Req. No. 759 Page 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 STATE OF OKLAHOMA 1st Session of the 59th Legislature (2023) SENATE BILL 458 By: Stanley AS INTRODUCED An Act relating to the practice of nursing ; providing for independent prescriptive authority of Advanced Practice Registered Nurses who meet certain requirements; stating application criteria; specifying duration of authority; authorizing supervision by Advanced Practice Registered Nurse with independent prescriptive authority who meets certain requirements; authorizing Oklahoma Board of Nursing to prescribe additional qualifications; providing for application approva l, denial, reapplication, fees, and independent prescriptive authority revocation; amending 59 O.S. 2021, Section 353.1, as amended by Section 6, Chap ter 288, O.S.L. 2022 (59 O.S. Supp. 2022, Section 353.1) , which relates to definitions used in the Oklahoma Pharmacy Act; modifying and adding definitions; amending 59 O.S. 2021, Section 353.1a, which relates to prescriptive authority of Advanced Practice Registered Nurses; modifyi ng prescriptive authority of certain Advanced Practice Registered Nurses ; amending 59 O.S. 2021, Section 567.3a, which relates to definitions used in the Oklahoma N ursing Practice Act; modifying and adding definitions; amending 59 O.S. 2021, Section 567.4a, which relates to prescriptive authority; directing the Board to promulgate certain rules; amending 59 O.S. 2021, Section 567.5a, which relates to Advanced Practice Registered Nurse license; providing for independent prescriptive authority by endorsement; amending 63 O.S. 2021, Section 2-312, as amended by Section 2 , Chapter 184, O.S.L. 2022 (63 O.S. Supp. 2022, Section 2-312), which relates to controlled dangerous substances; authorizing Certified Nurse Practitioner or Clinical Nurse Specialist to prescribe and administer certain controlled dangerous substances; Req. No. 759 Page 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 providing for codification; and providing an effective date. BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: SECTION 1. NEW LAW A new section of law to be codified in the Oklahoma Statutes as Section 567.4c of Title 59, unless there is created a duplication in numbering, reads as follow s: A. 1. An Advanced Practice Registered Nurse recognized by the Oklahoma Board of Nursing as a Certified Nurse Practition er or Clinical Nurse Specialist who has completed a minimum of two thousand (2,000) hours of practice with prescriptive authority supervised by a physician or a supervising Advanced Practice Registered Nurse may apply to the Oklahoma Board of Nursing for authority to prescribe and order independent of supervision. 2. The application for independent prescriptive authori ty shall include proof that the Certified Nurse Practitioner or Clinical Nurse Specialist: a. has satisfied the educational requirements stated in Section 567.5a of Title 59 of the Oklahoma Statutes, b. has successfully passed a national certification examination recognized by the Board that measures the Advanced Practice Registered Nurse role and specialty competencies, Req. No. 759 Page 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 c. holds a valid, current license in the appropriate Advanced Practice Registered Nurse role issued by the Board and is in good standing with the Board , and d. has completed a minimum of two thousand (2,000) hours of practice with prescriptive authority supervised by a physician or supervising Advanced Practice Registered Nurse. 3. Independent prescriptive authority granted under this subsection shall be valid until the expiration of the cu rrent license to practice and may be r enewed upon application to the Board at the same time and for the same period as the renewal of the license to practice. B. 1. A Certified Nurse Practitioner or Clinical Nurse Specialist who has obtained independent prescriptive authority under subsection A of this section and who has completed a minimum of eight thousand (8,000) hours of practice with independent prescriptive authority may serve as a supervising Advanced Practice Registered Nurse. 2. Notwithstanding paragraph 1 of this subsection, an Advanced Practice Registered Nurse who has been licensed and in practice for a minimum of five (5) years as of the effective date of this act without a lapse of work , upon obtainment of independent prescri ptive authority under subsection A of this section , may serve as a supervising Advanced Practice Registered Nurse. Req. No. 759 Page 4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 3. The Board may at its discretion prescribe by rule additional qualifications for supervising Advanced Practice Registered Nurses including, but not limited to, qualifications pertaining to the Advanced Practice Registered Nurse role or specialty. C. The Board shall review any application submitted under this section and shall approve or deny the application, stati ng the reason or reasons for denial, if denied. The Board shall mail the approval or denial letter to the applicant within fourteen (14) calendar days of receip t of the application. If denied, the applicant may reapply using the process prescribed by subsection A of this section. D. The Board may suspend or revoke independent prescriptive authority granted under this section for good cause at any time. E. The Board may establish a fe e for the review of initial and renewal applications under the provisions of this section. SECTION 2. AMENDATORY 59 O.S. 2021 , Section 353.1, as amended by Section 6, Chap ter 288, O.S.L. 2022 (59 O.S. Supp. 2022, Section 353.1), is amended to r ead as follows: Section 353.1. For the purposes of the Ok lahoma Pharmacy Act: 1. “Accredited program” means those seminars, classes, meetings, work projects, and oth er educational courses approved by the Board State Board of Pharmacy for purposes of continuing professional education; 2. “Act” means the Oklahoma Pharmacy Act; Req. No. 759 Page 5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 3. “Administer” means the direct application of a drug, whethe r by injection, inhalation, ingestion or any other means, to the body of a patient; 4. “Assistant pharmacist” means any person presently licensed as an assistant pharmacist in the State of Oklahom a by the Board pursuant to Section 353.10 of this title and for the purposes of the Oklahoma Pharmacy Act shal l be considered the same as a pharmacist, except where otherwise specified; 5. “Board” or “State Board” means the State Board of Pharmacy; 6. “Certify” or “certification of a prescription ” means the review of a filled prescription by a licensed pharmac ist or a licensed practitioner with dispensing authority to confirm that the medication, labeling an d packaging of the filled prescription are accurate and meet all requirements prescribed by state and feder al law. For the purposes of this paragraph, “licensed practitioner” shall not include optometrists with dispensing authority; 7. “Chemical” means any medicinal substance, whether simple or compound or obtained through the process of the science and art o f chemistry, whether of organic or inorganic ori gin; 8. “Compounding” means the combining, admixing, mixing, diluting, pooling, reconstituting or ot herwise altering of a drug or bulk drug substance to create a drug. Compounding includes the preparation of drugs or devices in anticipation of prescript ion drug orders based on routine, regularly observed prescribing patterns; Req. No. 759 Page 6 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 9. “Continuing professiona l education” means professional, pharmaceutical education in the general areas of the socioeconomic and legal aspects of health care; the properties and actions of drugs and dosage forms; and the etiology, characteristics and therapeutics of the diseased s tate; 10. “Dangerous drug”, “legend drug”, “prescription drug” or “Rx Only” means a drug: a. for human use subject to 21 U.S.C. 353(b)(1), or b. is labeled “Prescription Only”, or labeled with the following statement: “Caution: Federal law restricts this drug except for use by or on the order of a licensed veterinarian.”; 11. “Director” means the Executive Director of the State Board of Pharmacy unless context clearly indicates otherwise; 12. “Dispense” or “dispensing” means the interpretation, evaluation, and implementation of a prescription drug o rder including the preparation and delivery of a drug or de vice to a patient or a patient ’s agent in a suitable container appropria tely labeled for subsequent administration to, or use by, a patient . Dispense includes sell, distribute, leave with, give aw ay, dispose of, deliver or supply; 13. “Dispenser” means a retail pharmacy, hospital pharmacy, a group of chain pharmacies under c ommon ownership and control that do not act as a wholesale distributor, or any other person authorized Req. No. 759 Page 7 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 by law to dispense or administer prescription drugs, and the affiliated warehouse s or distributions of such entities und er common ownership and control t hat do not act as a wholesale distributor. For the purposes of this parag raph, “dispenser” does not mean a person who dispenses only products to be used in animals in accordance with 21 U.S.C. 360b(a)(5); 14. “Distribute” or “distribution” means the sale, purchase, trade, delivery, handling, storage, or receipt of a product, and does not include the dispensing of a product pur suant to a prescription executed in accordance with 21 U.S. C. 353(b)(1) or the dispensing of a product approved under 21 U.S.C. 360 b(b); provided, taking actual physical possession of a product or title s hall not be required; 15. “Doctor of Pharmacy” means a person licensed by the Board to engage in the practice of pharmacy. The terms “pharmacist”, “D.Ph.”, and “Doctor of Pharmacy” shall be interchangeable and shall have the same meaning wherever they a ppear in the Oklahoma Statutes and the rules promulga ted by the Board; 16. “Drug outlet” means all manufacturer s, repackagers, outsourcing faciliti es, wholesale distributors, third-party logistics providers, pharmacies, and all other facilities which are engaged in dispensing, delivery, distribution or stor age of dangerous drugs; Req. No. 759 Page 8 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 17. “Drugs” means all medicinal su bstances and preparations recognized by the United States Pharmacopoeia and National Formulary, or any revision thereof, and all substances an d preparations intended for external and/or internal us e in the cure, diagnosis, mitigation, treatment or preventi on of disease in humans or animals and all substances and preparations, other than food, intended to affect the structure or any function of t he body of a human or animals; 18. “Drug sample” means a unit of a prescription drug packaged under the authority and responsibility of the manufac turer that is not intended to be sold and is intended to promote the sale of the drug; 19. “Durable medical equipment” has the same meaning as provided by Section 2 of this act; 20. “Filled prescription” means a packaged prescription medication to which a label has been affixed which contain s such information as is required by the Oklahoma Pharmacy Act; 21. “Hospital” means any institution licensed as a hospital by this state for the care and treatment of patients, or a pharmacy operated by the Oklahoma Department of Vet erans Affairs; 22. “Licensed practitioner” means: a. an allopathic physician, b. an osteopathic physician, c. a podiatric physician, Req. No. 759 Page 9 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 d. a dentist, e. a veterinarian or, f. an optometrist, or g. a Certified Nurse Practitioner or Clinical Nurse Specialist who has obtained independent prescriptive authority under Section 1 of this act, licensed to practice and authorized to prescribe dangerous drugs within the scope of practice of such p ractitioner; 23. “Manufacturer” or “virtual manufacturer” means with respect to a product: a. a person that holds an application appr oved under 21 U.S.C. 355 or a license issued under 42 U.S.C. 262 for such product, or if such product is not the subject of an approved application or license, the person who manufactured the pro duct, b. a co-licensed partner of the person described in subparagraph a that obtains the product directly from a person described in this subpa ragraph or subparagraph a of this paragraph, c. an affiliate of a person described in subpara graph a or b who receives the product directly from a person described in this subparagraph or in subparagraph a or b of this paragraph, or Req. No. 759 Page 10 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 d. a person who contracts with another to manufacture a product; 24. “Manufacturing” means the production, preparation, propagation, compounding, conversion or processing of a device or a drug, either directly or indirectly by extraction from substances of natural origin or independently by means of chemic al or biological synthesis and includes any packaging or repackaging of the substances or labeling or relabeling of its container, and the promotion and marketing of such drug s or devices. The term “manufacturing” also includes the preparation and promoti on of commercially available pro ducts from bulk compounds for resale by licensed pharmacies, licensed practitioners or other persons; 25. “Medical gas” means those gases including those in liquid state upon which the manufacturer or distributor has placed one of several cautions, such a s “Rx Only”, in compliance with federal l aw; 26. “Medical gas order” means an order for medical gas issued by a licensed prescriber; 27. “Medical gas distributor ” means a person licensed to distribute, transfer, wholesale, deliver or sell medical gases o n drug orders to suppliers or oth er entities licensed to use, administer or distribute medical gas and may also include a patient or ultimate user; 28. “Medical gas supplier” means a person who di spenses medical gases on drug orders only to a patient or ultimate user; Req. No. 759 Page 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 29. “Medicine” means any drug or combination of drugs which has the property of curing, preventing, treating , diagnosing or mitigating diseases, or which is used for that purpose; 30. “Nonprescription drugs ” means medicines or drug s which are sold without a prescription and which are prepackaged for use by the consumer and labeled in accordance with the req uirements of the statutes and regulati ons of this state and the federal gov ernment. Such items shall also include medical and d ental supplies and bottled or nonbulk chemicals which are sold or offered for sale to the general public if such articles or pre parations meet the requirements of the Federal Food, Drug and Cosmetic Act, 21 U.S.C.A., Section 321 et seq.; 31. “Outsourcing facility” including “virtual outsourcing facility” means a facility at one geographic location or address that: a. is engaged in the compounding of sterile dru gs, b. has elected to register as an outsourcing facility, and c. complies with all requirem ents of 21 U.S.C. 353b; 32. “Package” means the smallest individual saleable unit of product for distribution by a manufact urer or repackager that is intended by the manufacturer for ultimate s ale to the dispenser of such product. For the purposes of this paragraph, “individual saleable unit” means the smallest container of a product introduced Req. No. 759 Page 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 into commerce by the manufactur er or repackager that is intended by the manufacturer or repackager fo r individual sale to a dispenser; 33. “Person” means an individual, partnership, limited liability company, corporation or association, unless the context otherwise requires; 34. “Pharmacist-in-charge” or “PIC” means the pharmacist licensed in this state responsible for the management control of a pharmacy and all other aspects of the practice of pharmacy in a licensed pharmacy as defined by Section 353.18 of this title; 35. “Pharmacy” means a place regularly licensed by the Board of Pharmacy in which prescriptions, drug s, medicines, chemicals and poisons are compounded or dispe nsed or such place where pharmacists practice the profession of pharmacy, or a pharmacy operated b y the Oklahoma Department of V eterans Affairs; 36. “Pharmacy technician”, “technician”, “Rx tech”, or “tech” means a person issued a Technician permit by the State Board of Pharmacy to assist the pharmacist and perform nonjudgmental, technical, manipulative, non-discretionary functions in the prescription department under the immediate and direct super vision of a pharmacist; 37. “Poison” means any substance which when introduced into the body, either directly or by absorption, produces violent, morbid or fatal changes, or wh ich destroys living tissue with which such substance comes into contact; Req. No. 759 Page 13 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 38. “Practice of pharmacy” means: a. the interpretation and evaluation of prescription orders, b. the compounding, dispensing, administering and labeling of drugs and devices, except labeling by a manufacturer, repackager or distributor of nonprescription drugs and commercially packaged legend drugs and devices, c. the participation in drug selection and drug utilization reviews, d. the proper and safe storage of drugs and de vices and the maintenance of proper r ecords thereof, e. the responsibility for advising by counseling and providing information, where professionally necessary or where regulated, of therapeutic values, content, hazards and use of drugs and devices, f. the offering or performing of those ac ts, services, operations or transactions necessary in the conduct, operation, management and control of a pharmacy, or g. the provision of those acts or services t hat are necessary to provide pharmaceutical care; 39. “Preparation” means an article which may or may not contain sterile products compounded in a licensed pharmacy pursuant to the order of a licensed prescriber; Req. No. 759 Page 14 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 40. “Prescriber” means a person licensed in this state who is authorized to prescribe dangerous drugs within the scope of p ractice of the person’s profession; 41. “Prescription” means and includes any order for drug or medical supplies written or signed, or transmitted by word of mouth, telephone or other means of communication: a. by a licensed prescriber, b. under the supervision of an Oklahoma licensed practitioner, an Oklahoma licensed advanced practice registered nurse or an Oklahoma license d a supervising physician, by a physician assistant or a Certified Nurse-Midwife licensed in this state , or c. (1) under the supervision of a supervising physician or supervising Advanced Practice Registered Nurse, by a Certified Nurse Practitioner or Clinical Nurse Specialist licensed in this state who has not obtained independent prescriptive authority under Section 1 of this act, or (2) by a Certified Nurse Practitioner or Clinical Nurse Specialist licensed in this state who has obtained independent prescriptive authority under Section 1 of this act, or d. by an Oklahoma licensed wholesaler or distributo r as authorized in Section 353.29.1 of this title; Req. No. 759 Page 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 42. “Product” means a prescription drug in a finished dosage form for administration to a patient w ithout substantial further manufacturing, such as capsules, tablets, and lyophilized products before reconstitution. “Product” does not include blo od components intended for transfusion, radioactive drugs or biologics and med ical gas; 43. “Repackager”, including “virtual repackager”, means a person who owns or operates an establishment that repac ks and relabels a product or package for further sale or distribution without further transaction; 44. “Sterile drug” means a drug that is intended for p arenteral administration, an ophthalmic or oral inhalati on drug in aqueous format, or a drug that is required to be sterile under state and federal law; 45. “Supervising Advanced Practice Registered Nurse” has the same meaning as provided by S ection 567.3a of this title; 46. “Supervising physician ” means an individual holding a current license to practice as a physician from the State Board of Medical Licensure and Supervision, pursuant to the provisions of the Oklahoma Allopathic Medical and Surgical Licensur e and Supervision Act, or the State Board of Osteop athic Examiners, pursuant to t he provisions of the Oklahoma Osteopathic Medicine Act, who supervises an advanced practice registered nurse: Req. No. 759 Page 16 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 a. a Certified Nurse Practitioner or Clinical Nurse Specialist as defined in Section 567.3a of this title who has not obtained independent prescriptive authority under Section 1 of this act, or b. a Certified Nurse-Midwife as defined in Section 567.3a of this title, and who is not in trai ning as an intern, resident, or fellow . To be eligible to supervise an advanced practice registered nurse, such The supervising physician shall remain in compliance with the rules promulgated by the State Board of Medical Li censure and Supervision or the State Board of O steopathic Examiners; 46. 47. “Supportive personnel ” means technicians and auxiliary supportive persons who are regularly paid employees of a pharma cy who work and perform ta sks in the pharmacy as authorized by Section 353.18A of this title; 47. 48. “Third-party logistics provider” including “virtual third-party logistics provider” means an entity that provides or coordinates warehousing, or other logi stics services of a product in interstate commerce on beh alf of a manufacturer, wholesale distributor, or dispenser of a produc t but does not take ownership of the product, nor h ave responsibility to direct the sale or disposition of the product. For the purposes of this paragraph, “third-party logistics provid er” does not include shippers and the United States Postal Service; Req. No. 759 Page 17 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 48. 49. “Wholesale distributor ” including “virtual wholesale distributor” means a person other than a manufacturer, a manufacturer’s co-licensed partner, a thir d-party logistics provider, or repackager engaged in wholesale distribution as defined by 21 U.S.C. 353(e)(4) as amended by the Drug Supply Chain Se curity Act; 49. 50. “County jail” means a facility operated by a county for the physical detention and correct ion of persons charged with, or convicted of, criminal o ffenses or ordinance violations or per sons found guilty of civil or criminal contempt; 50. 51. “State correctional facility ” means a facility or institution that houses a p risoner population under the j urisdiction of the Department of Corrections; 51. 52. “Unit dose package” means a package that contains a single dose drug with the name, str ength, control number, and expiration date of that drug on the label; and 52. 53. “Unit of issue package” means a package that provides multiple doses of the same drug, but each drug is individually separated and includes the name, lot number, and expirat ion date. SECTION 3. AMENDATORY 59 O.S. 20 21, Section 353.1a, is amended to read as f ollows: Section 353.1a. A. Prescribing 1. Prescriptive authority shall be allowed, under th e medical direction of a supervising physician or supervising Advanced Practice R egistered Nurse, for an Req. No. 759 Page 18 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 advanced practice nurse a licensed Advanced Practice Registered Nurse recognized by the Oklahom a Board of Nursing in one of the following categories: advanced registered nurse practitioners, clinical nurse specialists, or certified nurse -midwives as a Certified Nurse Practitioner or Clinical Nurse Specialist who has not obtained independent prescriptive authority under Section 1 of this act. 2. Prescriptive authority shall be allowed, independent of the medical direction of a supervising physician or supervising Advanced Practice Registered Nurse, for a licensed Advanced Practice Registered Nurse recognized by the Oklahoma Board of Nursing as a Certified Nurse Practitioner or Clinical Nurse Specialist who has obtained independent prescriptive authority under Section 1 of this act. B. Prescriptive authority shall be allowed , under the medical direction of a supervising physician , for a licensed Advanced Practice Registered Nurse recognized by the Oklahoma Board of Nursing as a Certified Nurse Practitioner. C. The advanced practice nurse Advanced Practice Registere d Nurse may write or sign, or transmit by word of mouth, telephone or other means of communication an order for drugs or medical supplie s that is intended to be filled, compounded, or dis pensed by a pharmacist. The supervising physician or supervising Advanced Practice Registered Nurse, if applicable, and the advanced practice Req. No. 759 Page 19 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 nurse prescribing Advanced Practice Registered Nurse shall be identified at the time of origination of the prescription and the name of the advanced practice nurse prescribing Advanced Practice Registered Nurse shall be printed on the prescription label. B. D. Pharmacists may dispense prescriptions for non-controlled prescription drugs authorized by an advanced practice nurse Advanced Practice Registered Nurse or physician assistant, not located in Oklahoma this state, provided that they are licensed in the state in which they are actively prescribing. C. E. 1. Pharmacists may only dispense prescriptions for controlled dangerous substances prescribed by an advanced practice nurse or physician assistant Advanced Practice Registered Nurse licensed in the State of Oklahoma and supervised by an Oklahoma- licensed practitioner this state who meets the criteria in paragraph 1 or 2 of subsection A of this section or who meets the criteria in subsection B of this section. 2. Pharmacists may only dis pense prescriptions for contro lled dangerous substances prescribed by a physician assistant licensed in this state and supervised by a supervising physician licensed in this state. SECTION 4. AMENDATORY 59 O.S. 2021, Section 567.3a, is amended to read as follows: Section 567.3a. As used in the Oklahoma Nursing Practice Act: 1. “Board” means the Oklahoma Board of Nursing; Req. No. 759 Page 20 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 2. “The practice of nursing ” means the performance of services provided for purposes of nursing diagnosis and treatment of human responses to actual or potential health problems consistent wit h educational preparation. Knowledge and skill are the basis fo r assessment, analysis, planning, intervention, and evaluation used in the promotion and maintenance of healt h and nursing management of illness, injury, infirmity, restoration or optimal func tion, or death with dignity. Practice is based on understanding the human condition across the human lifespan and understanding the relationship of the individual within th e environment. This practice includes execution of the medical regime including th e administration of medications and treatments prescribed by any person authorized by state law to so prescribe; 3. “Registered nursing” means the practice of the full scop e of nursing which includes, but is not limited to: a. assessing the health status of individuals, families and groups, b. analyzing assessment dat a to determine nursing care needs, c. establishing goals to meet identified health care needs, d. planning a strategy of care, e. establishing priorities of nursing intervention to implement the strategy of care, Req. No. 759 Page 21 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 f. implementing the strategy of care, g. delegating such tasks as may safely be performed by others, consistent with educational preparation and that do not conflict with the p rovisions of the Oklahoma Nursing Practice Act, h. providing safe and effective nursing care rendered directly or indirectl y, i. evaluating responses to interventions, j. teaching the principles and practice of nursing, k. managing and supervising the prac tice of nursing, l. collaborating with other health profess ionals in the management of health care, m. performing additiona l nursing functions in accordance with knowledge and skills acquired beyond basic nursing preparation, and n. delegating those nursin g tasks as defined in the rules of the Board that may be pe rformed by an advanced unlicensed assistive person; 4. “Licensed practical nursing” means the practice of nursing under the supervision or direction of a registered nurse, licensed physician or dentist. This directed scope of nursing practice includes, but is not limited to: a. contributing to the assessment of the h ealth status of individuals and groups, Req. No. 759 Page 22 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 b. participating in the development and modification of the plan of care, c. implementing the appropriate aspects of the plan of care, d. delegating such tasks as may safely be performed by others, consistent with ed ucational preparation and that do not conflict with the Oklahoma Nursing Practice Act, e. providing safe and effective nursing care r endered directly or indirectly, f. participating in the eva luation of responses to interventions, g. teaching basic nursing skills and related principles, h. performing additional nursing procedures in accordance with knowledge and skills acquired through education beyond nursing preparation, and i. delegating those nursing tasks as defined in the rules of the Board that may b e performed by an advanced unlicensed assistive per son; 5. “Advanced Practice Registered Nurse ” means a licensed Registered Nurse: a. who has completed an advanced practice registered nursing education program in preparation for one of Req. No. 759 Page 23 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 four recognized advanced practice registered nurse Advanced Practice Registered Nurse roles, b. who has passed a national certif ication examination recognized by the Board that measures the advanced practice registered nurse Advanced Practice Registered Nurse role and specialty competencies and who maintains recertification in the role and specialty through a national certification program, c. who has acquired adv anced clinical knowledge and skills in preparation for providing both direct and indirect care to patients; howeve r, the defining factor for all Advanced Practice Re gistered Nurses is that a significant component of the edu cation and practice focuses on di rect care of individuals, d. whose practice builds on the competencies of Registered Nurses by demonstrating a gre ater depth and breadth of knowledge, a greater synt hesis of data, and increased complexity of skills and inte rventions, and e. who has obtained a license as an Advanced Practice Registered Nurse in one of the following roles: Certified Registered Nurse An esthetist, Certified Nurse-Midwife, Clinical Nurse Specialist, or Certified Nurse Practitioner. Req. No. 759 Page 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Only those persons who hold a license to pract ice advanced practice registered nursing in this s tate shall have the right to use the title “Advanced Practice Re gistered Nurse” and to use the abbreviation “APRN”. Only those persons who have obtained a license in the following disciplines shall have th e right to fulfill the roles and use the applicabl e titles: Certified Registered Nurse Anesthetist and the abbrev iation “CRNA”, Certified Nurse-Midwife and the abbreviation “CNM”, Clinical Nurse Specialist and the abbreviation “CNS”, and Certified Nurse P ractitioner and the abbreviation “CNP”. It shall be unlawful for any person to assume the role or use the title Advanced Practice Registered Nurse or use the abbrevi ation “APRN” or use the respective specialty role titles a nd abbreviations or to use any other titles or abbreviations that would reasonably lead a person to believe the user is an Advanced Practice Regist ered Nurse, unless permitted by the Oklahoma Nursin g Practice Act. Any individual doing so shall be guilty o f a misdemeanor, which shall be punishable, upon conviction, by imprisonment in the county jail for not more than one (1) year or by a fine of not less than One Hundred Dollars ($100.00) nor more th an One Thousand Dollars ($1,000.00), or by both such imprisonment and fine for each offense ; 6. “Certified Nurse Practitioner” is means an Advanced Practice Registered Nurse who performs in an expanded ro le in the delivery of health care: Req. No. 759 Page 25 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 a. consistent with advanced educational preparation as a Certified Nurse Practitioner in an area of special ty, b. functions within the Certified Nurse Practi tioner scope of practice for the selected area of specialization, and c. is in accord with the standards for Certif ied Nurse Practitioners as identified by the certifying bo dy and approved by the Board. A Certified Nurse Practitioner shall be eligible, in accordance with the scope of practice of the Certified Nurse Pra ctitioner, to obtain recognition as authorized by t he Board to prescribe, as defined by the rules promulgated by the Board pursuant to this section and subject to the medical direction of a su pervising physician Section 567.4a of this title and Section 1 of this act. This authorization shall not include d ispensing drugs, but shall not preclude, subject to federa l regulations, the receipt of, th e signing for, or the dispensing of professional s amples to patients. The Certified Nurse Practitioner accepts res ponsibility, accountability, and obligation to prac tice in accordance with usual and customary advanced pract ice registered nursing standards and functions as defined by the scope of practice/ role definition statements for the Certified Nurse Practitioner; 7. a. “Clinical Nurse Specialist ” is means an Advanced Practice Registered Nurse who holds: Req. No. 759 Page 26 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (1) a master’s degree or higher in nursing with clinical specialization preparation to function in an expanded role, (2) specialty certification from a national certifying organization recognized by the Board, (3) an Advanced Practice Registered Nurse license from the Board, and (4) any nurse holding a specialty certification as a Clinical Nurse Specia list valid on January 1, 1994, granted by a national certifying organization recognized by the Board, shall be deemed to be a Clinical Nurse Specialist under the provisions of the Oklahoma Nursing Practice Act. b. In the expanded role, the Clinical Nurse S pecialist performs at an advanced practice level which shall include, but not be limited to: (1) practicing as an expert clinician in the provision of direct nursing care to a selected population of patien ts or clients in any setting, including private pra ctice, (2) managing the care of patients or clients with complex nursing problems, Req. No. 759 Page 27 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (3) enhancing patient or client c are by integrating the competencies of clinical practice, education, consultation, and re search, and (4) referring patients or clients to ot her services. c. A Clinical Nurse Specialist in accordance with t he scope of practice of such Clinical Nurse Special ist shall be eligible to obtain recognition as authorized by the Board to prescribe, as d efined by the rules promulgated by the Board pursua nt to this section, and subject to the medical direction of a sup ervising physician Section 567.4a of this title and Section 1 of this act. This authorization shall not i nclude dispensing drugs, but shall not preclude, subject to federal regulations, the receipt of, the signing for, or the dispensing of profes sional samples to patients. d. The Clinical Nurse Specialist acc epts responsibility, accountability, and obligation to practice in accordance with usual and customary advanced practice nursing standards and functions as defined by the scope of practice/rol e definition statements for the Clinical Nurse Specialist; 8. “Nurse-Midwife” is means a nurse who has received an Advanced Practice Registered Nurs e license from the Oklahoma Board Req. No. 759 Page 28 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 of Nursing who possesses evidence of certification according to the requirements of the American College of Nurse -Midwives. A Certified Nurse-Midwife in accordance with the scope of practice of such Certified Nurse -Midwife shall be eligible to obtain recognition as authori zed by the Board to prescribe, as defined by the rules promulgated by the Board pursuant to this section and subject to the medical direction of a supervising physician . This authorization shall not inclu de the dispensing of drugs, but shall not preclude, subject to federal regulations, the receipt of, the signing for, or the dispensing of professional samples to patients . The Certified Nurse-Midwife accepts responsibility , accountability, and obligation t o practice in accordance with usual and customary advanced practice registered nursing standards and functions as defined by the scope of practice/role definition statements for the Certified Nurse-Midwife; 9. “Nurse-midwifery practice” means providing management of care of normal newborns and women, ante partally, intrapartally, postpartally and gynecologicall y, occurring within a health care system which provides for med ical consultation, medical management or referral, and is in accord with the standards for nurse-midwifery practice as defined by the Ame rican College of Nurse -Midwives; 10. a. “Certified Registered Nurse Anesthetist ” is an Advanced Practice Registered Nur se who: Req. No. 759 Page 29 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (1) is certified by the National Board of Certification and Recertification f or Nurse Anesthetists as a Certified Registered Nur se Anesthetist within one (1) year following completion of an approved certified registered nurse anesthetist Certified Registered Nurse Anesthetist education program, and continues to maintain such recert ification by the National Board of Certification an d Recertification for Nurse Anesthetists, and (2) administers anesthesia in collaboration with a medical doctor, an oste opathic physician, a podiatric physician or a dentis t licensed in this state and under conditions in which timely onsite consultation by such doctor, osteopath, podiatric physician or dentist i s available. b. A Certified Registered Nurse Anesthetist, in collaboration with a medical doctor, osteopathic physician, podiatric physician or dent ist licensed in this state, and under conditions in which timely, on- site consultation by such medical docto r, osteopathic physician, podiatric physician or dentist is available, shall be authorized, pursuant to rules adopted by the Oklahoma Board of Nursi ng, to order, Req. No. 759 Page 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 select, obtain and administer legend drugs, Schedules II through, III, IV, and V controlled substances, devices, and medical gases only when engaged in the preanesthetic preparation and evaluation; anesthesia induction, maintenance and emergence; and postanesthesia care. A Certified Register ed Nurse Anesthetist may order, select, obtain and adminis ter drugs only during the perioperative or periobstetrical period. c. A Certified Registered Nurse Anesthetist who applies for authorization to order, select, obtain and administer drugs shall: (1) be currently recognized as a Certified Registered Nurse Anesthetist in this state, (2) provide evidence of completion, wi thin the two- year period immediately preceding the d ate of application, of a minimum of fifteen (15) units of continuing education in a dvanced pharmacology related to the administration of anes thesia as recognized by the National Board of Certification and Recertification for Nurse Anesthetists, and (3) complete and submit a no tarized application, on a form prescribed by the Board, accomp anied by the Req. No. 759 Page 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 application fee established pursuant to this section. d. The authority to order, select, obtain and administ er drugs shall be terminated if a Certified Register ed Nurse Anesthetist has: (1) ordered, selected, obtained or administered drugs outside of the Certified Registered Nurse Anesthetist scope of practice or ordered, selected, obtained or administered drugs for other than therapeutic purposes, or (2) violated any provision of st ate laws or rules or federal laws or regulations pertaining to the practice of nursing or the authority to order, select, obtain and administer drugs. e. The Oklahoma Board of Nursing shall notify the Board of Pharmacy after terminatio n of or a change in t he authority to order, select, obtain and administer drugs for a Certified Registered Nurse Anesthetist. f. The Board shall provide by rule for biennial application renewal and reauth orization of authority to order, select, obtain and administer drugs for Certified Registered Nurse Anesthetists. At the time of application renewal, a Certified Registered Nurse Anesthetist shall submit documentation of a minimum of Req. No. 759 Page 32 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 eight (8) units of co ntinuing education, completed during the previous tw o (2) years, in advan ced pharmacology relating to the administration of anesthesia, as recognized by the Council on Recertification of Nurse Anesthetists or the Council on Certification of Nurse Anestheti sts. g. This paragraph shall not prohibit the admini stration of local or topical anesthetics as now permitted by law. Provided further , nothing in this paragraph shall limit the authority of t he Board of Dentistry to establish the qualifications for denti sts who direct the administration of anesthesia. h. As used in this parag raph, “collaboration” means an agreement between a medical doc tor, osteopathic physician, podiatric physician or dentist performing the procedure or directly involved with the procedu re and the Certified Registered Nurse Anesthetist wo rking jointly toward a common goal providing services for the same patient. This c ollaboration involves the joint formulation, discussion an d agreement of the anesthesia plan by both parties, and the col laborating medical doctor, osteopathic physician, po diatric physician or dentist performing the procedure or directly involved with the procedure and that. The Req. No. 759 Page 33 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 collaborating physician shall re main available for timely onsite consultation during the delive ry of anesthesia for diagnosis, consultation, and tr eatment of medical conditions; 11. “Supervising Advanced Practice Registered Nurse” means an Advanced Practice Registered Nurse holding a current license to practice who has obtained independent prescriptive authority under Section 1 of this act and who otherwise meets the qualification s of a supervising Advanced Practice Registered Nur se under Section 1 of this act who supervises a Certified Nurse Practitioner or a Clinical Nurse Specialist who has not obtained independent prescriptive authority under Section 1 of this act ; 12. “Supervising physician” means an individual holding a current license to practice as a physi cian from the State Board of Medical Licensure and Supervision or the State Board of Osteopathic Examiners, who supervises : a. a Certified Nurse Practitioner , or a Clinical Nurse Specialist who has not obtained independent prescriptive authority under Section 1 of this act, or b. a Certified Nurse-Midwife, and who is not in training as an intern, resident, or fellow. To be eligible to supervise such Advanced Practice Regis tered Nurse, such The supervising physician shall remain in compliance with t he rules Req. No. 759 Page 34 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 promulgated by the State Board of Medical Licensure and Supervision or the State Board of Osteopathic Examiners; 12. 13. “Supervision of an Advanced Practice Registered Nurse with prescriptive authority” means overseeing and accepting responsibility for the ordering and transmission by: a. a Certified Nurse Practitioner , or a Clinical Nurse Specialist who has not obtained independent prescriptive authority under Section 1 of this act, or b. a Certified Nurse-Midwife, of written, telephonic, electronic or oral prescriptions for drugs and other medical supplies, subject to a defined fo rmulary; and 13. 14. “Advanced Unlicensed Assistant ” means any person who has successfully completed a certified training program approved by the Board that trains the Advanced Unlicensed Assistant to perform specified technical skills identified by the B oard in acute care settings under the direction and supervision of the Registered Nurse or Licensed Practical Nurse. SECTION 5. AMENDATORY 59 O.S. 2021, Section 567.4a, is amended to read as follows: Section 567.4a. The Oklahoma Board of Nursing may grant prescriptive authority through the Advanc ed Practice Registered Nurse license to Certified Nurse Practitioners, Certified Nurse- Midwives, and Clinical Nurse Specialists who meet the requirements for prescriptive authority identif ied by law and in the Board’s Req. No. 759 Page 35 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 rules. The rules regarding prescriptiv e authority recognition promulgated by the Oklahoma Board of Nursing pursuant to paragraphs 6 through 9, 11 and 12 of Section 567.3a of this ti tle shall: 1. Define the procedure for docu menting supervision by a supervising physician licensed in Oklahoma t o practice by the State Board of Medical Licensure and Supervision or the State Board of Osteopathic Examiners or a supervising Advanced Practice Registered Nurse, if applicable. Such procedure shall i nclude a written statement that defines appropriate referral, consultati on, and collaboration between the Advanced Practice Registered Nurse, recognized to prescribe as defined in paragraphs 6 through 9, 11 and 12 of Section 567.3a of this title, and the s upervising physician or supervising Advanced Practice Registered Nurse, if applicable. The written statement shall include a method of assuring availability of the supervising physician or supervising Advanced Practice Registered Nurse through direct contact, telecommun ications or other appropriate electronic means for consul tation, assistance with medical emergencies, or patient referral. The written statement shall be part of the initial application and the renewal application submitted to the Board for recognition fo r prescriptive authority for the Advanced Practice Regist ered Nurse. Changes to the written statement shall be filed with the Board within thirty (30) day s of the change and shall be effective on filing; Req. No. 759 Page 36 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 2. Define the procedure for documenting independent prescriptive authority for Certified Nurse Practitioners and Clinical Nurse Specialists who have obtained independent prescriptive authority unde r the Section 1 of this act; 3. Define minimal requirements for initial application for prescriptive authority which shall in clude, but not be limited to, evidence of completion of a minimum of forty-five (45) contact ho urs or three (3) academic credit hours of education in pharmacotherapeutics, clinical application, and use of pharmacological agents in the prevention of illness , and in the restoration and maintenance of health in a program beyond basic registered nurse preparation, approved by the Board. Such contact hours or academic credits shall be obtained within a time period of three (3) years immediately preceding the da te of application for prescriptive authority ; 3. 4. Define minimal requirements for applicatio n for renewal of prescriptive authority which shall include, but not be limited to, documentation of a minimum of: a. fifteen (15) contact hours or one (1) acade mic credit hour of education in pharmacother apeutics, clinical application, and use of pharmaco logical agents in the prevention of illness, and in the rest oration and maintenance of health in a program beyond basic registered nurse preparation, and Req. No. 759 Page 37 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 b. two (2) hours of education in pain management or two (2) hours of education in opioid use or addict ion, unless the Advanced Practice Registered Nurse has demonstrated to the satisfaction of the Board that the Advanced Practice Registered Nurse does not current ly hold a valid federal Drug Enforcement Adm inistration registration number, approved by the Board, within the two-year period immediately preceding the effective date of application for renewal of prescriptive authority; 4. 5. Require that beginning July 1, 2002, an Advanced Practice Registered Nurse shall demonstrate demonstrates successful completion of a master’s degree or higher in a clinical nurse specialty one of the four Advanced Practice Registered Nurs e roles in order to be eligible for initial application fo r prescriptive authority under the provisions of the Oklahoma Nursing Practice Act; 5. 6. Require an Advanced Practice Registered Nurse to have graduated from a program accredited by the Accredita tion Commission for Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE), or a substantially equivalent program approved by the Board in order to be eligible for initial application for prescriptive authority under the provi sions of the Oklahoma Nursing Practice Act . As a condition of obtaining prescriptive authority, an Advanced Practice Registered Nurse shall Req. No. 759 Page 38 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 show evidence of annual on -campus attendance for assessment and evaluation of student progress and competence in ad dition to completing the required clinical hours in the graduate program consistent with the national standard; 7. Define the method for communicating authority to pr escribe or termination of same, an d the formulary to the Board of Pharmacy, all pharmacies, and all registered pharmacists; 6. 8. Define terminology used in such rules; 7. 9. Define the parameters for the prescribing practices of the Advanced Practice Re gistered Nurse; 8. 10. Define the methods for termination of prescriptive authority for the Advanced Practice Registered Nurse; and 9. 11. a. Establish a Formulary Advisory Coun cil that shall develop and submit to the Board recommendations for an exclusionary formulary that shall list drugs or categories of drugs that shall not be prescribed by Advanced Practice Registered Nurse recognized to prescribe by the Oklahoma Board of Nu rsing. The Formulary Advisory Council shall also develop and submit to the Board recommendations for practice- specific prescriptive standards for each category of Advanced Practice Registered Nurse recognized to prescribe by the Oklahoma Board of Nursing pursuant to the provisions of the Oklahoma Nursing Practice Act. Req. No. 759 Page 39 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 The Board shall either accept or reject the recommendations made by the Council. No amendments to the recommended exclusionary formulary may be made by the Board without the approval of the Formulary Advisory Council. b. The Formulary Advisory Council shall be compos ed of twelve (12) members as follo ws: (1) four members, to include a pediatrician, an obstetrician-gynecological physician, a general internist, and a family practice physician; provided that three of such members shall be appointed by the Oklahoma State M edical Association, and one shall be appointed by the Oklahoma Osteopathic Association, (2) four members who are registered pharmacists, appointed by the Oklahoma Pharmaceutical Association, and (3) four members, one of whom shall be a Certified Nurse Practitioner, one of whom shall be a Clinical Nurse Specialist, one of whom shall be a Certified Nurse-Midwife, and one of whom shall be a current member of the Oklahoma Board of Nursing, all of whom shall be appointed by the Oklahoma Board of Nursing. Req. No. 759 Page 40 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 c. All professional members of the Formul ary Advisory Council shall be in active clinical practi ce, at least fifty percent (50%) of the time, withi n their defined area of specialty. Th e members of the Formulary Advisory Council shall serve at the pleasure of the appointing authority for a term o f three (3) years. The terms of the members shall be s taggered. Members of the Council may serve beyond the expiration of their term of office until a successor is appointed by the original appointing authority. A vacan cy on the Council shall be filled for the balance of the unexpired term by the original a ppointing authority. d. Members of the Council shal l elect a chair and a vice - chair from among the membership of the Council. For the transaction of business, at leas t seven members, with a minimum of two members present from each of the identified categories of physicians, pharmacists and advanced practice registered nurses Advanced Practice Registered Nurses, shall constitute a quorum. The Council shall recommend an d the Board shall approve and implement an initial exclusionary formulary on or before January 1, 1997. The Council and the Board shall annually review the approved exclusionary formulary and shall make any necessary revisions Req. No. 759 Page 41 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 utilizing the same procedure s used to develop the initial exclusionary formulary. SECTION 6. AMENDATORY 59 O.S. 2021, Section 567.5a, is amended to read as fo llows: Section 567.5a. A. All applicants for a license to practice a s an Advanced Practice Registered Nurse shall be subject to Section 567.8 of this title. B. An applicant for an initial license to practice as an Advanced Practice Registered Nurse shal l: 1. Submit a completed written application and appropriate fees as established by the Board; 2. Submit a criminal history records check that compl ies with Section 567.18 of this title; 3. Hold a current Registered Nurse license in this state; 4. Have completed an advanced practice registered nursing education program in one of the four advanced practice regi stered nurse Advanced Practice Registere d Nurse roles and a specialty area recognized by the Board. Effective January 1, 2016, the applic ant shall have completed an ac credited graduate level advanced practice registered nursing education program in at lea st one of the following population foci: family/individual across the lifespan, adult-gerontology, neonatal, pediatrics, women ’s health/gender- related, or psychiatric/ mental health; Req. No. 759 Page 42 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 5. Be currently certified in an advanced practice specialty certification consistent with educational preparatio n and by a national certifying body recognized by the Board; and 6. Provide any and all other evi dence as required by the Board in its rules. C. The Board may issue a license by endorsement to an Advanced Practice Registered Nurse licensed under the laws of another state if the applicant meets the qualifications for licensure in this state. An applicant by endorsement shall: 1. Submit a completed written application and appr opriate fees as established by the Board ; 2. Hold a current Registered Nurse li cense in this state; 3. Hold recognition as an Advanced Practice Registered Nurse in a state or territory; 4. Have completed a n advanced practice registered nursing education program in one of the four roles and a specialty area recognized by the Board. Effective January 1, 2016, the applicant shall have completed an accredited graduate level advanc ed practice registered nursing education program in at least one of the following population foci: family/individual across the lifespan, adult-gerontology, neonatal, pediatrics, women’s health/gender- related, or psychiatric/mental health; Req. No. 759 Page 43 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 5. Be currently certified in an advanced pra ctice specialty certification consistent with ed ucational preparation and by a national certifying body recognized by the Board; 6. Meet continued competency requirements as set forth in Board rules; and 7. Provide any and a ll other evidence as required by the Board in its rules. D. The Board may iss ue prescriptive authority recognition by endorsement to an Advanced Practice Reg istered Nurse licensed as an APRN-CNP, APRN-CNS, or APRN-CNM under the laws of another state if the applicant meets the requirem ents set forth in this section. An applicant for prescriptive authority recognition by endorsement shall: 1. Submit a complete d written application and appropriate fees as established by the Board; 2. Hold current Registere d Nurse and Advanced Practice Registered Nurse licenses (APRN-CNP, APRN-CNS, or APRN-CNM) in the state; 3. Hold current licensure or recognition as an Advanc ed Practice Registered Nurse in the same role and specialty with prescribing privileges in another state or territory; 4. Submit documentation verifying successful completion of a graduate level advanced practice re gistered nursing education program that included an academic course in pharmacotherapeutic Req. No. 759 Page 44 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 management, and didactic and clinical preparati on for prescribing incorporated throughout the program; 5. Submit: a. a written statement from an Oklahoma licensed physician or supervising Advanced Practice Registered Nurse supervising prescriptive authority as required by the Board in its rules , if the applicant is a Certified Nurse Practitioner or Clinical Nurse Specialist, b. a written statement from an Oklahoma licensed physician supervising prescriptive authority as required by the Board in its rules , if the applicant is a Certified Nurse -Midwife, or c. submit documentation that the applicant meets the requirements for independ ent prescriptive authority under Section 1 of this act; 6. Meet continued competency requirements as set forth in Board rules; and 7. Provide any and all other evide nce as required by the Board in its rules. E. An Advanced Practice Registered Nurs e license issued under this section shall be renewed concurrently with the regis tered nurse license provided that qualifying criteria c ontinue to be met. Req. No. 759 Page 45 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 F. The Board may reinstate a license as set forth in Boa rd rules. SECTION 7. AMENDATORY 63 O.S. 2021, Section 2-312, as amended by Section 2 , Chapter 184, O.S.L. 2022 (63 O.S. Supp. 2022, Section 2-312), is amended to read a s follows: Section 2-312. A. A physician, podiatrist, optometrist or a dentist who has complied with the registration requirements of the Uniform Controlled Dangerous Substan ces Act, in good faith and in the course of such person’s professional practice only, may prescribe and administer controlled dangerous substances, or may cause the same to be administer ed by medical or paramedical personnel acting under the direction and supervision of the physician, podiatrist , optometrist or dentist, and only may d ispense controlled dangerous substa nces pursuant to the provisions of Sections 355.1 and 355.2 of Title 59 of the Oklahoma Statutes. B. A veterinarian who has complied wi th the registration requirements of the Uniform Controlled Dangerous Substances Act, in good faith and in the cours e of the professiona l practice of the veterinarian only, and not for use by a human being, may prescribe, administer, and dispense controlled dangerous substances and may cause them to be administered by an assistant or o rderly under the direction and supervision of the veter inarian. C. 1. An advanced practice nurse Advanced Practice Registered Nurse who is recognized to prescribe by the Oklahoma Board of Req. No. 759 Page 46 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Nursing as an advanced registered nurse practitioner, clinical nurse specialist or certified nurse-midwife, a Certified Nurse Practitioner or Clinical Nurse Specialist but who has not obtained independent prescriptive authority under Section 1 of this act and therefore is subject to medical direction by a supervising physician, or supervising Advanced Prac tice Registered Nurse pursuant to Section 567.3a of Title 59 of the Oklahoma St atutes, and who has complied with the re gistration requirements of the Unif orm Controlled Dangerous Substances Act, in good faith and in the cours e of professional practi ce only, may prescribe and administer Schedule III, IV and V controlled dangerous subs tances. 2. An Advanced Practice Registered Nurse wh o is recognized to prescribe by the Okla homa Board of Nursing as a Certified Nurse Practitioner or Clinical Nurse Specialist who has obtained independent prescriptive authority under Section 1 of this act, and who has complied with the regis tration requirements of th e Uniform Controlled Dangerous Subs tances Act, in good faith and in the course of professional practice only, may prescribe and administer Schedule III, IV, and V controlled dangerous substances. D. An Advanced Practice Registered Nurse wh o is recognized to prescribe by the Okla homa Board of Nursing as a Certified Nurse- Midwife, who is subject to medical direction by a supervising physician pursuant to Section 567.3a of Title 59 of the Oklahoma Statutes, and who has complied with the registration requirements of Req. No. 759 Page 47 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 the Uniform Controlled Dangerous Substances Act, in good faith and in the course of professional practice only, may prescribe and administer Schedule III, IV, and V controlled dangerous sub stances. E. An advanced practice nurse Advanced Practice Register ed Nurse who is recognized to order , select, obtain and administer drugs by the Oklahoma Board of Nursing as a certified registered nurse anesthetist Certified Registered Nurse Anesthetist pursuant to Section 353.1b of Title 59 of the Oklahoma Statutes and who has complied with the registra tion requirements of the Uniform Controlled Dangerous Substances Act, in good faith and i n the course of such practitioner’s professional practice only, may order, select, obtain and administer S chedules II through, III, IV, and V controlled dangerous subst ances in a preanesthetic preparation or evaluation; anesthesia induction, maintenance or emergence; or postanesthesia care setting only. A certified registered nurse anesthetist Certified Registered Nurse Anesthetist may order, select, obtain and administ er such drugs only during the perioperative or periobstetrical period. E. F. A physician assistant who is recognized to prescribe by the State Board of Medical Licensure and Supervision under th e medical direction of a s upervising physician, pursuant to Section 519.6 of Title 59 of the O klahoma Statutes, and who has complied with the registration requirements of the Uniform Controlled Dangerous Substances Act, in good faith and in the course of Req. No. 759 Page 48 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 professional practice only, may prescribe and administe r Schedule II through V Schedules II, III, IV, and V controlled dangerous substances. SECTION 8. This act shall become effective November 1, 2023. 59-1-759 DC 1/17/2023 11:08:41 AM