FirstHB1077_S_HHS.001 RegularSENATE SessionCOMMITTEE Seventy-secondOF GeneralREFERENCE AssemblyREPORT STATE_______________________________ OFFebruary COLORADO20, REENGROSSED2019 ThisChair Versionof IncludesCommittee AllDate AmendmentsCommittee Adoptedon inHealth & Human Services After consideration on the Housemerits, ofthe IntroductionCommittee LLSrecommends NO.the following:

19-0420.01HB19-1077 Kristenbe Forrestalamended x4217as HOUSEfollows, BILLand 19-1077as HOUSEso SPONSORSHIPamended, Roberts,be Baisley,referred Becker,to Beckman,the Bird,Committee Buckner,of Buentello,the Caraveo,Whole Cutter,with Esgar,favorable Exum,recommendation Galindo, Garnett, Herod, Hooton, Humphrey, Jackson, Jaquez Lewis, Kennedy, Landgraf, Lewis, Lontine, McCluskie, McLachlan, Michaelson Jenet, Mullica, Snyder, Titone, Van Winkle, Weissman SENATE SPONSORSHIP Tate and Pettersen,with Housea Committeesrecommendation Senatethat Committeesit Healthbe &placed Insuranceon Athe BILLconsent FORcalendar: AN ACT C ONCERNING AUTHORIZATION FOR A PHARMACIST TO DISPENSE A CHRONIC MAINTENANCE DRUG TO A PATIENT WITHOUT A CURRENT PRESCRIPTION IN LIMITED CIRCUMSTANCES .

BillAmend Summaryreengrossed ebill, (Note:page 2, line 11, strike " "FOOD ," and substitute ""FERAL FOOD ,".

ThisPage summary4, appliesline to21, thisstrike bill"NSED". as introduced and does n 9 notreflectanyamendmentsthatmaybesubsequentlyadopted.Ifthisbill m 0 E n , passes third reading in the house of introduction, a bill summary that U U 2 applies to the reengrossed version of this bill will be available at O i r H a u http://leg.colorado.gov.) R a r J The bill allows a pharmacist to dispense an emergency supply of 3 a chronic maintenance drug to a patient without a prescription if:

!Page The5, pharmacistafter isline unable14 toinsert: obtain authorization to refill i 1 the prescription from a health care provider;

a"SECTION4. 2 ! The pharmacist has a record of a prescription in the name E e 5 U d 2 O 2 a Shading denotes HOUSE amendment.

DoubleInColoradoRevisedStatutes,12-280-103,amend underliningas denotesrelocated SENATEby amendment.House Bill 19-1172 (39)(b)(III) and (39)(c)(II)(C);

Hand dadd n(9.5) Capitaland letters(39)(d) oras boldfollows: & italic numbers indicate new material to be added to existing statude.J Dashes through the words indicate deletions from existing statute.

e12-280-103. A of the patient who is requesting the emergency supply of the chronic maintenance drug or, in the pharmacist's professional judgment, the refusal to dispense an emergency supply will endanger the health of the patient;

!Definitions-rules.Asusedinthisarticle280,unless Thethecontextotherwiserequiresorthetermisotherwisedefinedinanother amountpart of thethis chronicarticle maintenance280: drug dispensed doesnotexceedtheamountof themostrecentprescription orthestandardquantityorunitofusepackagedispensedof the drug;

and(9.5) !"CRONIC TheMAINTENANCE pharmacistDRUG has"MEANS notA dispensedDRUG anTHAT emergencysupplyof: the chronic maintenance drug to the same patient in the previous 12-month period.

The(a) billI requiresNOT theAN stateOPIOID boardOR ofIS pharmacyNOT toA promulgateCONTROLLED rulesSUBSTANCE toTHAT establishIS standardPROHIBITED proceduresFROM forBEING dispensingDISPENSED chronicWITHOUT maintenanceA drugs.PRESCRIPTION UNDER THE "FEDERAL FOOD,D RUG,AND C OSMETIC ACT",21U.S.C.

ASEC.301ET pharmacist,SEQ.,AS theAMENDED pharmacist's;AND employer,(b) andI thePRESCRIBED originalTO prescriberA ofPATIENT theTO drugTAKE areON notA civillyRECURRING liableBASIS forOR dispensingIS aUSED chronicAS maintenanceA drugL-SAVING unlessRESCUE thereDRUG isFOR negligence,A recklessness,CHRONIC orCONDITION. willful or wanton misconduct.

Be(39) it"Practice enacted by the General Assembly of thepharmacy" Statemeans: of Colorado:

SECTION1.(b) (III) The maintenance of proper records for the drugs and devices;

InColoradoRevisedStatutes,12-42.5-102,amendand (31)(b)(III),(31)(c)introductoryportion,and(31)(c)(II)(C);andadd(6.7)*HB1077_S_HHS.001* and(c) (31)(d)The asprovision follows:of a therapeutic interchange selection or a therapeuticallyequivalentselectiontoapatientif,duringthepatient'sstay atanursingcarefacilityoralong-termacutecarehospitallicensedunder part 1 of article 3 of title 25, the selection has been approved for the patient:

12-42.5-102.

Definitions.

As used in this article 42.5, unless the contextotherwiserequiresorthetermisotherwisedefinedinanotherpart of this article 42.5:

(6.7) "CHRONIC MAINTENANCE DRUG "MEANS A DRUG THAT :

(a) I NOT AN OPIOID OR IS NOT A CONTROLLED SUBSTANCE THAT IS PROHIBITED FROM BEING DISPENSED WITHOUT A PRESCRIPTION UNDER THE FEDERAL "FOOD ,DRUG ,AND C OSMETIC A CT",21U.S.C.

SEC.301 ET SEQ.,AS AMENDED ;AND (b) I PRESCRIBED TO A PATIENT TO TAKE ON A RECURRING BASIS OR IS USED AS A LI-SAVING RESCUE DRUG FOR A CHRONIC CONDITION .

(31) "Practice of pharmacy" means:

(b) (III) The maintenance of proper records for such drugs and -2- 1077 devices;

and (c) The provision of a therapeutic interchange selection or a therapeuticallyequivalentselectiontoapatientif,duringthepatient'sstay atanursingcarefacilityoralong-termacutecarehospitallicensedunder part 1 of article 3 of title 25, C.R.S.,ction has been approved for the patient:

(C) An advanced practice nurse prescriber licensed as a professional nurse under section 12-38-111,12-255-110, registered as an advanced practice nurse under section 12-38-111.5,12-255-111, and authorized to prescribe controlled substances or prescription drugs pursuant to section 12-38-111.6,12-255-112, if the advanced practice nurse prescriber has developed an articulated plan to maintain ongoing collaboration with physicians and other health care professionals;

(d)(d)THEDISPENSINGOFCHRONICMAINTENANCEDRUGSPURSUANT THEDISPENSINGOFCHRONICMAINTENANCEDRUGSPURSUANT TO SECTION 12-42.5-122.AND12-280-125.5AND BOARD RULES ADOPTED IN ACCORDANCE WITH THAT SECTIONSECTION. .

SECTION2.SECTION 5.

InColoradoRevisedStatutes,12-42.5-120,amendInColoradoRevisedStatutes, 12-280-123, amend as relocated by House Bill 19-1172 (1) as follows:

12-42.5-120.12-280-123.

Prescription required - exception - dispensing opiate antagonistsantagonists. - definitions.

(1) Except as provided in section SECTIONS 18-18-414C.R.S.,AND18-18-414AND 12-42.5-122.5,andsubsections(2)and12-280-125.5 and subsections (2) and (3) of this section, ananorderisrequiredpriortodispensinganyprescriptiondrug.Ordersshall orderbe isreadily requiredretrievable priorwithin tothe dispensingappropriate anystatute prescriptionof drug.limitations.

OrdersSECTION shall6. be readily retrievable within the appropriate statute of limitations.

SECTIONIn 3.Colorado Revised Statutes, add to article 280 as relocated by House Bill 19-1172 12-280-125.5 as follows:

In12-280-125.5. Colorado Revised Statutes, add 12-42.5-122.5 as follows:

-3-Pharmacists' 1077authority 12-42.5-122.5.to dispense chronic maintenancedrugs-rules-liability.

Pharmacists'(1)NACCORDANCEWITHBOARD authority to dispense chronic maintenancedrugs-rules-liability.(1) IACCORDANCE WITHBOARD RULES ADOPTED UNDER SUBSECTION (2)OF THIS SECTIO,ON AND AFTER JANUARY 1,2020,A PHARMACIST MAY DISPENSE AN EMERGENCY SUPPLY OF A CHRONIC MAINTENANCE DRUG TO A PATIENT WITHOUT A CURRENT,CURRENT , VALID PRESCRIPTION I:

(a) TEPHARMACISTMAKESEVERYREASONABLEATTEMPTBUTIS UNABLE TO OBTAIN AUTHORIZATION TO REFILL THE PRESCRIPTION FROM THE PRESCRIBING HEALTH CARE PROVIDER OR ANOTHER HEALTH CARE PROVIDER RESPONSIBLE FOR THE PATIENSPATIENTS CARE;

(b)(I) TEPHARMACISTHASARECORDOFAPRESCRIPTIONATTHE PHARMACY OR HAS BEEN PRESENTED PROOF OF A RECENT PRESCRIPTION FORTHECHRONICMAINTENANCEDRUGINTHENAMEOFTHEPATIENTWHO IS REQUESTING THE EMERGENCY SUPPLY;ORSUPPLY ;OR (II) IHEPHARMACIST 'SPROFESSIONALJUDGMENT ,THEREFUSAL TO DISPENSE AN EMERGENCY SUPPLY OF THE CHRONIC MAINTENANCE *HB1077_S_HHS.001* -2- DRUG WILL ENDANGER THE PATIENT S HEALTH OR DISRUPT ESSENTIAL DRUG THERAPY FOR A CHRONIC CONDITION OF THE PATIEN;PATIE;T (c) TEAMOUNTOFTHECHRONICMAINTENANCEDRUGDISPENSED DOES NOT EXCEED THE AMOUNT OF THE MOST RECENT PRESCRIPTION OR THE STANDARD QUANTITY OR UNIT OF USE PACKAGE OF THE DRU;

(c)(d) HEAMOUNTOFTHECHRONICMAINTENANCEDRUGDISPENSEDTEPHARMACISTHASNOTDISPENSEDANEMERGENCYSUPPLY DOESOF NOTTHE EXCEEDCHRONIC THEMAINTENANCE AMOUNTDRUG OFTO THE MOSTSAME RECENTPATIENT PRESCRIPTIONIN OR THE STANDARDPREVIOUS QUANTITYTWELVE-MONTH ORPERIOD;AND UNIT(e) OFTE USEPRESCRIBER PACKAGE DISPENSED OF THE DRUG ;HAS NOT INDICATED THAT NO EMERGENCY REFILLS ARE AUTHORIZED.