GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 2013

H                                                                                                                                                    1

HOUSE BILL 832*

Short Title:        Expand Pharmacists' Immunizing Authority.		(Public)
Sponsors:	Representatives Avila, Lewis, Foushee, and Glazier (Primary Sponsors). For a complete list of Sponsors, refer to the North Carolina General Assembly Web Site.
Referred to:	Health and Human Services, if favorable, Commerce and Job Development.

April 11, 2013

A BILL TO BE ENTITLED

AN ACT to protect the public's HEALTH by increasing access to immunizations and vaccines through the expanded role of immunizing pharmacists.

The General Assembly of North Carolina enacts:

SECTION 1.  G.S. 90-85.3 is amended by adding the following new subsection to read:

"(i1) "Immunizing pharmacist" means a licensed pharmacist who meets all of the following qualifications:

(1) Holds a current provider level cardiopulmonary resuscitation certification issued by the American Heart Association or the American Red Cross, or an equivalent certification.

(2) Has successfully completed a certificate program in vaccine administration accredited by the Centers for Disease Control and Prevention, the Accreditation Council for Pharmacy Education, or a similar health authority or professional body approved by the Board.

(3) Maintains documentation of three hours of continuing education every two years, designed to maintain competency in the disease states, drugs, and vaccine administration.

(4) Has successfully completed training approved by the Division of Public Health's Immunization Branch for participation in the North Carolina Immunization Registry.

(5) Has notified the North Carolina Board of Pharmacy and the North Carolina Medical Board of immunizing pharmacist status.

(6) Administers vaccines or immunizations in accordance with G.S. 90-18.15B."

SECTION 2.  G.S. 90-85.3(r) reads as rewritten:

"(r)       "Practice of pharmacy" means the responsibility for: interpreting and evaluating drug orders, including prescription orders; compounding, dispensing and labeling prescription drugs and devices; properly and safely storing drugs and devices; maintaining proper records; and controlling pharmacy goods and services. A pharmacist may advise and educate patients and health care providers concerning therapeutic values, content, uses and significant problems of drugs and devices; assess, record and report adverse drug and device reactions; take and record patient histories relating to drug and device therapy; monitor, record and report drug therapy and device usage; perform drug utilization reviews; and participate in drug and drug source selection and device and device source selection as provided in G.S. 90-85.27 through G.S. 90-85.31. A pharmacist who has received special training may be authorized and permitted to administer drugs pursuant to a specific prescription order in accordance with rules adopted by each of the Boards of Pharmacy, the Board of Nursing, and the North Carolina Medical Board. The rules shall be designed to ensure the safety and health of the patients for whom such drugs are administered. An approved clinical pharmacist practitioner may collaborate with physicians in determining the appropriate health care for a patient, subject to the provisions of G.S. 90-18.4.is as specified in G.S. 90-85.3A."

SECTION 3.  Article 4A of Chapter 90 of the General Statutes is amended by adding a new section to read:

"§ 90-85.3A.  Practice of pharmacy.

(a) A pharmacist is responsible for interpreting and evaluating drug orders, including prescription orders; compounding, dispensing, and labeling prescription drugs and devices; properly and safely storing drugs and devices; maintaining proper records; and controlling pharmacy goods and services.

(b) A pharmacist may advise and educate patients and health care providers concerning therapeutic values, content, uses, and significant problems of drugs and devices; assess, record, and report adverse drug and device reactions; take and record patient histories relating to drug and device therapy; monitor, record, and report drug therapy and device usage; perform drug utilization reviews; and participate in drug and drug source selection and device and device source selection as provided in G.S. 90-85.27 through G.S. 90-85.31.

(c) An immunizing pharmacist is authorized and permitted to administer drugs as provided in G.S. 90-85.15B.

(d) An approved clinical pharmacist practitioner may collaborate with physicians in determining the appropriate health care for a patient, subject to the provisions of G.S. 90-18.4."SECTION 4.  Article 4A of Chapter 90 of the General Statutes is amended by adding a new section to read:

"§ 90-85.15B.  Immunizing pharmacists.

(a) Except as provided in subsection (b) of this section, an immunizing pharmacist shall only administer vaccines or immunizations recommended or required by the Centers for Disease Control and Prevention to persons at least 18 years of age pursuant to a specific prescription order.

(b) An immunizing pharmacist may administer the following vaccinations or immunizations pursuant to a standing order or protocols developed with and overseen by a physician licensed in and whose practice is physically located in North Carolina:

(1) Pneumococcal polysaccharide or pneumococcal conjugate vaccines.

(2) Herpes zoster vaccine.

(3) Hepatitis B vaccine.

(4) Meningococcal polysaccharide or meningococcal conjugate vaccines.

(5) Tetanus-diphtheria, tetanus and diphtheria toxoids and pertussis, tetanus and diphtheria toxoids and acellular pertussis, or tetanus toxoid vaccines.

(6) Influenza vaccine pursuant to 21 NCAC 46 .2507 and 21 NCAC 32U .101, which may be administered to patients aged 14 years and older.

(c) An immunizing pharmacist who administers a vaccine or immunization to any patient pursuant to this section shall do all of the following:

(1) Maintain a record of any vaccine or immunization administered to the patient in a patient profile.

(2) Notify within 72 hours after administration the patient's primary care provider, if the patient has identified a primary care provider, and either the prescribing physician or the physician who issued the standing order or protocol. If the patient does not have a primary care provider, the immunizing pharmacist shall direct the patient to information describing the benefits to a patient of having a primary care physician, prepared by any of the following: North Carolina Medical Board, North Carolina Academy of Family Physicians, North Carolina Medical Society, or Community Care of North Carolina.

(3) Except for influenza administered pursuant to G.S. 90-85.15B(b)(6), access the North Carolina Immunization Registry prior to administering the vaccine or immunization and record any vaccine or immunization administered to the patient in the registry within 72 hours after the administration."

SECTION 5.  G.S. 130A-153 reads as rewritten:

"§ 130A-153.  Obtaining immunization; reporting by local health departments; access to immunization information in patient records; immunization of minors.

(a)        The required immunization may be obtained from a physician licensed to practice medicine or medicine, from a local health department. department, or in the case of a person at least 18 years of age, from an immunizing pharmacist. Local health departments shall administer required and State-supplied immunizations at no cost to uninsured or underinsured patients with family incomes below two hundred percent (200%) of the federal poverty level. A local health department may redistribute these vaccines only in accordance with the rules of the Commission.

(b)        Local health departments shall file monthly immunization reports with the Department. The report shall be filed on forms prepared by the Department and shall state, at a minimum, each patient's age and the number of doses of each type of vaccine administered.

(c)        Immunization certificates and information concerning immunizations contained in medical or other records shall, upon request, be shared with the Department, local health departments, an immunizing pharmacist, and the patient's attending physician. In addition, an insurance institution, agent, or insurance support organization, as those terms are defined in G.S. 58-39-15, may share immunization information with the Department. The Commission may, for the purpose of assisting the Department in enforcing this Part, provide by rule that other persons may have access to immunization information, in whole or in part.

(d)        A physician or local health department may immunize a minor with the consent of a parent, guardian, or person standing in loco parentis to the minor. A physician or local health department may also immunize a minor who is presented for immunization by an adult who signs a statement that he or she is authorized by a parent, guardian, or person standing in loco parentis to the minor to obtain the immunization for the minor."

SECTION 6.  G.S. 130A-154(a) reads as rewritten:

"(a)       A physician or physician, immunizing pharmacist acting pursuant to G.S. 90-85.15B, or local health department administering a required vaccine shall give a certificate of immunization to the person who presented the child for immunization. The certificate shall state the name of the child, the name of the child's parent, guardian, or person responsible for the child obtaining the required immunization, the address of the child and the parent, guardian or responsible person, the date of birth of the child, the sex of the child, the number of doses of the vaccine given, the date the doses were given, the name and address of the physician or physician, immunizing pharmacist, or local health department administering the required immunization and other relevant information required by the Commission."

SECTION 7.  21 NCAC 46 .2507 shall govern the administration of influenza, pneumococcal, and zoster vaccines by an immunizing pharmacist; provided, however, an immunizing pharmacist shall be granted the authority to administer influenza vaccine to patients aged 14 years and older.  Acting in cooperation with the North Carolina Board of Pharmacy, the North Carolina Medical Board shall similarly amend 21 NCAC 32U .101 to grant immunizing pharmacists the authority to administer influenza vaccine to patients aged 14 years and older.

SECTION 8.  This act becomes effective July 1, 2013.