Req. No. 1481 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 931 By: Garvin AS INTRODUCED An Act relating to the Oklahoma Pharmacy Act; amending 59 O.S. 2021, Section 353.1, as amended by Section 6, Chapter 288, O.S.L. 2022 (59 O.S. Supp. 2022, Section 353.1) , which relates to definition; expanding definition; allowing a licensed pharm acist to administer certain treatment under certain condition; defining term; permitting certain tests for certain treatments; allowing a pharmac ist to dispense certain products under ce rtain circumstances; requiring the Board of Pharmacy to promulgate certain rules by certain time; providing for codification; providing an effective date; and declaring an emergency. BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: SECTION 1. AMENDATORY 59 O.S. 2021, Section 353.1, as amended by Section 6, Chapter 288, O.S.L. 2022 (5 9 O.S. Supp. 2022, Section 353.1), is amen ded to read as follows: Section 353.1. For the purposes of the Oklahoma Pharmacy Act: 1. “Accredited program” means those seminars, classes, meetings, work projects, and oth er educational courses approved by the Board for purposes of continuing professional education; 2. “Act” means the Oklahoma Pharmac y Act; Req. No. 1481 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 3. “Administer” means the direct application of a drug, whether by injection, inhalation, ingestion or any other m eans, to the body of a patient; 4. “Assistant pharmacist” means any person presently licensed as an assistant pharmacist in the State of Oklahoma 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 Pharm acy; 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 authori ty to confirm that the medication, labeling and packaging of the filled prescriptio n are accurate and meet all requirements prescribed by state and federal law. For the purposes of this paragraph, “licensed practitioner” shall not include optometrists wit h dispensing authority; 7. “Chemical” means any medicinal substance, whether simpl e or compound or obtained through the process of the science and art of chemistry, whether of organic or inorganic ori gin; 8. “Compounding” means the combining, admixing, m ixing, diluting, pooling, reconstituting or otherwise 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 pre scribing patterns; Req. No. 1481 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 9. “Continuing professional 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, char acteristics and therapeutics of the diseased state; 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 or der of a licensed veterinarian.”; 11. “Director” means the Executive Director of the State Board of Pharmacy unless context clearly indic ates otherwise; 12. “Dispense” or “dispensing” means the interpretation, evaluation, and implementation of a prescrip tion drug order including the preparation and delivery of a drug or device to a patient or a patient ’s agent in a suitable container appro priately labeled for subsequent ad ministration to, or use by, a patient. Dispense includes sell, distribute, leave wi th, give away, dispose of, deliver or supply; 13. “Dispenser” means a retail pharmacy, hospital pharmacy, a group of chain pharmacies und er common ownership and control th at do not act as a wholesale distributor, or any other person authorized Req. No. 1481 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 by law to dispense or administer prescription drugs, and the affiliated warehouses or distributions of such entities und er common ownership and control that do not act as a wholesale distributor. For the purposes of this paragraph, “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 pursuant 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. 360b(b); provided, taking actual physical possession of a product or title shall 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 s hall have the same meaning wherever they appear in the Oklahoma Statutes and the rules promulgated by the Board; 16. “Drug outlet” means all manufacturers, repackagers, outsourcing faciliti es, wholesale distributors, thir d-party logistics providers, pharm acies, and all other facilities which are engaged in dispensing, delivery, distribut ion or storage of dangerous drugs; Req. No. 1481 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 17. “Drugs” means all medicinal substances and preparations recognized by the United States Pharmacopo eia and National Formulary, or any revision thereof, and all substances and preparations intended for external and/or internal use in the cure, diagnosis, mitigation, treatment or prevention of disease in humans or animals and all substances and preparatio ns, other than food, intended to affect the structure or any function of the 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 s old 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 con tains such information as is requi red 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 Veterans Affairs; 22. “Licensed practitioner ” means an allopathic physician, osteopathic physician, podiatric physician, dentist, veterin arian or optometrist licensed to practice and authorize d to prescribe dangerous drugs within the scope of practice of such practitione r; Req. No. 1481 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 23. “Manufacturer” or “virtual manufacturer” means with respect to a product: a. a person that holds an application ap proved 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 product, 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 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 pac kaging 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 Req. No. 1481 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 “manufacturing” also includes the preparation and promoti on of commercially available products 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 as “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 on drug orders to suppliers or oth er entities licensed to use, administer or distribute medical gas and may als o include a patient or ultimate user; 28. “Medical gas supplier” means a person who dispe nses medical gases on drug orders only to a pati ent or ultimate user; 29. “Medicine” means any drug or combination of drugs which has the property of curing, prevent ing, 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 wit h the requirements 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 Req. No. 1481 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 the general public if such articl es or preparations 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 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 th e 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; Req. No. 1481 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 35. “Pharmacy” means a place regularly licensed by the Board of Pharmacy in which prescriptions, drugs, medicines, chemicals and poisons are compounded or dispensed or such place where pharmacists practice the profession of pharmacy, or a pharmacy operated b y the Oklahoma Department of Veterans Affairs; 36. “Pharmacy technician”, “technician”, “Rx tech”, or “tech” means a person issued a Technician permi t 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 supervi sion of a pharmacist; 37. “Poison” means any substance which when introduced into the body, either directly or by a bsorption, produces violent, morbid or fatal changes, or which destroys living tissue with which such substance comes into contact; 38. “Practice of pharmacy” means: a. the interpretation and evaluation of prescription orders, b. the compounding, dispensi ng, administering and labeling of drugs and devices , except labeling by a manufacturer, repackager or distributor of nonprescription drugs a nd commercially packaged legend drugs and devices, Req. No. 1481 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 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, con tent, hazards and use of drugs and devices, f. the offering or performing of those ac ts, services, operations or transactions necessary in t he conduct, operation, management and control of a pharmacy, or g. order, performing, and interpreting tests authorized by the Food and Drug A dministration and waived under the federal Clinical Laboratory Improvement Amendments of 1988, and initiating drug therapy for minor, nonchronic health conditions , h. the dispensing of self -administered hormonal contraceptives and any nicotine replacement therapy product that is approved by the United States F ood and Drug Administration, or i. the provision of those acts or services that are necessary to provide pharmaceutical care; Req. No. 1481 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 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; 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 co mmunication: a. by a licensed prescriber, b. under the supervision of an Okla homa licensed practitioner, an Oklahoma licensed advanced practice registered nurse or an Oklahoma licensed physician assistant, or c. by an Oklahoma licensed wholesaler or distri butor as authorized in Section 353.29.1 of this titl e; 42. “Product” means a prescription drug in a finished dosage form for administration to a patient w ithout substantial further manufacturing, such as ca psules, 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 Req. No. 1481 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 relabels a product or package for further sale or distribution without further transaction; 44. “Sterile drug” means a drug that is intended for parenteral administration, an ophthalmic or oral inhalation drug in aqueous format, or a drug that is required to be sterile under state and federal law; 45. “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 Osteopathic Examiners, pursuant to t he provisions of the Oklahoma Osteopathic Medicine Act, who supervises an advanced practice registered nurse as defined in Secti on 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 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. “Supportive personnel” means technicians and auxil iary 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. “Third-party logistics provider ” including “virtual third- party logistics provider ” means an entity that provides or Req. No. 1481 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 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 product but does not take ownership of the product, nor have res ponsibility 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; 48. “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 wh olesale distribution as defined by 21 U.S.C. 353(e)(4) as amended by the Drug Supply Chain Security Act; 49. “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 persons found guilty of civil or criminal contempt; 50. “State correctional facility ” means a facility or institution that houses a p risoner population under the j urisdiction of the Department of Corrections; 51. “Unit dose package” means a package that contains a single dose drug with the name, strength, control number, and expiratio n date of that drug on the label; and Req. No. 1481 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 52. “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 2. NEW LAW A new section of law to be codified in the Oklahoma Statutes as Section 353.31 of Title 59, unless there is created a duplication i n numbering, reads as follows: A. A pharmacist may test or screen for a nd administer treatment for a minor, nonchronic health conditions. For purposes of this section, a “minor, nonchronic health condition” means a typically short-term health condition t hat is generally managed with noncontrolled drug therapies, minimal treatment, or self-care, which includes the following: 1. Influenzas; 2. Streptococcus; 3. SARS-COV-2 or other respiratory illness, condition, or disease; 4. Lice; 5. Urinary tract infections; 6. Skin conditions, such as ringworm and athlete ’s foot; and 7. Other emerging and existing public health treat s identified by the State Department of Health if permitted by an order, rule, or regulation. B. A pharmacist who tests or scree ns for and treats minor, nonchronic health conditions provided by this secti on may use any Req. No. 1481 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 test that may guide clinical decision making, which the Centers for Medicare and Medicaid Services has determined quali fies for a waiver under the federal Clinical Labor atory Improvement Amendments of 1988, or the federal rules adopted there under, or any establishing screen procedures that c an safely be performed by a pharmacist. C. A pharmacist may dispense a self-administered hormonal contraceptive and nicotine replacement therapy products under the protocol established pursuant to Subsection D of this section, regardless of whether the patient has obtained a prescription. D. The Board of Pharmacy shall adopt re gulations establishing a protocol for dispensing sel f-administered hormonal contraceptives and nicotine replacement therapy produc ts by January 1, 2024. SECTION 3. This act shall become effective July 1, 2023. SECTION 4. It being immediately necessary for the preservation of the public peace, health or safety, an emergency is hereby declared to exist, by reason whereof this act shall take effect and be in full force from and after its passage and approval. 59-1-1481 MR 1/19/2023 10:53:29 AM