December 11, 2013
Starting Jan. 1, California Law Expands Scope of
Practice for Pharmacists

Sacramento, CA—As of January 1, the scope of pharmacy practice has been expanded in California, and national pharmacy groups expressed optimism that this could be part of a new nationwide trend.

The California law, SB 493, authorizes all licensed pharmacists to administer drugs and biologics by injection when ordered by a prescriber; provide consultation, training, and education about drug therapy, disease management, and disease prevention; participate in multidisciplinary review of patient progress, including appropriate access to medical records; and order and interpret tests to monitor and manage the efficacy and toxicity of drug therapies, in coordination with the patient’s prescriber. It also allows pharmacists to provide self-administered hormonal contraceptives under a statewide protocol; offer travel medications not requiring a diagnosis; furnish prescription-level nicotine replacement drugs for smoking cessation under a statewide protocol; and administer immunizations to patients 3 years and older without a physician protocol.

In addition, SB 493 establishes an Advanced Practice Pharmacist (APP) recognition, authorizing those pharmacists to:

• Perform patient assessments;
• Order and interpret drug therapy–related laboratory tests;
• Refer patients to other providers;
• Initiate, adjust, and discontinue medications under physician protocol;
• Work with other healthcare providers to evaluate and manage a patient’s health issues.

To become an APP, California pharmacists will have to complete two of three criteria, including certification in a relevant area of practice, a postgraduate residency program, or 1 year of experience providing clinical services to patients under a collaborative practice agreement or protocol with a physician, APP pharmacist, collaborative drug therapy management pharmacist, or health system.

The law was designed to address a growing shortage in primary care providers. Millions of newly insured Californians are expected to be seeking medical care as the state’s Medi-Cal program grows under the federal Patient Protection and Affordable Care Act.

The pharmacy bill was part of a series of four laws that sought to expand the scope of practice for pharmacists, optometrists, nurse practitioners, physician assistants, and other midlevel practitioners in order to alleviate the primary care shortage.

“Hopefully adoption of this legislation by the most populous U.S. state will prompt more states to enact similar legislation in the coming months,” according to a press release from the National Community Pharmacists Association. “NCPA will continue to support similar efforts by pharmacy organizations in other states. At the 2012 House of Delegates meeting, NCPA members reaffirmed support for granting pharmacists provider status, and NCPA staff has worked with other pharmacy organizations to that end throughout 2013.”

The American Pharmacists Association also applauded the new law.

“APhA could not be more excited with the progress on provider status being made at the state level. These state successes are incredibly valuable to pharmacy’s pursuit of coverage of pharmacists’ patient care services across the country,” said Stacie Maass, BSPharm, JD, APhA, senior vice president of Pharmacy Practice and Government Affairs. “California’s new law recognizes the services pharmacists are trained and qualified to provide and the importance of having pharmacists as part of the health care team.”

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