Texas 2025 - 89th Regular

Texas House Bill HB4051 Compare Versions

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1	1	By: Frank H.B. No. 4051
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6	6	A BILL TO BE ENTITLED
7	7	AN ACT
8	8	relating to the authority of certain healthcare providers to order
9	9	and provide or dispense limited prescription drugs.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 483.001(11), Health and Safety Code, is
12	12	amended to read as follows:
13	13	(11) "Practice of pharmacy" has the meaning assigned
14	14	by Section 551.003, Occupations Code [means:
15	15	[(A) provision of those acts or services
16	16	necessary to provide pharmaceutical care;
17	17	[(B) interpretation and evaluation of
18	18	prescription drug orders or medication orders;
19	19	[(C) participation in drug and device selection
20	20	as authorized by law, drug administration, drug regimen review, or
21	21	drug or drug-related research;
22	22	[(D) provision of patient counseling;
23	23	[(E) responsibility for:
24	24	[(i) dispensing of prescription drug orders
25	25	or distribution of medication orders in the patient's best
26	26	interest;
27	27	[(ii) compounding and labeling of drugs and
28	28	devices, except labeling by a manufacturer, repackager, or
29	29	distributor of nonprescription drugs and commercially packaged
30	30	prescription drugs and devices;
31	31	[(iii) proper and safe storage of drugs and
32	32	devices; or
33	33	[(iv) maintenance of proper records for
34	34	drugs and devices. In this subdivision, "device" has the meaning
35	35	assigned by Subtitle J, Title 3, Occupations Code; or
36	36	[(F) performance of a specific act of drug
37	37	therapy management for a patient delegated to a pharmacist by a
38	38	written protocol from a physician licensed by the state under
39	39	Subtitle B, Title 3, Occupations Code].
40	40	SECTION 2. Section 151.002, Occupations Code, is amended by
41	41	adding Subdivisions (3-a) and (13-a) to read as follows:
42	42	(3-a) "Dispense" has the meaning assigned by Section
43	43	551.003.
44	44	(13-a) "Provision" means the supply of one or more
45	45	unit doses of a drug, medicine, or dangerous drug.
46	46	SECTION 3. The heading to Section 157.002, Occupations
47	47	Code, is amended to read as follows:
48	48	Sec. 157.002. GENERAL DELEGATION OF ADMINISTRATION, [AND]
49	49	PROVISION, AND DISPENSING OF DANGEROUS DRUGS.
50	50	SECTION 4. Sections 157.002(a), (b), (e), and (g),
51	51	Occupations Code, are amended to read as follows:
52	52	(a) In this section, "administering" [:
53	53	[(1) "Administering"] means the direct application of
54	54	a drug to the body of a patient by injection, inhalation, ingestion,
55	55	or any other means.
56	56	[(2) "Provision" means the supply of one or more unit
57	57	doses of a drug, medicine, or dangerous drug.]
58	58	(b) A physician may delegate to any qualified and properly
59	59	trained person acting under the physician's supervision the act of
60	60	administering [or providing] dangerous drugs in the physician's
61	61	office, as ordered by the physician, that are used or required to
62	62	meet the immediate needs of the physician's patients or the act of
63	63	providing or dispensing dangerous drugs as ordered by the physician
64	64	to the physician's patients. The administration, [or] provision,
65	65	or dispensing of the dangerous drugs must be performed in
66	66	compliance with laws relating to the practice of medicine and state
67	67	and federal laws relating to those dangerous drugs.
68	68	(e) The administration, [or] provision, or dispensing of
69	69	the drugs may be delegated through a physician's order, a standing
70	70	medical order, a standing delegation order, or another order
71	71	defined by the board.
72	72	(g) A drug or medicine provided or dispensed under
73	73	Subsection (b) or (c) must be:
74	74	(1) supplied in a child-resistant container unless the
75	75	patient request it not be in a child-resistant container or the
76	76	product is exempt from requirements of the Poison Prevention
77	77	Packaging Act of 1970;
78	78	(2) dispensed in a container with a label on the container
79	79	that contains the name of the drug, the date the prescription is
80	80	dispensed, the name of the prescribing practitioner, the quantity
81	81	dispensed, dosage and route of administration, date after which the
82	82	prescription should not be used or beyond-use-date, and appropriate
83	83	ancillary instructions such as storage instructions or cautionary
84	84	statements printed in an easily readable font size;
85	85	(3) stored prior to dispensing in a location with a
86	86	temperature range compatible with the proper storage of each drug,
87	87	including refrigeration where required, and secured against theft
88	88	or diversion of prescription drugs and locked to prohibit
89	89	unauthorized access when the physician is not on-site; and
90	90	(4) dispensed with written consumer information or written
91	91	directions to obtain written information online that provides the
92	92	therapeutic use of the drug and the names of generically equivalent
93	93	drugs.
94	94	(h) A physician dispensing a drug under this subchapter
95	95	must:
96	96	(1) complete a drug utilization review prior to dispensing
97	97	for therapeutic duplication, drug-to-disease contraindications,
98	98	drug-to-drug interactions, correct dosage, and drug-to-allergy
99	99	interactions;
100	100	(2) maintain records of dispensed medications including
101	101	patient information, prescription details and dispensing
102	102	information including the dispensing physicians name and office
103	103	address where drugs were dispensed from;
104	104	(3) counsel the patient on proper use of a prescription drug
105	105	or device; and
106	106	(4) perform a final check on all prescriptions filled onsite
107	107	for the accuracy and completeness of the prescription.
108	108	[supplied in a suitable container labeled in compliance with
109	109	applicable drug laws. A qualified and trained person, acting under
110	110	the supervision of a physician, may specify at the time of the
111	111	provision or dispensing of the drug the inclusion on the container
112	112	of the date of the provision or dispensing and the patient's name
113	113	and address.]
114	114	SECTION 5. The heading to Chapter 158, Occupations Code, is
115	115	amended to read as follows:
116	116	CHAPTER 158. AUTHORITY OF PHYSICIAN TO PROVIDE OR DISPENSE CERTAIN
117	117	DRUGS AND SUPPLIES
118	118	SECTION 6. Sections 158.001(a) and (c), Occupations Code,
119	119	are amended to read as follows:
120	120	(a) A physician licensed under this subtitle may provide
121	121	[supply] a patient with any drug, remedy, or clinical supply
122	122	necessary to meet the patient's immediate needs.
123	123	(c) This chapter does not prohibit a physician from
124	124	providing [supplying] to a patient, free of charge, a drug provided
125	125	to the physician by a drug manufacturer for an indigent
126	126	pharmaceutical program if, in the physician's opinion, it is
127	127	advantageous to the patient, in adhering to a course of treatment
128	128	prescribed by the physician, to receive the drug.
129	129	SECTION 7. Section 158.002(a), Occupations Code, is amended
130	130	to read as follows:
131	131	(a) This chapter does not prohibit a physician from
132	132	providing [supplying] a pharmaceutical sample to a patient free of
133	133	charge if, in the physician's opinion, it is advantageous to the
134	134	patient, in adhering to a course of treatment prescribed by the
135	135	physician, to receive the sample.
136	136	SECTION 8. The heading to Section 158.003, Occupations
137	137	Code, is amended to read as follows:
138	138	Sec. 158.003. DISPENSING OF DANGEROUS DRUGS TO CERTAIN
139	139	PATIENTS IN CERTAIN RURAL AREAS.
140	140	SECTION 9. Section 158.003, Occupations Code, is amended by
141	141	adding Subsection (a-1) to read as follows:
142	142	(a-1) This section applies only to a physician providing
143	143	care under workers' compensation insurance coverage, as defined by
144	144	Section 401.011, Labor Code.
145	145	SECTION 10. Chapter 158, Occupations Code, is amended by
146	146	adding Section 158.004 to read as follows:
147	147	Sec. 158.004. PROVISION AND DISPENSING OF DANGEROUS DRUGS.
148	148	(a) In this section, "reimbursement for cost" means an additional
149	149	charge, separate from that imposed for the physician's professional
150	150	services, that includes the cost of a drug product and all other
151	151	actual costs to the physician incidental to providing dispensing
152	152	service. The term does not include a separate fee imposed for the
153	153	act of dispensing a drug itself.
154	154	(b) This section does not apply to a physician providing
155	155	care under workers' compensation insurance coverage, as defined by
156	156	Section 401.011, Labor Code.
157	157	(c) A physician may:
158	158	(1) provide or dispense dangerous drugs to the
159	159	physician's patients; and
160	160	(2) be reimbursed for the cost of providing or
161	161	dispensing those drugs without obtaining a license under Chapter
162	162	558.
163	163	(d) A physician may not provide or dispense under this
164	164	section a controlled substance listed in Schedules II through V as
165	165	established under Subchapter B, Chapter 481, Health and Safety
166	166	Code.
167	167	(e) A physician who provides or dispenses dangerous drugs
168	168	under this section shall oversee compliance with the laws of this
169	169	state and federal law relating to those dangerous drugs.
170	170	(f) Before providing or dispensing dangerous drugs under
171	171	this section, a physician must notify the patient that the
172	172	prescription for the dangerous drug may be filled at a pharmacy.
173	173	With respect to dangerous drugs provided or dispensed in a
174	174	physician's office, the notification requirement of this
175	175	subsection may be satisfied by a written notice placed
176	176	conspicuously in the office.
177	177	(g) Not later than the 30th day after the date a physician
178	178	first provides or dispenses dangerous drugs under this section, the
179	179	physician shall notify the Texas State Board of Pharmacy and the
180	180	board that the physician is providing or dispensing dangerous drugs
181	181	under this section. The Texas State Board of Pharmacy and the board
182	182	shall jointly adopt a form by which a physician may provide
183	183	notification as required by this subsection.
184	184	(h) A physician who notifies the board under Subsection (g)
185	185	that the physician is providing or dispensing dangerous drugs under
186	186	this section and who intends to continue to provide or dispense
187	187	dangerous drugs under this section shall include notice of that
188	188	intent in any subsequent registration permit renewal application
189	189	submitted to the board. The board by rule shall prescribe the form
190	190	of a registration permit renewal application in accordance with
191	191	this subsection.
192	192	SECTION 11. Section 551.003(31) and (33), Occupations Code,
193	193	is amended to read as follows:
194	194	(31) "Pharmacy" means a facility at which a
195	195	prescription drug or medication order is received, processed, or
196	196	dispensed under this subtitle, Chapter 481 or 483, Health and
197	197	Safety Code, or the Comprehensive Drug Abuse Prevention and Control
198	198	Act of 1970 (21 U.S.C. Section 801 et seq.). The term does not
199	199	include:
200	200	(A) a narcotic drug treatment program that is
201	201	regulated under Chapter 466, Health and Safety Code; or
202	202	(B) a location where:
203	203	(i) a physician provides or dispenses a
204	204	dangerous drug under Section 158.003 or 158.004; or
205	205	(ii) a person provides or dispenses a
206	206	dangerous drug under a physician's supervision in accordance with
207	207	Section 157.002(b).
208	208	(33) "Practice of pharmacy" means:
209	209	(A) providing an act or service necessary to
210	210	provide pharmaceutical care;
211	211	(B) interpreting or evaluating a prescription
212	212	drug order or medication order;
213	213	(C) participating in drug or device selection as
214	214	authorized by law, and participating in drug administration, drug
215	215	regimen review, or drug or drug-related research;
216	216	(D) providing patient counseling;
217	217	(E) being responsible for:
218	218	(i) dispensing a prescription drug order or
219	219	distributing a medication order;
220	220	(ii) compounding or labeling a drug or
221	221	device, other than labeling by a manufacturer, repackager, or
222	222	distributor of a nonprescription drug or commercially packaged
223	223	prescription drug or device;
224	224	(iii) properly and safely storing a drug or
225	225	device; or
226	226	(iv) maintaining proper records for a drug
227	227	or device;
228	228	(F) performing for a patient a specific act of
229	229	drug therapy management delegated to a pharmacist by a written
230	230	protocol from a physician licensed in this state in compliance with
231	231	Subtitle B; [or]
232	232	(G) administering an immunization or vaccination
233	233	under a physician's written protocol; or
234	234	(H) ordering or furnishing a prescription drug to
235	235	treat an acute condition in accordance with Section 562.058.
236	236	SECTION 12. Section 551.004, Occupations Code, is amended
237	237	by adding Subsection (a-1) and amending Subsection (b) to read as
238	238	follows:
239	239	(a-1) For purposes of Subsection (a)(1), "retailing of
240	240	prescription drugs" does not include the collection of a
241	241	reimbursement for cost, as defined by Section 158.003(a) or
242	242	158.004(a).
243	243	(b) This subtitle does not prevent:
244	244	(1) a practitioner from:
245	245	(A) administering a drug to a patient of the
246	246	practitioner; or
247	247	(B) providing or dispensing dangerous drugs
248	248	under Section 158.003 or 158.004; or
249	249	(2) a person from providing or dispensing a dangerous
250	250	drug under a physician's supervision in accordance with Section
251	251	157.002(b).
252	252	SECTION 13. Section 558.001, Occupations Code, is amended
253	253	by amending Subsection (c) and adding Subsection (d) to read as
254	254	follows:
255	255	(c) Except as provided by Subsection (d), a [A] person may
256	256	not dispense or distribute prescription drugs unless the person:
257	257	(1) is a pharmacist; or
258	258	(2) is otherwise authorized by this subtitle to
259	259	dispense or distribute prescription drugs.
260	260	(d) A physician or person acting under the physician's
261	261	supervision may provide or dispense dangerous drugs in accordance
262	262	with Section 157.002(b), 158.003, or 158.004.
263	263	SECTION 14. Subchapter B, Chapter 562, Occupations Code, is
264	264	amended by adding Section 562.058 to read as follows:
265	265	Sec. 562.058. ORDERING AND FURNISHING CERTAIN PRESCRIPTION
266	266	DRUGS. (a) In this section:
267	267	(1) "Acute condition" means a condition or disease
268	268	that begins abruptly, intensifies rapidly, and is generally not
269	269	long-lasting.
270	270	(2) "Waived clinical laboratory test" means a clinical
271	271	laboratory test that is classified as waived under federal
272	272	regulations issued under the Clinical Laboratory Improvement
273	273	Amendments of 1988 (42 U.S.C. Section 263a).
274	274	(b) Notwithstanding any other law, a pharmacist may order
275	275	and furnish to a patient a prescription drug to treat an acute
276	276	condition that is:
277	277	(1) identified through performance of one of the following
278	278	tests, if the test is a waived clinical laboratory test:
279	279	(A) a rapid strep test or rapid antigen detection test
280	280	used in the identification of group A streptococcus (GAS);
281	281	(B) a rapid influenza diagnostic test used in the
282	282	identification of influenza types A and B; or
283	283	(C) a rapid diagnostic test for SARS-CoV-2 or a
284	284	related virus used in the identification of COVID-19 or a related
285	285	illness[.]; or
286	286	(2) for treatment of minor, uncomplicated infections,
287	287	including lice, skin conditions, such as ringworm and athlete's
288	288	foot, and urinary tract infections.
289	289	(c) The board shall adopt rules to permit a pharmacist to
290	290	order and furnish a prescription drug under this section to a
291	291	patient.
292	292	(d) A pharmacist who orders and furnishes a prescription
293	293	drug under this section must provide notice to the patient's
294	294	primary care physician, as identified by the patient if the patient
295	295	has a primary care physician, not later than the 14th day after the
296	296	date the drug is ordered and furnished by the pharmacist.
297	297	(e) The board by rule shall establish requirements to ensure
298	298	that a pharmacist possesses the necessary skill and training to
299	299	order and furnish prescription drugs under this section.
300	300	SECTION 15. The heading to Chapter 563, Occupations Code,
301	301	is amended to read as follows:
302	302	CHAPTER 563. [PRESCRIPTION REQUIREMENTS;] DELEGATION OF
303	303	ADMINISTRATION, [AND] PROVISION, AND DISPENSING OF DANGEROUS DRUGS
304	304	SECTION 16. Sections 563.051(a) and (c), Occupations Code,
305	305	are amended to read as follows:
306	306	(a) A physician may delegate to any qualified and properly
307	307	trained person acting under the physician's supervision the act of
308	308	administering [or providing] dangerous drugs in the physician's
309	309	office, as ordered by the physician, that are used or required to
310	310	meet the immediate needs of the physician's patients or the act of
311	311	providing or dispensing dangerous drugs, as ordered by the
312	312	physician, to the physician's patients. The administration, [or]
313	313	provision, or dispensing of the dangerous drugs must be performed
314	314	in compliance with laws relating to the practice of medicine and
315	315	state and federal laws relating to those dangerous drugs.
316	316	(c) The administration, [or] provision, or dispensing of
317	317	the drugs may be delegated through a physician's order, a standing
318	318	medical order, a standing delegation order, or another order
319	319	defined by the Texas Medical [State] Board [of Medical Examiners].
320	320	SECTION 17. Section 563.052, Occupations Code, is amended
321	321	to read as follows:
322	322	Sec. 563.052. SUITABLE CONTAINER REQUIRED. A drug or
323	323	medicine provided or dispensed under this subchapter must be
324	324	provided or dispensed [supplied] in a suitable container labeled in
325	325	compliance with applicable drug laws. A qualified and trained
326	326	person, acting under the supervision of a physician, may specify at
327	327	the time of the provision or dispensing of the drug the inclusion on
328	328	the container of the date of the provision or dispensing and the
329	329	patient's name and address.
330	330	SECTION 18. The heading to Section 563.053, Occupations
331	331	Code, is amended to read as follows:
332	332	Sec. 563.053. DISPENSING OF DANGEROUS DRUGS TO CERTAIN
333	333	PATIENTS IN CERTAIN RURAL AREAS.
334	334	SECTION 19. Section 563.053, Occupations Code, is amended
335	335	by adding Subsection (a-1) to read as follows:
336	336	(a-1) This section applies only to a physician providing
337	337	care under workers' compensation insurance coverage, as defined by
338	338	Section 401.011, Labor Code.
339	339	SECTION 20. The heading to Subchapter B, Chapter 563,
340	340	Occupations Code, is repealed.
341	341	SECTION 21. Not later than January 1, 2026, the Texas State
342	342	Board of Pharmacy shall adopt the rules required under Section
343	343	562.058, Occupations Code, as added by this Act.
344	344	SECTION 22. Not later than January 1, 2026, the Texas
345	345	Medical Board shall adopt the rules required under Section 558.001,
346	346	Occupations Code, as added by this Act.
347	347	SECTION 23. This Act takes effect September 1, 2025.