AB186 - Revises provisions governing pharmacists. (BDR 54-344)

EXEMPT (Reprinted with amendments adopted on April 21, 2025) FIRST REPRINT A.B. 186 - *AB186_R1* ASSEMBLY BILL NO. 186–ASSEMBLYMEMBER ORENTLICHER PREFILED FEBRUARY 3, 2025 ____________ Referred to Committee on Commerce and Labor SUMMARY—Revises provisions governing pharmacists. (BDR 54-344) FISCAL NOTE: Effect on Local Government: No. Effect on the State: Yes. ~ EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. AN ACT relating to pharmacy; authorizing a registered pharmacist to prescribe drugs and devices to treat certain health conditions and dispense a refill without the authorization of a practitioner, other than a pharmacist, under certain circumstances; authorizing a registered pharmacist to administer drugs; authorizing a registered pharmacist to engage in certain activity relating to laboratories and laboratory testing; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law authorizes, under certain conditions, a pharmacist to dispense a 1 self-administered hormonal contraceptive without a prescription and prescribe and 2 dispense a drug for the medication-assisted treatment of opioid use disorder. (NRS 3 639.28078, 639.28079) Section 1 of this bill authorizes a registered pharmacist to 4 prescribe and dispense drugs and devices for the treatment of health conditions that: 5 (1) have been previously diagnosed; (2) are self-limiting; or (3) are acute conditions 6 diagnosed after the performance of certain tests. Section 1 additionally authorizes a 7 registered pharmacist to dispense a one-time refill of a prescription without the 8 authorization of a practitioner, other than a pharmacist, if the drug was previously 9 prescribed to the patient and losing access to the drug would threaten the health of 10 the patient. Section 1 additionally prohibits a registered pharmacist from taking 11 such action with regard to: (1) drugs and devices not approved by the United States 12 Food and Drug Administration; (2) controlled substances that are not opioids, 13 except in certain clinical settings; and (3) controlled substances that are an opioid 14 except in accordance with the protocols for prescribing and dispensing a drug for 15 medication-assisted treatment. (NRS 639.28079) Section 1 also authorizes the State 16 Board of Pharmacy to adopt regulations establishing: (1) the scope of the ability of 17 a registered pharmacist to prescribe drugs and devices and dispense refills without 18 the authorization of another type of practitioner; (2) the standard of care required of 19 – 2 – - *AB186_R1* a registered pharmacist who engages in such activities; and (3) the requirements for 20 adequate liability insurance for registered pharmacists who engage in such 21 activities. Section 2 of this bill provides that prescribing and dispensing drugs and 22 devices and dispensing refills pursuant to section 1 constitutes the practice of 23 pharmacy. Sections 3, 10-13 and 15 of this bill make additional changes necessary 24 to authorize a registered pharmacist to prescribe and dispense drugs and devices 25 and dispense refills without the authorization of another type of practitioner 26 pursuant to section 1. The Board would be authorized to suspend or revoke the 27 registration of a pharmacist who prescribes or dispenses a drug or device or 28 dispenses a refill without the authorization of another type of practitioner and fails 29 to comply with the provisions of section 1 or the regulations adopted pursuant 30 thereto. (NRS 639.210) 31 Existing law includes within the practice of pharmacy the performance or 32 supervision of activities associated with manufacturing, compounding, labeling, 33 dispensing and distributing a drug. (NRS 629.0124) Section 2 additionally includes 34 the performance or supervision of activities associated with administering a drug, 35 thereby authorizing a registered pharmacist to perform or supervise such activities. 36 Sections 14, 16 and 17 of this bill accordingly provide general authorization for a 37 registered pharmacist to possess and administer controlled substances and 38 dangerous drugs. 39 Existing law requires the Board to adopt regulations governing the 40 manipulation of a person for the collection of specimens by a registered pharmacist 41 that: (1) require the pharmacist to use only a fingerstick or oral or nasal swab to 42 collect the specimens; and (2) set forth the procedures and requirements the 43 pharmacist is required to follow when manipulating a person for the collection of a 44 specimen. (NRS 639.0747) Section 4 of this bill removes the requirement that a 45 pharmacist use only a fingerstick or oral or nasal swab to collect a specimen, 46 thereby authorizing a pharmacist to collect a specimen using any method available 47 for the collection of the specimen. 48 Existing law authorizes a registered pharmacist or a registered intern 49 pharmacist to: (1) perform a home blood glucose test; and (2) order and perform 50 laboratory tests that are necessary for therapy that uses a drug approved by the 51 United States Food and Drug Administration for preventing the acquisition of 52 human immunodeficiency virus. (NRS 639.2808, 639.28085) Section 5 of this bill 53 additionally authorizes a registered pharmacist to: (1) order laboratory tests that are 54 necessary for any drug therapy or that otherwise facilitate the care of a patient 55 within the authorized scope of practice of the pharmacist; and (2) perform certain 56 other laboratory tests determined by the Federal Government to be simple 57 laboratory examinations and procedures that have an insignificant risk of an 58 erroneous result. (42 U.S.C. 263a(d)(3); 42 C.F.R. Part 493, Subpart A) Section 5 59 also authorizes the State Board of Pharmacy to adopt regulations to authorize 60 registered intern pharmacists to order and perform such laboratory tests. Section 2 61 provides that ordering and performing such laboratory tests constitutes the practice 62 of pharmacy. Sections 2 and 6 of this bill remove duplicative provisions from 63 existing law. Sections 8, 9 and 18-24 of this bill make conforming changes so that 64 requirements for insurance coverage of certain services performed by registered 65 pharmacists are not changed by this bill. 66 Existing law requires the State Board of Health to adopt regulations for the 67 certification and licensure of laboratory directors. (NRS 652.125) Existing 68 regulations define an exempt laboratory to be a laboratory that: (1) conducts only 69 certain microscopy tests and tests determined by the Federal Government to be 70 simple laboratory examinations and procedures that have an insignificant risk of an 71 erroneous result; and (2) does not perform only tests for human immunodeficiency 72 virus. (42 U.S.C. 493.19; 42 C.F.R. Part 493, Subpart A; NAC 652.072) Section 7 73 – 3 – - *AB186_R1* of this bill requires regulations of the Board to authorize a registered pharmacist to 74 serve as the laboratory director of an exempt laboratory. 75 THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 639 of NRS is hereby amended by adding 1 thereto a new section to read as follows: 2 1. Subject to the limitations set forth in subsection 2, a 3 registered pharmacist may, in accordance with any requirements 4 prescribed pursuant to subsection 3: 5 (a) Prescribe drugs or devices that are used for the treatment 6 of health conditions, other than opioid use disorder, that: 7 (1) Have been previously diagnosed; 8 (2) Are self-limiting; or 9 (3) Are acute conditions diagnosed after performing a test 10 that is classified as a waived test pursuant to 42 C.F.R. Part 493, 11 Subpart A; and 12 (b) Dispense a one-time refill of an existing prescription 13 without authorization from a practitioner, other than a 14 pharmacist, if, in the professional judgment of the pharmacist, the 15 health of the patient will be harmed without the patient continuing 16 to have access to the prescribed drug. 17 2. A registered pharmacist shall not take any action described 18 in subsection 1 with regard to a: 19 (a) Drug or device that is not approved by the United States 20 Food and Drug Administration. 21 (b) Controlled substance that is not an opioid, except if the 22 registered pharmacist is prescribing such a controlled substance 23 in: 24 (1) An inpatient medical facility in accordance with the 25 policies of the facility; 26 (2) An outpatient medical facility or clinic, only if the 27 registered pharmacist is acting within a multidisciplinary team; 28 (3) A program for hospice care or palliative care; or 29 (4) A program for treatment for substance use disorder. 30 (c) Controlled substance that is an opioid. 31 3. The Board may adopt regulations: 32 (a) Requiring a registered pharmacist who takes the actions 33 authorized by this section to be covered by adequate liability 34 insurance, as determined by the Board; 35 (b) Establishing the scope of the ability for a registered 36 pharmacist to prescribe drugs and devices and dispense refills as 37 authorized by subsection 1; and 38 – 4 – - *AB186_R1* (c) Establishing the standard of care required of a registered 1 pharmacist who prescribes drugs and devices and dispenses refills 2 as authorized by subsection 1. 3 4. As used in this section: 4 (a) “Medical facility” has the meaning ascribed to it in 5 NRS 449.0151. 6 (b) “Program of hospice care” means a program of hospice 7 care described in NRS 449.196. 8 (c) “Self-limiting” means that a health condition generally 9 persists for a limited period of time. 10 Sec. 2. NRS 639.0124 is hereby amended to read as follows: 11 639.0124 1. “Practice of pharmacy” includes, but is not 12 limited to, the: 13 (a) Performance or supervision of activities associated with 14 manufacturing, compounding, labeling, dispensing , [and] 15 distributing [of] and administering a drug, including the receipt, 16 handling and storage of prescriptions and other confidential 17 information relating to patients. 18 (b) Interpretation and evaluation of prescriptions or orders for 19 medicine. 20 (c) Participation in drug evaluation and drug research. 21 (d) Advising of the therapeutic value, reaction, drug interaction, 22 hazard and use of a drug. 23 (e) Selection of the source, storage and distribution of a drug. 24 (f) Maintenance of proper documentation of the source, storage 25 and distribution of a drug. 26 (g) Interpretation of clinical data contained in a person’s record 27 of medication. 28 (h) Development of written guidelines and protocols in 29 collaboration with a practitioner which authorize collaborative drug 30 therapy management. The written guidelines and protocols must 31 comply with NRS 639.2629. 32 (i) Implementation and modification of drug therapy, 33 administering drugs and ordering and performing tests in 34 accordance with a collaborative practice agreement. 35 (j) Prescribing, dispensing and administering of drugs for 36 preventing the acquisition of human immunodeficiency virus and 37 [ordering and] conducting laboratory tests necessary for therapy that 38 uses such drugs pursuant to the protocol prescribed pursuant to 39 NRS 639.28085. 40 (k) Dispensing a self-administered hormonal contraceptive 41 pursuant to NRS 639.28078. 42 (l) Assessing a patient and prescribing and dispensing a drug for 43 medication-assisted treatment in accordance with NRS 639.28079. 44 – 5 – - *AB186_R1* (m) Ordering and performing laboratory tests in accordance 1 with NRS 639.2808. 2 (n) Prescribing and dispensing drugs and devices and 3 dispensing refills without the authorization of a practitioner, other 4 than a pharmacist, in accordance with section 1 of this act. 5 2. The term does not include the changing of a prescription by 6 a pharmacist or practitioner without the consent of the prescribing 7 practitioner, except as otherwise provided in NRS 639.2583, 8 639.28078 and 639.28085. 9 Sec. 3. NRS 639.0125 is hereby amended to read as follows: 10 639.0125 “Practitioner” means: 11 1. A physician, dentist, veterinarian or podiatric physician who 12 holds a license to practice his or her profession in this State; 13 2. A hospital, pharmacy or other institution licensed, registered 14 or otherwise permitted to distribute, dispense, conduct research with 15 respect to or administer drugs in the course of professional practice 16 or research in this State; 17 3. An advanced practice registered nurse who has been 18 authorized to prescribe controlled substances, poisons, dangerous 19 drugs and devices; 20 4. A physician assistant who: 21 (a) Holds a license issued by the Board of Medical Examiners; 22 and 23 (b) Is authorized by the Board to possess, administer, prescribe 24 or dispense controlled substances, poisons, dangerous drugs or 25 devices under the supervision of a physician as required by chapter 26 630 of NRS; 27 5. A physician assistant who: 28 (a) Holds a license issued by the State Board of Osteopathic 29 Medicine; and 30 (b) Is authorized by the Board to possess, administer, prescribe 31 or dispense controlled substances, poisons, dangerous drugs or 32 devices under the supervision of an osteopathic physician as 33 required by chapter 633 of NRS; 34 6. An optometrist who is certified by the Nevada State Board 35 of Optometry to prescribe and administer pharmaceutical agents 36 pursuant to NRS 636.288, when the optometrist prescribes or 37 administers pharmaceutical agents within the scope of his or her 38 certification; 39 7. A dental hygienist who: 40 (a) Holds a valid license to practice dental hygiene in this State; 41 (b) Is authorized to prescribe and dispense the dangerous drugs 42 and devices listed in NRS 631.3105 in accordance with the 43 provisions of that section and the regulations adopted pursuant 44 thereto; and 45 – 6 – - *AB186_R1* (c) Holds a certificate issued pursuant to NRS 639.1374 by the 1 State Board of Pharmacy authorizing him or her to so prescribe; 2 8. A pharmacist who [is] : 3 (a) Is registered pursuant to NRS 639.28079 to prescribe and 4 dispense drugs for medication-assisted treatment; or 5 (b) Prescribes drugs or devices or dispenses refills [Text truncated for display. Full text available on LegiScan.]