1298S.03C
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SENATE COMMITTEE SUBSTITUTE
FOR
SENATE BILL NO. 292
AN ACT
To repeal sections 195.010, 195.030, 195.070,
334.031, 334.035, and 338.165, RSMo, and to enact in
lieu thereof six new sections relating to health care
providers.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 195.010, 195.030, 195.070, 334.031,
334.035, and 338.165, RSMo, are repealed and six new sections
enacted in lieu thereof, to be known as sections 195.010,
195.030, 195.070, 334.031, 334.035, and 338.165, to read as
follows:
195.010. The following words and phrases as used in
this chapter and chapter 579, unless the context otherwise
requires, mean:
(1) "Acute pain", pain, whether resulting from
disease, accidental or intentional trauma, or other causes,
that the practitioner reasonably expects to last only a
short period of time. Acute pain shall not include chronic
pain, pain being treated as part of cancer care, hospice or
other end-of-life care, or medication -assisted treatment for
substance use disorders;
(2) "Addict", a person who habitually uses one or more
controlled substances to such an extent as to create a
tolerance for such drugs, and who does not have a medical
need for such drugs, or who is so far addicted to the use of
such drugs as to have lost the power of self -control with
reference to his or her addiction;
(3) "Administer", to apply a controlled substance,
whether by injection, inhalation, ingestion, or any other
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means, directly to the body of a patient or research subject
by:
(a) A practitioner (or, in his or her presence, by his
or her authorized agent); or
(b) The patient or research subject at the direction
and in the presence of the practitioner;
(4) "Agent", an authorized person who acts on behalf
of or at the direction of a manufacturer, distributor, or
dispenser. The term does not include a common or contract
carrier, public warehouseman, or employee of the carrier or
warehouseman while acting in the usual and lawful course of
the carrier's or warehouseman's business;
(5) "Attorney for the state", any prosecuting
attorney, circuit attorney, or attorney general authorized
to investigate, commence and prosecute an action under this
chapter;
(6) "Controlled substance", a drug, subs tance, or
immediate precursor in Schedules I through V listed in this
chapter;
(7) "Controlled substance analogue", a substance the
chemical structure of which is substantially similar to the
chemical structure of a controlled substance in Schedu le I
or II and:
(a) Which has a stimulant, depressant, or
hallucinogenic effect on the central nervous system
substantially similar to the stimulant, depressant, or
hallucinogenic effect on the central nervous system of a
controlled substance in cluded in Schedule I or II; or
(b) With respect to a particular individual, which
that individual represents or intends to have a stimulant,
depressant, or hallucinogenic effect on the central nervous
system substantially similar to the stimulant, depressant,
or hallucinogenic effect on the central nervous system of a
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controlled substance included in Schedule I or II. The term
does not include a controlled substance; any substance for
which there is an approved new drug application; any
substance for which an exemption is in effect for
investigational use, for a particular person, under Section
505 of the federal Food, Drug and Cosmetic Act (21 U.S.C.
Section 355) to the extent conduct with respect to the
substance is pursuant to the exemp tion; or any substance to
the extent not intended for human consumption before such an
exemption takes effect with respect to the substance;
(8) "Counterfeit substance", a controlled substance
which, or the container or labeling of which, without
authorization, bears the trademark, trade name, or other
identifying mark, imprint, number or device, or any likeness
thereof, of a manufacturer, distributor, or dispenser other
than the person who in fact manufactured, distributed, or
dispensed the substance;
(9) "Deliver" or "delivery", the actual, constructive,
or attempted transfer from one person to another of drug
paraphernalia or of a controlled substance, or an imitation
controlled substance, whether or not there is an agency
relationship, and includes a sale;
(10) "Dentist", a person authorized by law to practice
dentistry in this state;
(11) "Depressant or stimulant substance":
(a) A drug containing any quantity of barbituric acid
or any of the salts of barbituric acid or any derivative of
barbituric acid which has been designated by the United
States Secretary of Health and Human Services as habit
forming under 21 U.S.C. Section 352(d);
(b) A drug containing any quantity of:
a. Amphetamine or any of its isomers;
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b. Any salt of amphetamine or any salt of an isomer of
amphetamine; or
c. Any substance the United States Attorney General,
after investigation, has found to be, and by regulation
designated as, habit forming because of its sti mulant effect
on the central nervous system;
(c) Lysergic acid diethylamide; or
(d) Any drug containing any quantity of a substance
that the United States Attorney General, after
investigation, has found to have, and by regulation
designated as having, a potential for abuse because of its
depressant or stimulant effect on the central nervous system
or its hallucinogenic effect;
(12) "Dispense", to deliver a narcotic or controlled
dangerous drug to an ultimate user or research subjec t by or
pursuant to the lawful order of a practitioner including the
prescribing, administering, packaging, labeling, or
compounding necessary to prepare the substance for such
delivery. "Dispenser" means a practitioner who dispenses;
(13) "Distribute", to deliver other than by
administering or dispensing a controlled substance;
(14) "Distributor", a person who distributes;
(15) "Drug":
(a) Substances recognized as drugs in the official
United States Pharmacopoeia, Official Ho meopathic
Pharmacopoeia of the United States, or Official National
Formulary, or any supplement to any of them;
(b) Substances intended for use in the diagnosis,
cure, mitigation, treatment or prevention of disease in
humans or animals;
(c) Substances, other than food, intended to affect
the structure or any function of the body of humans or
animals; and
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(d) Substances intended for use as a component of any
article specified in this subdivision. It does not include
devices or their components, parts or accessories;
(16) "Drug-dependent person", a person who is using a
controlled substance and who is in a state of psychic or
physical dependence, or both, arising from the use of such
substance on a continuous basis. Drug dependence is
characterized by behavioral and other responses which
include a strong compulsion to take the substance on a
continuous basis in order to experience its psychic effects
or to avoid the discomfort caused by its absence;
(17) "Drug enforcement agency", the Drug Enforcement
Administration in the United States Department of Justice,
or its successor agency;
(18) "Drug paraphernalia", all equipment, products,
substances and materials of any kind which are used,
intended for use, or designed for use, in planting,
propagating, cultivating, growing, harvesting,
manufacturing, compounding, converting, producing,
processing, preparing, storing, containing, concealing,
injecting, ingesting, inhaling, or otherwise introducing
into the human body a controlled substance or an imitation
controlled substance in violation of this chapter or chapter
579. It includes, but is not limited to:
(a) Kits used, intended for use, or designed for use
in planting, propagating, cultivating, growing or harvesting
of any species of plant which is a controlled substance or
from which a controlled substance can be derived;
(b) Kits used, intended for use, or designed for use
in manufacturing, compounding, converting, producing,
processing, or preparing controlled substances or imitation
controlled substances;
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(c) Isomerization devices used, intended for use, or
designed for use in increasing the potency of any species of
plant which is a controlled substance or an imitation
controlled substance;
(d) Testing equipment used, intended for use, or
designed for use in identifying, or in analyzing the
strength, effectiveness or purity of controlled substances
or imitation controlled substances;
(e) Scales and balances u sed, intended for use, or
designed for use in weighing or measuring controlled
substances or imitation controlled substances;
(f) Dilutents and adulterants, such as quinine
hydrochloride, mannitol, mannite, dextrose and lactose,
used, intended for use, or designed for use in cutting
controlled substances or imitation controlled substances;
(g) Separation gins and sifters used, intended for
use, or designed for use in removing twigs and seeds from,
or in otherwise cleaning or refining, mar ijuana;
(h) Blenders, bowls, containers, spoons and mixing
devices used, intended for use, or designed for use in
compounding controlled substances or imitation controlled
substances;
(i) Capsules, balloons, envelopes and other containers
used, intended for use, or designed for use in packaging
small quantities of controlled substances or imitation
controlled substances;
(j) Containers and other objects used, intended for
use, or designed for use in storing or concealing controlled
substances or imitation controlled substances;
(k) Hypodermic syringes, needles and other objects
used, intended for use, or designed for use in parenterally
injecting controlled substances or imitation controlled
substances into the human body;
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(l) Objects used, intended for use, or designed for
use in ingesting, inhaling, or otherwise introducing
marijuana, cocaine, hashish, or hashish oil into the human
body, such as:
a. Metal, wooden, acrylic, glass, stone, plastic, or
ceramic pipes with or without screens, permanent screens,
hashish heads, or punctured metal bowls;
b. Water pipes;
c. Carburetion tubes and devices;
d. Smoking and carburetion masks;
e. Roach clips meaning objects used to hold burning
material, such as a marijuana cigarette, that has become too
small or too short to be held in the hand;
f. Miniature cocaine spoons and cocaine vials;
g. Chamber pipes;
h. Carburetor pipes;
i. Electric pipes;
j. Air-driven pipes;
k. Chillums;
l. Bongs;
m. Ice pipes or chillers;
(m) Substances used, intended for use, or designed for
use in the manufacture of a controlled substance.
In determining whether an object, product, substance or
material is drug paraphernalia, a court or other authority
should consider, in addition to all other logically relevant
factors, the following:
a. Statements by an owner or by anyone in control of
the object concerning its use;
b. Prior convictions, if any, o f an owner, or of
anyone in control of the object, under any state or federal
law relating to any controlled substance or imitation
controlled substance;
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c. The proximity of the object, in time and space, to
a direct violation of this chapter or chapter 579;
d. The proximity of the object to controlled
substances or imitation controlled substances;
e. The existence of any residue of controlled
substances or imitation controlled substances on the object;
f. Direct or circumstant ial evidence of the intent of
an owner, or of anyone in control of the object, to deliver
it to persons who he or she knows, or should reasonably
know, intend to use the object to facilitate a violation of
this chapter or chapter 579; the innocence of an owner, or
of anyone in control of the object, as to direct violation
of this chapter or chapter 579 shall not prevent a finding
that the object is intended for use, or designed for use as
drug paraphernalia;
g. Instructions, oral or written, p rovided with the
object concerning its use;
h. Descriptive materials accompanying the object which
explain or depict its use;
i. National or local advertising concerning its use;
j. The manner in which the object is displayed for
sale;
k. Whether the owner, or anyone in control of the
object, is a legitimate supplier of like or related items to
the community, such as a licensed distributor or dealer of
tobacco products;
l. Direct or circumstantial evidence of the ratio of
sales of the object to the total sales of the business
enterprise;
m. The existence and scope of legitimate uses for the
object in the community;
n. Expert testimony concerning its use;
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o. The quantity, form or packaging of the produc t,
substance or material in relation to the quantity, form or
packaging associated with any legitimate use for the
product, substance or material;
(19) "Federal narcotic laws", the laws of the United
States relating to controlled substances;
(20) "Hospital", a place devoted primarily to the
maintenance and operation of facilities for the diagnosis,
treatment or care, for not less than twenty -four hours in
any week, of three or more nonrelated individuals suffering
from illness, disease, injury, deformity or other abnormal
physical conditions; or a place devoted primarily to
provide, for not less than twenty -four consecutive hours in
any week, medical or nursing care for three or more
nonrelated individuals. The term hospital does not include
convalescent, nursing, shelter or boarding homes as defined
in chapter 198, but shall include outpatient facilities
owned and operated by a hospital ;
(21) "Illegal industrial hemp":
(a) All nonseed parts and varieties of the Cannabis
sativa L. plant, growing or not, that contain an average
delta-9 tetrahydrocannabinol (THC) concentration exceeding
three-tenths of one percent on a dry weight basis;
(b) Illegal industrial hemp shall be destroyed in the
most effective manner p ossible, and such destruction shall
be verified by the Missouri state highway patrol;
(22) "Immediate precursor", a substance which:
(a) The state department of health and senior services
has found to be and by rule designates as being the
principal compound commonly used or produced primarily for
use in the manufacture of a controlled substance;
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(b) Is an immediate chemical intermediary used or
likely to be used in the manufacture of a controlled
substance; and
(c) The control of which is necessary to prevent,
curtail or limit the manufacture of the controlled substance;
(23) "Imitation controlled substance", a substance
that is not a controlled substance, which by dosage unit
appearance (including color, shape, size a nd markings), or
by representations made, would lead a reasonable person to
believe that the substance is a controlled substance. In
determining whether the substance is an imitation controlled
substance the court or authority concerned should conside r,
in addition to all other logically relevant factors, the
following:
(a) Whether the substance was approved by the federal
Food and Drug Administration for over -the-counter
(nonprescription or nonlegend) sales and was sold in the
federal Food and Drug Administration -approved package, with
the federal Food and Drug Administration -approved labeling
information;
(b) Statements made by an owner or by anyone else in
control of the substance concerning the nature of the
substance, or its us e or effect;
(c) Whether the substance is packaged in a manner
normally used for illicit controlled substances;
(d) Prior convictions, if any, of an owner, or anyone
in control of the object, under state or federal law related
to controlled substances or fraud;
(e) The proximity of the substances to controlled
substances;
(f) Whether the consideration tendered in exchange for
the noncontrolled substance substantially exceeds the
reasonable value of the substance considering the actual
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chemical composition of the substance and, where applicable,
the price at which over -the-counter substances of like
chemical composition sell. An imitation controlled
substance does not include a placebo or registered
investigational drug eit her of which was manufactured,
distributed, possessed or delivered in the ordinary course
of professional practice or research;
(24) "Industrial hemp":
(a) All nonseed parts and varieties of the Cannabis
sativa L. plant, growing or not, that contain an average
delta-9 tetrahydrocannabinol (THC) concentration that does
not exceed three-tenths of one percent on a dry weight basis
or the maximum concentration allowed under federal law,
whichever is greater;
(b) Any Cannabis sativa L. seed that is part of a
growing crop, retained by a grower for future planting, or
used for processing into or use as agricultural hemp seed;
(c) Industrial hemp includes industrial hemp
commodities and products and topical or ingestible animal
and consumer products derived from industrial hemp with a
delta-9 tetrahydrocannabinol concentration of not more than
three-tenths of one percent on a dry weight basis;
(25) "Initial prescription", a prescription issued to
a patient who has never pre viously been issued a
prescription for the drug or its pharmaceutical equivalent
or who was previously issued a prescription for the drug or
its pharmaceutical equivalent, but the date on which the
current prescription is being issued is more than five
months after the date the patient last used or was
administered the drug or its equivalent;
(26) "Laboratory", a laboratory approved by the
department of health and senior services as proper to be
entrusted with the custody of controlled substan ces but does
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not include a pharmacist who compounds controlled substances
to be sold or dispensed on prescriptions;
(27) "Manufacture", the production, preparation,
propagation, compounding or processing of drug paraphernalia
or of a controlled s ubstance, or an imitation controlled
substance, either directly or by extraction from substances
of natural origin, or independently by means of chemical
synthesis, or by a combination of extraction and chemical
synthesis, and includes any packaging or repackaging of the
substance or labeling or relabeling of its container. This
term does not include the preparation or compounding of a
controlled substance or an imitation controlled substance or
the preparation, compounding, packaging or labeling o f a
narcotic or dangerous drug:
(a) By a practitioner as an incident to his or her
administering or dispensing of a controlled substance or an
imitation controlled substance in the course of his or her
professional practice; or
(b) By a practitioner or his or her authorized agent
under his or her supervision, for the purpose of, or as an
incident to, research, teaching or chemical analysis and not
for sale;
(28) "Marijuana", all parts of the plant genus
Cannabis in any species or form thereof, including, but not
limited to Cannabis Sativa L., except industrial hemp,
Cannabis Indica, Cannabis Americana, Cannabis Ruderalis, and
Cannabis Gigantea, whether growing or not, the seeds
thereof, the resin extracted from any part of the p lant; and
every compound, manufacture, salt, derivative, mixture, or
preparation of the plant, its seeds or resin. It does not
include the mature stalks of the plant, fiber produced from
the stalks, oil or cake made from the seeds of the plant,
any other compound, manufacture, salt, derivative, mixture
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or preparation of the mature stalks (except the resin
extracted therefrom), fiber, oil or cake, or the sterilized
seed of the plant which is incapable of germination;
(29) "Methamphetamine prec ursor drug", any drug
containing ephedrine, pseudoephedrine, phenylpropanolamine,
or any of their salts, optical isomers, or salts of optical
isomers;
(30) "Narcotic drug", any of the following, whether
produced directly or indirectly by extracti on from
substances of vegetable origin, or independently by means of
chemical synthesis, or by a combination of extraction and
chemical analysis:
(a) Opium, opiate, and any derivative, of opium or
opiate, including their isomers, esters, ethers, salts, and
salts of isomers, esters, and ethers, whenever the existence
of the isomers, esters, ethers, and salts is possible within
the specific chemical designation. The term does not
include the isoquinoline alkaloids of opium;
(b) Coca leaves, but not including extracts of coca
leaves from which cocaine, ecgonine, and derivatives of
ecgonine or their salts have been removed;
(c) Cocaine or any salt, isomer, or salt of isomer
thereof;
(d) Ecgonine, or any derivative, salt, isome r, or salt
of isomer thereof;
(e) Any compound, mixture, or preparation containing
any quantity of any substance referred to in paragraphs (a)
to (d) of this subdivision;
(31) "Official written order", an order written on a
form provided for that purpose by the United States
Commissioner of Narcotics, under any laws of the United
States making provision therefor, if such order forms are
authorized and required by federal law, and if no such order
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form is provided, then on an official for m provided for that
purpose by the department of health and senior services;
(32) "Opiate" or "opioid", any substance having an
addiction-forming or addiction -sustaining liability similar
to morphine or being capable of conversion into a drug
having addiction-forming or addiction -sustaining liability.
The term includes its racemic and levorotatory forms. It
does not include, unless specifically controlled under
section 195.017, the dextrorotatory isomer of 3 -methoxy-n-
methyl-morphinan and its salts (dextromethorphan);
(33) "Opium poppy", the plant of the species Papaver
somniferum L., except its seeds;
(34) "Over-the-counter sale", a retail sale licensed
pursuant to chapter 144 of a drug other than a controlled
substance;
(35) "Person", an individual, corporation, government
or governmental subdivision or agency, business trust,
estate, trust, partnership, joint venture, association, or
any other legal or commercial entity;
(36) "Pharmacist", a licensed pharmacist as defined by
the laws of this state, and where the context so requires,
the owner of a store or other place of business where
controlled substances are compounded or dispensed by a
licensed pharmacist; but nothing in this chapter shall be
construed as conferring on a person who is not registered
nor licensed as a pharmacist any authority, right or
privilege that is not granted to him by the pharmacy laws of
this state;
(37) "Poppy straw", all parts, except the seeds, of
the opium poppy, aft er mowing;
(38) "Possessed" or "possessing a controlled
substance", a person, with the knowledge of the presence and
nature of a substance, has actual or constructive possession
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of the substance. A person has actual possession if he has
the substance on his or her person or within easy reach and
convenient control. A person who, although not in actual
possession, has the power and the intention at a given time
to exercise dominion or control over the substance either
directly or through anot her person or persons is in
constructive possession of it. Possession may also be sole
or joint. If one person alone has possession of a substance
possession is sole. If two or more persons share possession
of a substance, possession is joint;
(39) "Practitioner", a physician, dentist,
optometrist, podiatrist, veterinarian, scientific
investigator, pharmacy, hospital or other person licensed,
registered or otherwise permitted by this state to
distribute, dispense, conduct research with resp ect to or
administer or to use in teaching or chemical analysis, a
controlled substance in the course of professional practice
or research in this state, or a pharmacy, hospital or other
institution licensed, registered, or otherwise permitted to
distribute, dispense, conduct research with respect to or
administer a controlled substance in the course of
professional practice or research;
(40) "Production", includes the manufacture, planting,
cultivation, growing, or harvesting of drug parapher nalia or
of a controlled substance or an imitation controlled
substance;
(41) "Registry number", the number assigned to each
person registered under the federal controlled substances
laws;
(42) "Sale", includes barter, exchange, or gift, or
offer therefor, and each such transaction made by any
person, whether as principal, proprietor, agent, servant or
employee;
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(43) "State" when applied to a part of the United
States, includes any state, district, commonwealth,
territory, insular possession thereof, and any area subject
to the legal authority of the United States of America;
(44) "Synthetic cannabinoid", includes unless
specifically excepted or unless listed in another schedule,
any natural or synthetic material, compound , mixture, or
preparation that contains any quantity of a substance that
is a cannabinoid receptor agonist, including but not limited
to any substance listed in paragraph (ll) of subdivision (4)
of subsection 2 of section 195.017 and any analogues;
homologues; isomers, whether optical, positional, or
geometric; esters; ethers; salts; and salts of isomers,
esters, and ethers, whenever the existence of the isomers,
esters, ethers, or salts is possible within the specific
chemical designation, however , it shall not include any
approved pharmaceutical authorized by the United States Food
and Drug Administration;
(45) "Ultimate user", a person who lawfully possesses
a controlled substance or an imitation controlled substance
for his or her own use or for the use of a member of his or
her household or immediate family, regardless of whether
they live in the same household, or for administering to an
animal owned by him or by a member of his or her household.
For purposes of this section, the phrase "immediate family"
means a husband, wife, parent, child, sibling, stepparent,
stepchild, stepbrother, stepsister, grandparent, or
grandchild;
(46) "Wholesaler", a person who supplies drug
paraphernalia or controlled substances or imitatio n
controlled substances that he himself has not produced or
prepared, on official written orders, but not on
prescriptions.
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195.030. 1. The department of health and senior
services upon public notice and hearing pursuant to this
section and chapter 536 may promulgate rules and charge
reasonable fees relating to the registration and control of
the manufacture, distribution and dispensing of controlled
substances within this state. No rule or portion of a rule
promulgated pursuant to the authority of this chapter shall
become effective unless it has been promulgated pursuant to
the provisions of section 536.024.
2. No person shall manufacture, compound, mix,
cultivate, grow, or by any other process produce or prepare,
distribute, dispense or prescribe any controlled substance
and no person as a wholesaler shall supply the same, without
having first obtained a registration issued by the
department of health and senior services in accordance with
rules and regulations pr omulgated by it. No registration
shall be granted for a term exceeding three years.
3. Persons registered by the department of health and
senior services pursuant to this chapter to manufacture,
distribute, or dispense or conduct research with co ntrolled
substances are authorized to possess, manufacture,
distribute or dispense such substances, including any such
activity in the conduct of research, to the extent
authorized by their registration and in conformity with
other provisions of this chapter and chapter 579.
4. The following persons shall not be required to
register and may lawfully possess controlled substances
pursuant to this chapter and chapter 579:
(1) An agent or employee, excluding physicians,
dentists, optometris ts, podiatrists or veterinarians, of any
registered manufacturer, distributor, or dispenser of any
controlled substance if such agent is acting in the usual
course of his or her business or employment;
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(2) A common or contract carrier or warehouse man, or
an employee thereof, whose possession of any controlled
substance is in the usual course of business or employment;
(3) An ultimate user or a person in possession of any
controlled substance pursuant to a lawful order of a
practitioner or in lawful possession of a Schedule V
substance.
5. The department of health and senior services may,
by regulation, waive the requirement for registration of
certain manufacturers, distributors, or dispensers if it
finds it consistent with the p ublic health and safety.
6. A separate registration shall be required at each
principal place of business or professional practice where
the applicant manufactures, distributes, or dispenses
controlled substances. A hospital may obtain a separate
registration for each outpatient facility owned or operated
by the hospital in which behavioral health or substance
abuse services are delivered. Such outpatient facility may
distribute or dispense drugs to the extent allowed under a
hospital registration.
7. The department of health and senior services is
authorized to inspect the establishment of a registrant or
applicant in accordance with the provisions of this chapter.
195.070. 1. A physician, podiatrist, dentist, a
registered optometrist certified to administer
pharmaceutical agents as provided in section 336.220, or an
assistant physician in accordance with section 334.037 or a
physician assistant in accordance with section 334.747 in
good faith and in the course of his or her professional
practice only, may prescribe, administer, and dispense
controlled substances or he or she may cause the same to be
administered or dispensed by an individual as authorized by
statute.
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2. An advanced practice registered nurse, as defined
in section 335.016, but not a certified registered nurse
anesthetist as defined in subdivision (8) of section
335.016, who holds a certificate of controlled substance
prescriptive authority from the board of nursing under
section 335.019 and who is delegated the authority to
prescribe controlled substances under a collaborative
practice arrangement under section 334.104 may prescribe any
controlled substances listed in Schedules III, IV, and V of
section 195.017, and may have rest ricted authority in
Schedule II. Prescriptions for Schedule II medications
prescribed by an advanced practice registered nurse who has
a certificate of controlled substance prescriptive authority
are restricted to only those medications containing
hydrocodone and Schedule II controlled substances for
hospice patients pursuant to the provisions of section
334.104. However, no such certified advanced practice
registered nurse shall prescribe controlled substance for
his or her own self or family. Schedule III narcotic
controlled substance and Schedule II - hydrocodone
prescriptions shall be limited to a one hundred twenty -hour
supply without refill.
3. A veterinarian, in good faith and in the course of
the veterinarian's professional prac tice only, and not for
use by a human being, may prescribe, administer, and
dispense controlled substances and the veterinarian may
cause them to be administered by an assistant or orderly
under his or her direction and supervision.
4. A practitioner shall not accept any portion of a
controlled substance unused by a patient, for any reason, if
such practitioner did not originally dispense the drug,
except:
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(1) When the controlled substance is delivered to the
practitioner to administer t o the patient for whom the
medication is prescribed [as authorized by federal law ].
Practitioners shall maintain records and secure the
medication as required by this chapter and regulations
promulgated pursuant to this chapter; or
(2) As provided in section 195.265.
5. An individual practitioner shall not prescribe or
dispense a controlled substance for such practitioner's
personal use except in a medical emergency.
334.031. 1. Candidates for licenses as physicians and
surgeons shall furnish [satisfactory evidence of their good
moral character, and their preliminary qualifications, to
wit: a certificate of graduation from an accredited high
school or its equivalent, and satisfactory evidence of
completion of prepro fessional education consisting of a
minimum of sixty semester hours of college credits in
acceptable subjects leading towards the degree of bachelor
of arts or bachelor of science from an accredited college or
university. They shall also furnish satis factory evidence
of having attended throughout at least four terms of thirty -
two weeks of actual instructions in each term and of having
received a diploma from some reputable medical college or
osteopathic college that enforces requirements of four te rms
of thirty-two weeks for actual instruction in each term,
including, in addition to class work, such experience in
operative and hospital work during the last two years of
instruction as is required by the American Medical
Association and the Ameri can Osteopathic Association before
the college is approved and accredited as reputable. Any
medical college approved and accredited as reputable by the
American Medical Association or the Liaison Committee on
Medical Education and any osteopathic coll ege approved and
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accredited as reputable by the American Osteopathic
Association is deemed to have complied with the requirements
of this subsection]:
(1) Evidence of good moral character by submitting to
a criminal background check as provided i n section 43.540;
(2) A diploma and academic transcripts from a school
accredited by the Liaison Committee on Medical Education,
the Commission on Osteopathic College Accreditation, the
Educational Commission for Foreign Medical Graduates
(ECFMG), or a similar accrediting agency; and
(3) A certificate demonstrating that the applicant has
satisfied the requirements of section 334.035. An applicant
who holds a valid certificate issued by the ECFMG shall
submit satisfactory evidence of succ essful completion of two
years of such training. Except as provided in subsection 3
of this section, the board shall not require applicants to
provide information regarding the internship or resident
training in addition to what the applicant is requi red to
furnish by this subsection .
2. In determining the qualifications necessary for
licensure as a qualified physician and surgeon, the board,
by rule and regulation, may accept the certificate of the
National Board of Medical Examiners of the United States,
chartered pursuant to the laws of the District of Columbia,
of the National Board of Examiners for Osteopathic
Physicians and Surgeons chartered pursuant to the laws of
the state of Indiana, or of the Licentiate of the Medical
Counsel of Canada (LMCC) in lieu of and as equivalent to its
own professional examination. Every applicant for a license
on the basis of such certificate, upon making application
showing necessary qualifications as provided in subsection 1
of this section, sha ll be required to pay the same fee
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required of applicants to take the examination before the
board.
3. The board may require applicants to list all
licenses to practice as a physician currently or previously
held in any other state, territory, or country and to
disclose any past or pending investigations, discipline, or
sanctions against each such license.
4. In addition to the criminal background screening
required by this section, the board may obtain a report on
the applicant from the National Practitioner Data Bank or
the Federation of State Medical Boards.
334.035. 1. For purposes of this section, the
following terms mean:
(1) "ACGME", the Accreditation Council for Graduate
Medical Education;
(2) "Applicant", an applicant for a permanent license
as a physician and surgeon;
(3) "Hospital", the same meaning given to the term in
section 197.020.
2. Except as otherwise provided in section 334.036,
every applicant [for a permanent license as a physician and
surgeon] shall provide the board with satisfactory evidence
of having successfully completed such postgraduate training
in hospitals or medical or osteopathic colleges as the board
may prescribe by rule.
3. Any applicant who has c ompleted unaccredited
postgraduate training in a medical subspecialty for which no
program accredited by ACGME exists shall be deemed to have
satisfactorily completed the training requirements of 20
C.S.R. 2150-2.004(2) or any successor regulation if s uch
unaccredited postgraduate training occurred in a teaching
hospital accredited by ACGME. The training period shall be
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equal to or exceed an accredited postgraduate training
program.
4. The board shall waive the training requirements of
20 C.S.R. 2150-2.004(2) or any successor regulation for any
applicant who is licensed as a physician in good standing in
another state and has been in good standing more than three
years.
338.165. 1. As used in this section, the following
terms mean:
(1) "Board", the Missouri board of pharmacy;
(2) "Hospital", a hospital as defined in section
197.020;
(3) "Hospital clinic or facility", a clinic or
facility under the common control, management, or ownership
of the same hospital or hospital system;
(4) "Medical staff committee", the committee or other
body of a hospital or hospital system responsible for
formulating policies regarding pharmacy services and
medication management;
(5) "Medication order", an or der for a legend drug or
device that is:
(a) Authorized or issued by an authorized prescriber
acting within the scope of his or her professional practice
or pursuant to a protocol or standing order approved by the
medical staff committee; and
(b) To be distributed or administered to the patient
by a health care practitioner or lawfully authorized
designee at a hospital or a hospital clinic or facility;
(6) "Patient", an individual receiving medical
diagnosis, treatment or care at a hospital or a hospital
clinic or facility.
2. The department of health and senior services shall
have sole authority and responsibility for the inspection
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and licensure of hospitals as provided by chapter 197
including, but not limited to all par ts, services,
functions, support functions and activities which contribute
directly or indirectly to patient care of any kind
whatsoever. However, the board may inspect a class B
pharmacy or any portion thereof that is not under the
inspection authority vested in the department of health and
senior services by chapter 197 to determine compliance with
this chapter or the rules of the board. This section shall
not be construed to bar the board from conducting an
investigation pursuant to a public o r governmental complaint
to determine compliance by an individual licensee or
registrant of the board with any applicable provisions of
this chapter or the rules of the board.
3. The department of health and senior services shall
have the sole authority to promulgate rules governing
pharmacy services in hospitals, but may promulgate rules in
conjunction with the board governing medication distribution
and the provision of medication therapy services , as
described in section 338.010, by a pharmacist at or within a
hospital. [Rules may include, but are not limited to,
medication management, preparation, compounding,
administration, storage, distribution, packaging and
labeling. Until such rules are jointly promulgated,
hospitals shall comp ly with all applicable state law and
department of health and senior services rules governing
pharmacy services and medication management in hospitals. ]
The board shall have the sole authority to promulgate rules
governing inspection and licensure of c lass B pharmacies.
The rulemaking authority granted herein to the department of
health and senior services shall not include the dispensing
of medication by prescription.
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4. All pharmacists providing medication therapy
services shall obtain a ce rtificate of medication
therapeutic plan authority as provided by rule of the
board. Medication therapy services may be provided by a
pharmacist for patients of a hospital pursuant to a
protocol with a physician as required by section 338.010 or
pursuant to a protocol approved by the medical staff
committee. However, the medical staff protocol shall
include a process whereby an exemption to the protocol for a
patient may be granted for clinical efficacy should the
patient's physician make such r equest. The medical staff
protocol shall also include an appeals process to request a
change in a specific protocol based on medical evidence
presented by a physician on staff.
5. Medication may be dispensed by a class B hospital
pharmacy pursuant to a prescription or a medication order.
6. A drug distributor license shall not be required to
transfer medication from a class B hospital pharmacy to a
hospital clinic or facility for patient care or treatment.
7. Medication dispensed by a class A pharmacy located
in a hospital to a hospital patient for use or
administration outside of the hospital under a medical staff -
approved protocol for medication therapy shall be dispensed
only by a prescription order for medication therapy from an
individual physician for a specific patient.
8. Medication dispensed by a hospital to a hospital
patient for use or administration outside of the hospital
shall be labeled as provided by rules jointly promulgated by
the department of health a nd senior services and the board
including medication distributed for administration by or
under the supervision of a health care practitioner at a
hospital clinic or facility.
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9. This section shall not be construed to preempt any
law or rule governing controlled substances.
10. Any rule, as that term is defined in section
536.010, that is created under the authority delegated in
this section shall only become effective if it complies with
and is subject to all of the provisions of chapte r 536 and,
if applicable, section 536.028. This section and chapter
536 are nonseverable and if any of the powers vested with
the general assembly under chapter 536 to review, to delay
the effective date, or to disapprove and annul a rule are
subsequently held unconstitutional, then the grant of
rulemaking authority and any rule proposed or adopted after
August 28, 2014, shall be invalid and void.
11. The board shall appoint an advisory committee to
review and make recommendations to the boar d on the merit of
all rules and regulations to be jointly promulgated by the
board and the department of health and senior services
pursuant to the joint rulemaking authority granted by this
section. The advisory committee shall consist of:
(1) Two representatives designated by the Missouri
Hospital Association, one of whom shall be a pharmacist;
(2) One pharmacist designated by the Missouri Society
of Health System Pharmacists;
(3) One pharmacist designated by the Missouri Pharmacy
Association;
(4) One pharmacist designated by the department of
health and senior services from a hospital with a licensed
bed count that does not exceed fifty beds or from a critical
access hospital as defined by the department of social
services for purposes of MO HealthNet reimbursement;
(5) One pharmacist designated by the department of
health and senior services from a hospital with a licensed
bed count that exceeds two hundred beds; and
27
(6) One pharmacist designated by the bo ard with
experience in the provision of hospital pharmacy services.
12. Nothing in this section shall be construed to
limit the authority of a licensed health care provider to
prescribe, administer, or dispense medications and
treatments within the scope of their professional practice.