FIRSTREGULARSESSION
HOUSEBILLNO.797
103RDGENERALASSEMBLY
INTRODUCEDBYREPRESENTATIVEINGLE.
1633H.01I JOSEPHENGLER,ChiefClerk
ANACT
Torepealsection338.010,RSMo,andtoenactinlieuthereoftwonewsectionsrelatingto
contraceptives.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Section338.010,RSMo,isrepealedandtwonewsectionsenactedinlieu
2thereof,tobeknownassections338.010and338.720,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)Thedispensingofself-administeredhormonalcontraceptivesundersection
28338.720;and
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.
HB797 2 54 7.Nothinginthissectionshallbeconstruedtoapplytoorinterferewiththesaleof
55nonprescriptiondrugsandtheordinaryhouseholdremediesandsuchdrugsormedicinesas
56arenormallysoldbythoseengagedinthesaleofgeneralmerchandise.
57 8.Nohealthcarrierasdefinedinchapter376shallrequireanyphysicianwithwhich
58theycontracttoenterintoawrittenprotocolwithapharmacistformedicationtherapeutic
59services.
60 9.Thissectionshallnotbeconstruedtoallowapharmacisttodiagnoseor
61independentlyprescribepharmaceuticals.
62 10.Thestateboardofregistrationforthehealingarts,undersection334.125,andthe
63stateboardofpharmacy,undersection338.140,shalljointlypromulgaterulesregulatingthe
64useofprotocolsformedicationtherapyservices.Suchrulesshallrequireprotocolstoinclude
65provisionsallowingfortimelycommunicationbetweenthepharmacistandtheprotocol
66physicianorsimilarbodyauthorizedbythissection,andanyotherpatientprotection
67provisionsdeemedappropriatebybothboards.Inordertotakeeffect,suchrulesshallbe
68approvedbyamajorityvoteofaquorumofeachboard.Neitherboardshallseparately
69promulgaterulesregulatingtheuseofprotocolsformedicationtherapyservices.Anyruleor
70portionofarule,asthattermisdefinedinsection536.010,thatiscreatedundertheauthority
71delegatedinthissectionshallbecomeeffectiveonlyifitcomplieswithandissubjecttoallof
72theprovisionsofchapter536and,ifapplicable,section536.028.Thissectionandchapter
73536arenonseverableandifanyofthepowersvestedwiththegeneralassemblypursuantto
74chapter536toreview,todelaytheeffectivedate,ortodisapproveandannularuleare
75subsequentlyheldunconstitutional,thenthegrantofrulemakingauthorityandanyrule
76proposedoradoptedafterAugust28,2007,shallbeinvalidandvoid.
77 11.Thestateboardofpharmacymaygrantacertificateofmedicationtherapeutic
78planauthoritytoalicensedpharmacistwhosubmitsproofofsuccessfulcompletionofa
79board-approvedcourseofacademicclinicalstudybeyondabachelorofscienceinpharmacy,
80includingbutnotlimitedtoclinicalassessmentskills,fromanationallyaccreditedcollegeor
81university,oracertificationofequivalenceissuedbyanationallyrecognizedprofessional
82organizationandapprovedbytheboardofpharmacy.
83 12.Anypharmacistwhohasreceivedacertificateofmedicationtherapeuticplan
84authoritymayengageinthedesigning,initiating,implementing,andmonitoringofa
85medicationtherapeuticplanasdefinedbyawrittenprotocolfromaphysicianthatmaybe
86specifictoeachpatientforcarebyapharmacist.
87 13.Nothinginthissectionshallbeconstruedtoallowapharmacisttomakea
88therapeuticsubstitutionofapharmaceuticalprescribedbyaphysicianunlessauthorizedby
89thewrittenprotocolorthephysician'sprescriptionorder.
HB797 3 90 14."Veterinarian","doctorofveterinarymedicine","practitionerofveterinary
91medicine","DVM","VMD","BVSe","BVMS","BSe(VetScience)","VMB","MRCVS",or
92anequivalenttitlemeansapersonwhohasreceivedadoctor'sdegreeinveterinarymedicine
93fromanaccreditedschoolofveterinarymedicineorholdsanEducationalCommissionfor
94ForeignVeterinaryGraduates(EDFVG)certificateissuedbytheAmericanVeterinary
95MedicalAssociation(AVMA).
96 15.Inadditiontootherrequirementsestablishedbythejointpromulgationofrulesby
97theboardofpharmacyandthestateboardofregistrationforthehealingarts:
98 (1)Apharmacistshalladministervaccinesbyprotocolinaccordancewithtreatment
99guidelinesestablishedbytheCentersforDiseaseControlandPrevention(CDC);
100 (2)Apharmacistwhoisadministeringavaccineshallrequestapatienttoremainin
101thepharmacyasafeamountoftimeafteradministeringthevaccinetoobserveanyadverse
102reactions.Suchpharmacistshallhaveadoptedemergencytreatmentprotocols.
103 16.Inadditiontootherrequirementsbytheboard,apharmacistshallreceive
104additionaltrainingasrequiredbytheboardandevidencedbyreceivingacertificatefromthe
105boarduponcompletion,andshalldisplaythecertificationinhisorherpharmacywhere
106vaccinesaredelivered.
107 17.Apharmacistshallinformthepatientthattheadministrationofavaccinewillbe
108enteredintotheShowMeVaxsystem,asadministeredbythedepartmentofhealthandsenior
109services.Thepatientshallattesttotheinclusionofsuchinformationinthesystembysigning
110aformprovidedbythepharmacist.Ifthepatientindicatesthatheorshedoesnotwantsuch
111informationenteredintotheShowMeVaxsystem,thepharmacistshallprovideawritten
112reportwithinfourteendaysofadministrationofavaccinetothepatient'shealthcareprovider,
113ifprovidedbythepatient,containing:
114 (1)Theidentityofthepatient;
115 (2)Theidentityofthevaccineorvaccinesadministered;
116 (3)Therouteofadministration;
117 (4)Theanatomicsiteoftheadministration;
118 (5)Thedoseadministered;and
119 (6)Thedateofadministration.
120 18.Apharmacistlicensedunderthischaptermayorderandadministervaccines
121approvedorauthorizedbytheU.S.FoodandDrugAdministrationtoaddressapublichealth
122need,aslawfullyauthorizedbythestateorfederalgovernment,oradepartmentoragency
123thereof,duringastateorfederallydeclaredpublichealthemergency.
338.720.1.Forpurposesofthissection,theterm"self-administeredhormonal
2contraceptive"shallmeanadrugcomposedofoneormorehormonesthatisapproved
3bytheUnitedStatesFoodandDrugAdministrationtopreventpregnancy.
HB797 4 4 2.Apharmacistmaydispenseself-administeredhormonalcontraceptivestoa
5personunderaprescriptionorderformedicationtherapyservicesasdescribedin
6section338.010.Aprescriptionorderforaself-administeredhormonalcontraceptive
7shallhavenoexpirationdate.
8 3.Theboardofpharmacy,undersection338.140,andtheboardofregistration
9forthehealingarts,undersection334.125,shalljointlypromulgaterulesregulatingthe
10useofprotocolsforprescriptionordersforself-administeredhormonalcontraceptives.
11Anyruleorportionofarule,asthattermisdefinedinsection536.010,thatiscreated
12undertheauthoritydelegatedinthissectionshallbecomeeffectiveonlyifitcomplies
13withandissubjecttoalloftheprovisionsofchapter536and,ifapplicable,section
14536.028.Thissectionandchapter536arenonseverable,andifanyofthepowersvested
15withthegeneralassemblypursuanttochapter536toreview,todelaytheeffectivedate,
16ortodisapproveandannularulearesubsequentlyheldunconstitutional,thenthegrant
17ofrulemakingauthorityandanyruleproposedoradoptedafterAugust28,2025,shall
18beinvalidandvoid.
19 4.Therulesadoptedunderthissectionshallrequireapharmacistto:
20 (1)Completeatrainingprogramapprovedbytheboardofpharmacythatis
21relatedtodispensingself-administeredhormonalcontraceptivesunderthissection;
22 (2)Provideaself-screeningriskassessmenttoolthatthepatientshalluseprior
23tothepharmacist'sdispensingtheself-administeredhormonalcontraceptiveunderthis
24section;
25 (3)Atleastonceeverytwelvemonths,verballyreferthepatienttothehealth
26careproviderwithwhomthepharmacisthasaprescriptionorderbeforedispensingthe
27self-administeredhormonalcontraceptivetothepatient;
28 (4)Providethepatientwithawrittenrecordoftheself-administeredhormonal
29contraceptivedispensedandadvisethepatienttoconsultwithahealthcareprovider;
30and
31 (5)Dispensetheself-administeredhormonalcontraceptivetothepatientassoon
32aspracticable.
33 5.Allstateandfederallawsgoverninginsurancecoverageofcontraceptive
34drugs,devices,products,andservicesshallapplytoself-administeredhormonal
35contraceptivesdispensedbyapharmacistunderthissection.
36 6.Nothinginthissectionshallbeconstruedtoallowapharmacisttomakea
37therapeuticsubstitutionofapharmaceuticalprescribedbyaphysicianunless
38authorizedbythewrittenprotocolorthephysician'swrittenprescriptionorder.
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