistrationforthehealingarts |
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| 27 | 27 | | 16unlessrulesareestablishedunderastateofemergencyasdescribedinsection44.100; |
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| 28 | 28 | | EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis |
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| 29 | 29 | | intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 17 (5)Theparticipationindrugselectionaccordingtostatelawandparticipationindrug |
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| 30 | 30 | | 18utilizationreviews; |
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| 31 | 31 | | 19 (6)Theproperandsafestorageofdrugsanddevicesandthemaintenanceofproper |
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| 32 | 32 | | 20recordsthereof; |
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| 33 | 33 | | 21 (7)Consultationwithpatientsandotherhealthcarepractitioners,andveterinarians |
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| 34 | 34 | | 22andtheirclientsaboutlegenddrugs,aboutthesafeandeffectiveuseofdrugsanddevices; |
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| 35 | 35 | | 23 (8)Theprescribinganddispensingofanynicotinereplacementtherapyproductunder |
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| 36 | 36 | | 24section338.665; |
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| 37 | 37 | | 25 (9)ThedispensingofHIVpostexposureprophylaxispursuanttosection338.730; |
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| 38 | 38 | | 26[and] |
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| 39 | 39 | | 27 (10)Thedispensingofanemergencysupplyofinsulinundersection338.740; |
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| 40 | 40 | | 28and |
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| 41 | 41 | | 29 (11)Theofferingorperformingofthoseacts,services,operations,ortransactions |
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| 42 | 42 | | 30necessaryintheconduct,operation,managementandcontrolofapharmacy. |
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| 43 | 43 | | 31 2.Nopersonshallengageinthepracticeofpharmacyunlessheorsheislicensed |
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| 44 | 44 | | 32undertheprovisionsofthischapter. |
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| 45 | 45 | | 33 3.Thischaptershallnotbeconstruedtoprohibittheuseofauxiliarypersonnelunder |
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| 46 | 46 | | 34thedirectsupervisionofapharmacistfromassistingthepharmacistinanyofhisorherduties. |
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| 47 | 47 | | 35Thisassistanceinnowayisintendedtorelievethepharmacistfromhisorherresponsibilities |
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| 48 | 48 | | 36forcompliancewiththischapterandheorshewillberesponsiblefortheactionsofthe |
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| 49 | 49 | | 37auxiliarypersonnelactinginhisorherassistance. |
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| 50 | 50 | | 38 4.Thischaptershallnotbeconstruedtoprohibitorinterferewithanylegally |
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| 51 | 51 | | 39registeredpractitionerofmedicine,dentistry,orpodiatry,orveterinarymedicineonlyforuse |
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| 52 | 52 | | 40inanimals,orthepracticeofoptometryinaccordancewithandasprovidedinsections |
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| 53 | 53 | | 41195.070and336.220inthecompounding,administering,prescribing,ordispensingofhisor |
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| 54 | 54 | | 42herownprescriptions. |
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| 55 | 55 | | 43 5.Apharmacistwithacertificateofmedicationtherapeuticplanauthoritymay |
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| 56 | 56 | | 44providemedicationtherapyservicespursuanttoawrittenprotocolfromaphysicianlicensed |
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| 57 | 57 | | 45underchapter334topatientswhohaveestablishedaphysician-patientrelationship,as |
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| 58 | 58 | | 46describedinsubdivision(1)ofsubsection1ofsection191.1146,withtheprotocolphysician. |
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| 59 | 59 | | 47Thewrittenprotocolauthorizedbythissectionshallcomeonlyfromthephysicianandshall |
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| 60 | 60 | | 48notcomefromanurseengagedinacollaborativepracticearrangementundersection |
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| 61 | 61 | | 49334.104,orfromaphysicianassistantengagedinacollaborativepracticearrangementunder |
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| 62 | 62 | | 50section334.735. |
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| 63 | 63 | | 51 6.Nothinginthissectionshallbeconstruedastopreventanyperson,firmor |
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| 64 | 64 | | 52corporationfromowningapharmacyregulatedbysections338.210to338.315,providedthat |
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| 65 | 65 | | 53alicensedpharmacistisinchargeofsuchpharmacy. |
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| 66 | 66 | | HB471 2 54 7.Nothinginthissectionshallbeconstruedtoapplytoorinterferewiththesaleof |
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| 67 | 67 | | 55nonprescriptiondrugsandtheordinaryhouseholdremediesandsuchdrugsormedicinesas |
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| 68 | 68 | | 56arenormallysoldbythoseengagedinthesaleofgeneralmerchandise. |
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| 69 | 69 | | 57 8.Nohealthcarrierasdefinedinchapter376shallrequireanyphysicianwithwhich |
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| 70 | 70 | | 58theycontracttoenterintoawrittenprotocolwithapharmacistformedicationtherapeutic |
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| 71 | 71 | | 59services. |
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| 72 | 72 | | 60 9.Thissectionshallnotbeconstruedtoallowapharmacisttodiagnoseor |
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| 73 | 73 | | 61independentlyprescribepharmaceuticalsexcepttotheextentdescribedundersection |
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| 74 | 74 | | 62338.740. |
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| 75 | 75 | | 63 10.Thestateboardofregistrationforthehealingarts,undersection334.125,andthe |
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| 76 | 76 | | 64stateboardofpharmacy,undersection338.140,shalljointlypromulgaterulesregulatingthe |
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| 77 | 77 | | 65useofprotocolsformedicationtherapyservices.Suchrulesshallrequireprotocolstoinclude |
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| 78 | 78 | | 66provisionsallowingfortimelycommunicationbetweenthepharmacistandtheprotocol |
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| 79 | 79 | | 67physicianorsimilarbodyauthorizedbythissection,andanyotherpatientprotection |
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| 80 | 80 | | 68provisionsdeemedappropriatebybothboards.Inordertotakeeffect,suchrulesshallbe |
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| 81 | 81 | | 69approvedbyamajorityvoteofaquorumofeachboard.Neitherboardshallseparately |
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| 82 | 82 | | 70promulgaterulesregulatingtheuseofprotocolsformedicationtherapyservices.Anyruleor |
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| 83 | 83 | | 71portionofarule,asthattermisdefinedinsection536.010,thatiscreatedundertheauthority |
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| 84 | 84 | | 72delegatedinthissectionshallbecomeeffectiveonlyifitcomplieswithandissubjecttoallof |
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| 85 | 85 | | 73theprovisionsofchapter536and,ifapplicable,section536.028.Thissectionandchapter |
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| 86 | 86 | | 74536arenonseverableandifanyofthepowersvestedwiththegeneralassemblypursuantto |
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| 87 | 87 | | 75chapter536toreview,todelaytheeffectivedate,ortodisapproveandannularuleare |
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| 88 | 88 | | 76subsequentlyheldunconstitutional,thenthegrantofrulemakingauthorityandanyrule |
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| 89 | 89 | | 77proposedoradoptedafterAugust28,2007,shallbeinvalidandvoid. |
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| 90 | 90 | | 78 11.Thestateboardofpharmacymaygrantacertificateofmedicationtherapeutic |
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| 91 | 91 | | 79planauthoritytoalicensedpharmacistwhosubmitsproofofsuccessfulcompletionofa |
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| 92 | 92 | | 80board-approvedcourseofacademicclinicalstudybeyondabachelorofscienceinpharmacy, |
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| 93 | 93 | | 81includingbutnotlimitedtoclinicalassessmentskills,fromanationallyaccreditedcollegeor |
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| 94 | 94 | | 82university,oracertificationofequivalenceissuedbyanationallyrecognizedprofessional |
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| 95 | 95 | | 83organizationandapprovedbytheboardofpharmacy. |
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| 96 | 96 | | 84 12.Anypharmacistwhohasreceivedacertificateofmedicationtherapeuticplan |
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| 97 | 97 | | 85authoritymayengageinthedesigning,initiating,implementing,andmonitoringofa |
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| 98 | 98 | | 86medicationtherapeuticplanasdefinedbyawrittenprotocolfromaphysicianthatmaybe |
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| 99 | 99 | | 87specifictoeachpatientforcarebyapharmacist. |
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| 100 | 100 | | 88 13.Nothinginthissectionshallbeconstruedtoallowapharmacisttomakea |
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| 101 | 101 | | 89therapeuticsubstitutionofapharmaceuticalprescribedbyaphysicianunlessauthorizedby |
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| 102 | 102 | | 90thewrittenprotocolorthephysician'sprescriptionorder. |
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| 103 | 103 | | HB471 3 91 14."Veterinarian","doctorofveterinarymedicine","practitionerofveterinary |
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| 104 | 104 | | 92medicine","DVM","VMD","BVSe","BVMS","BSe(VetScience)","VMB","MRCVS",or |
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| 105 | 105 | | 93anequivalenttitlemeansapersonwhohasreceivedadoctor'sdegreeinveterinarymedicine |
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| 106 | 106 | | 94fromanaccreditedschoolofveterinarymedicineorholdsanEducationalCommissionfor |
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| 107 | 107 | | 95ForeignVeterinaryGraduates(EDFVG)certificateissuedbytheAmericanVeterinary |
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| 108 | 108 | | 96MedicalAssociation(AVMA). |
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| 109 | 109 | | 97 15.Inadditiontootherrequirementsestablishedbythejointpromulgationofrulesby |
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| 110 | 110 | | 98theboardofpharmacyandthestateboardofregistrationforthehealingarts: |
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| 111 | 111 | | 99 (1)Apharmacistshalladministervaccinesbyprotocolinaccordancewithtreatment |
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| 112 | 112 | | 100guidelinesestablishedbytheCentersforDiseaseControlandPrevention(CDC); |
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| 113 | 113 | | 101 (2)Apharmacistwhoisadministeringavaccineshallrequestapatienttoremainin |
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| 114 | 114 | | 102thepharmacyasafeamountoftimeafteradministeringthevaccinetoobserveanyadverse |
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| 115 | 115 | | 103reactions.Suchpharmacistshallhaveadoptedemergencytreatmentprotocols. |
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| 116 | 116 | | 104 16.Inadditiontootherrequirementsbytheboard,apharmacistshallreceive |
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| 117 | 117 | | 105additionaltrainingasrequiredbytheboardandevidencedbyreceivingacertificatefromthe |
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| 118 | 118 | | 106boarduponcompletion,andshalldisplaythecertificationinhisorherpharmacywhere |
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| 119 | 119 | | 107vaccinesaredelivered. |
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| 120 | 120 | | 108 17.Apharmacistshallinformthepatientthattheadministrationofavaccinewillbe |
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| 121 | 121 | | 109enteredintotheShowMeVaxsystem,asadministeredbythedepartmentofhealthandsenior |
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| 122 | 122 | | 110services.Thepatientshallattesttotheinclusionofsuchinformationinthesystembysigning |
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| 123 | 123 | | 111aformprovidedbythepharmacist.Ifthepatientindicatesthatheorshedoesnotwantsuch |
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| 124 | 124 | | 112informationenteredintotheShowMeVaxsystem,thepharmacistshallprovideawritten |
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| 125 | 125 | | 113reportwithinfourteendaysofadministrationofavaccinetothepatient'shealthcareprovider, |
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| 126 | 126 | | 114ifprovidedbythepatient,containing: |
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| 127 | 127 | | 115 (1)Theidentityofthepatient; |
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| 128 | 128 | | 116 (2)Theidentityofthevaccineorvaccinesadministered; |
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| 129 | 129 | | 117 (3)Therouteofadministration; |
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| 130 | 130 | | 118 (4)Theanatomicsiteoftheadministration; |
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| 131 | 131 | | 119 (5)Thedoseadministered;and |
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| 132 | 132 | | 120 (6)Thedateofadministration. |
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| 133 | 133 | | 121 18.Apharmacistlicensedunderthischaptermayorderandadministervaccines |
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| 134 | 134 | | 122approvedorauthorizedbytheU.S.FoodandDrugAdministrationtoaddressapublichealth |
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| 135 | 135 | | 123need,aslawfullyauthorizedbythestateorfederalgovernment,oradepartmentoragency |
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| 136 | 136 | | 124thereof,duringastateorfederallydeclaredpublichealthemergency. |
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| 137 | 137 | | 338.740.1.Notwithstandinganyotherprovisionoflaw,apharmacistmay |
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| 138 | 138 | | 2dispenseanemergencysupplyofinsulintoapatientwithoutacurrent,valid |
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| 139 | 139 | | 3prescriptionif: |
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| 140 | 140 | | HB471 4 4 (1)Thepharmacistmakeseveryreasonableattemptbutisunabletoobtain |
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| 141 | 141 | | 5authorizationtorefilltheprescriptionfromtheprescribinghealthcareprovideror |
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| 142 | 142 | | 6anotherhealthcareproviderresponsibleforthepatient'scare; |
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| 143 | 143 | | 7 (2)Either: |
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| 144 | 144 | | 8 (a)Thepharmacisthasarecordofaprescriptionatthepharmacyorhasbeen |
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| 145 | 145 | | 9presentedproofofarecentprescriptionfortheinsulininthenameofthepatientwhois |
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| 146 | 146 | | 10requestingtheemergencysupply;or |
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| 147 | 147 | | 11 (b)Inthepharmacist'sprofessionaljudgment,therefusaltodispensean |
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| 148 | 148 | | 12emergencysupplyoftheinsulinwillendangerthepatient'shealthordisruptessential |
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| 149 | 149 | | 13drugtherapyforachronicconditionofthepatient; |
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| 150 | 150 | | 14 (3)Theamountofinsulindispenseddoesnotexceedtheamountofthemost |
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| 151 | 151 | | 15recentprescriptionorthestandardquantityorunit-of-usepackageofthedrug;and |
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| 152 | 152 | | 16 (4)Theprescriberofthedrughasnotindicatedthatnoemergencyrefillsare |
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| 153 | 153 | | 17authorized. |
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| 154 | 154 | | 18 2.Apharmacist,thepharmacist'semployer,andtheoriginalprescriberofthe |
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| 155 | 155 | | 19drugarenotcivillyliableforanactoromissioninconnectionwiththedispensingof |
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| 156 | 156 | | 20insulinunderthissectionunlesstheactoromissionconstitutesnegligence,recklessness, |
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| 157 | 157 | | 21orwillfulorwantonmisconduct. |
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| 158 | 158 | | 22 3.Theboardofpharmacyshalladoptrules,inconsultationwiththestateboard |
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| 159 | 159 | | 23ofregistrationforthehealingartsandthestateboardofnursing,toestablishstandard |
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| 160 | 160 | | 24proceduresforpharmaciststofollowindispensinginsulinunderthissection.Therules |
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| 161 | 161 | | 25adoptedshallincludedocumentationrequirementsforapharmacisttocompletewhen |
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| 162 | 162 | | 26dispensinginsulinwithoutacurrentprescription.Anyruleorportionofarule,asthat |
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| 163 | 163 | | 27termisdefinedinsection536.010,thatiscreatedundertheauthoritydelegatedinthis |
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| 164 | 164 | | 28sectionshallbecomeeffectiveonlyifitcomplieswithandissubjecttoallofthe |
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| 165 | 165 | | 29provisionsofchapter536and,ifapplicable,section536.028.Thissectionandchapter |
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| 166 | 166 | | 30536arenonseverableandifanyofthepowersvestedwiththegeneralassembly |
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| 167 | 167 | | 31pursuanttochapter536toreview,todelaytheeffectivedate,ortodisapproveandannul |
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| 168 | 168 | | 32arulearesubsequentlyheldunconstitutional,thenthegrantofrulemakingauthority |
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| 169 | 169 | | 33andanyruleproposedoradoptedafterAugust28,2025,shallbeinvalidandvoid. |
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| 170 | 170 | | âś” |
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| 171 | 171 | | HB471 5 |
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