California has always been a bellwether state when it comes to the practice of pharmacy. The Pharm.D. degree took root in California and was first awarded in California in the 50s. The Golden State took the lead yet again, to advance the practice of pharmacy, with the passage of SB-493.
So, what is Senate Bill 493 and what does it mean for a pharmacist? The California Senate Bill No. 493 was signed into State law on October 1, 2013, and it added various components to the professional designation and job functions of a practicing pharmacist. Formerly, pharmacists were not considered as healthcare providers and their job function and reimbursement were relegated mostly to the administration orally or topically, drugs, and biologicals pursuant to a prescriber’s order. Furthermore, pharmacists could administer immunizations under a protocol with a prescriber and furnish emergency contraception drug therapy according to standardized procedures if they have completed a training program.
The Senate Bill, 493 vastly adds to the pharmacists’ repertoire of services that is commensurate to their training and degree. The following is a summary of the bill and its provisions:
This bill, instead, would authorize a pharmacist to administer drugs and biological products that have been ordered by a prescriber. The bill would authorize pharmacists to perform other functions, including, among other things, to furnish self-administered hormonal contraceptives, nicotine replacement products, and prescription medications not requiring a diagnosis that is recommended for international travelers, as specified. Additionally, the bill would authorize pharmacists to order and interpret tests for monitoring and managing the efficacy and toxicity of drug therapies and to independently initiate and administer routine vaccinations, as specified. This bill also would establish board recognition for an advanced practice pharmacist, as defined, would specify the criteria for that recognition, and would specify additional functions that may be performed by an advanced practice pharmacist, including, among other things, performing patient assessments, and certain other functions, as specified. The bill would authorize the board, by regulation, to set the fee for the issuance and renewal of advanced practice pharmacist recognition at the reasonable cost of regulating advanced practice pharmacists pursuant to these provisions, not to exceed $300. (http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140SB493) (Accessed: 4/30/2020).
Major Implications of SB 493
Provider Status: For decades, the pharmacy profession has been one of the few health care professions lacking the designation of “provider” in statute – until now. SB 493 officially declares that pharmacists are “healthcare providers.” This change will open up new and exciting reimbursement opportunities as payers increasingly recognize the importance of utilizing pharmacy services to improve health and wellness.
Pharmacy and Disease Management: Moving our healthcare system from a focus on “sick care” to a focus on “healthcare” requires far more emphasis on managing patients with chronic diseases. SB 493 adds language to the law explicitly stating the pharmacists’ role in disease management and prevention.
Advanced Practice Pharmacist: SB 493 creates a new category of pharmacists in California – the Advanced Practice Pharmacist (APP). Pharmacists who meet the necessary criteria for APP recognition will have unique authorities. These will include the ability to perform patient assessments, refer patients to other providers, and operate as a collaborative drug therapy management pharmacist outside of hospital walls. The state board of pharmacy delineates the requirements to be considered as an APP.
Hormonal Contraception: Existing law allows a pharmacist to furnish emergency contraception. SB 493 expands a pharmacists’ authority to now allow for the furnishing of hormonal contraception.
Nicotine Replacement Products: SB 493 authorizes pharmacists to furnish prescription nicotine replacement products.
Travel Medications: SB 493 authorizes pharmacists to furnish travel medications as called for by the CDC.
Ordering Tests: SB 493 authorizes pharmacists to order tests related to managing a patient’s medication regimen.
While the law has been in effect for the past six years, the practice of pharmacy is yet to catch up fully. This is partly due to the healthcare business model and insurance reimbursement process, followed by a lack of awareness among prescribers and healthcare institutions. The situation is, however, changing as pharmacy organizations are advocating for increasing responsibility not only at the state level but also at the federal level. More needs to be done at an individual level by practicing pharmacists as they constantly demonstrate the value of their education and training by improving the care of their patients.
About American University of Health Sciences
AUHS is a Christian based, minority-serving university, which educates students for careers in the healthcare profession. AUHS emphasizes the values of faith in God, love of humankind, and belief that all people have a right to healthcare and deserve a good quality of life based on the wellness of body, mind, and spirit. The university celebrates diversity and reaches out to groups currently underrepresented in healthcare and research. AUHS provides the undergraduate and graduate curriculum, hands-on practical training and supportive environment required to create competent and compassionate healthcare professionals.
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American University of Health Sciences (AUHS) is a member of the Transnational Association of Christian Colleges and Schools (TRACS) [15935 Forest Road, Forest VA 24551; Telephone: (434) 525-9539; e-mail: firstname.lastname@example.org], having been awarded Accredited Status as a Category III institution by the TRACS Accreditation Commission on October 24, 2017. This status is effective for a period of up to five years. TRACS is recognized by the United States Department of Education (USDOE), the Council for Higher Education Accreditation (CHEA), and the International Network for Quality Assurance Agencies in Higher Education (INQAAHE). tracs.org