Connecticut 2022 Regular Session Status: In Committee 1 D cosponsors

SB 186 — AN ACT CONCERNING COLLABORATIVE DRUG THERAPY MANAGEMENT AGREEMENTS AND POLICIES.

Last action — FAV. RPT., TAB. FOR CAL., SEN.

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  1. ✓
    Introduced
  2. 2
    In Committee
  3. 3
    Passed Senate
  4. 4
    Passed House
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2022 Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Bill Text

What changed in the latest version

21 added · 199 removed

21 line(s) added, 199 removed.

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Senate General Assembly File No.
General Assembly Substitute Bill No.
213 February Session, 2022 Substitute Senate Bill No.
186 February Session, 2022 AN ACT CONCERNING COLLABORATIVE DRUG THERAPY MANAGEMENT AGREEMENTS AND POLICIES.
186 Senate, March 30, 2022 The Committee on General Law reported through SEN.
MARONEY of the 14th Dist., Chairperson of the Committee on the part of the Senate, that the substitute bill ought to pass.
AN ACT CONCERNING COLLABORATIVE DRUG THERAPY MANAGEMENT AGREEMENTS AND POLICIES.
sSB186 / File No.
(4) "Collaborative drug therapy management agreement" means an agreement between one or more qualified pharmacists and one or more prescribing practitioners to manage the drug therapy of individual patients, or a patient population, based on a written protocol or a collaborative drug therapy care plan;
213 1 sSB186 File No.
LCO \\PRDFS1\SCOUSERS\FORZANOF\WS\2022SB-00186-R01 of 6 SB.docx Substitute Bill No.
213 (4) "Collaborative drug therapy management agreement" means an agreement between one or more qualified pharmacists and one or more prescribing practitioners to manage the drug therapy of individual patients, or a patient population, based on a written protocol or a collaborative drug therapy care plan;
186 (5) "Collaborative drug therapy management policy" means a written policy adopted by a care-giving institution under which one or more qualified pharmacists manage the drug therapy of individual patients, or a patient population, based on a written protocol or a collaborative drug therapy care plan;
(5) "Collaborative drug therapy management policy" means a written policy adopted by a care-giving institution under which one or more qualified pharmacists manage the drug therapy of individual patients, or a patient population, based on a written protocol or a collaborative drug therapy care plan;
[(a)] (b) Except as provided in section 20-631b, one or more qualified pharmacists [licensed under this chapter who are determined competent in accordance with regulations adopted pursuant to subsection (d) of this section] may enter into a [written protocol-based] collaborative drug therapy management agreement [with one or more physicians licensed under chapter 370 or advanced practice registered sSB186 / File No.
[(a)] (b) Except as provided in section 20-631b, one or more qualified pharmacists [licensed under this chapter who are determined competent in accordance with regulations adopted pursuant to subsection (d) of this section] may enter into a [written protocol-based] collaborative drug therapy management agreement [with one or more physicians licensed under chapter 370 or advanced practice registered nurses licensed under chapter 378 to] or manage the drug therapy of individual patients, or a patient population, under a collaborative drug therapy management policy.
213 2 sSB186 File No.
In order to enter into a [written protocol- based] collaborative drug therapy management agreement [, such physician or advanced practice registered nurse shall have established] LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2022SB-00182 of 6 R02-SB.docx } Substitute Bill No.
213 nurses licensed under chapter 378 to] or manage the drug therapy of individual patients, or a patient population, under a collaborative drug therapy management policy.
186 or collaborative drug therapy care plan,or operate under acollaborative drug therapy management policy, a prescribing practitioner must first establish a provider-patient relationship with the patient or patients whowillreceivecollaborativedrugtherapy.Eachpatient's collaborative drug therapy management shall be [governed by a written protocol which may include guideline-directed management established by the treating physician or advanced practice registered nurse in consultation withthepharmacist.Forpurposesofthissubsection,a"provider-patient relationship" is a relationship based on (1) the patient making a medical complaint, (2) the patient providing a medical history, (3) the patient receiving a physical examination, and (4) a logical connection existing between the medical complaint, the medical history, the physical examination and any drug prescribed for the patient] based on a diagnosis made by such patient's prescribing practitioner or a specific test set forth in a collaborative drug therapy management agreement or collaborative drug therapy management policy.
In order to enter into a [written protocol- based] collaborative drug therapy management agreement [, such physician or advanced practice registered nurse shall have established] or collaborative drug therapy care plan,or operate under acollaborative drug therapy management policy, a prescribing practitioner must first establish a provider-patient relationship with the patient or patients whowillreceivecollaborativedrugtherapy.Eachpatient's collaborative drug therapy management shall be [governed by a written protocol which may include guideline-directed management established by the treating physician or advanced practice registered nurse in consultation withthepharmacist.Forpurposesofthissubsection,a "provider-patient relationship" is a relationship based on (1) the patient making a medical complaint, (2) the patient providing a medical history, (3) the patient receiving a physical examination, and (4) a logical connection existing between the medical complaint, the medical history, the physical examination and any drug prescribed for the patient] based on a diagnosis made by such patient's prescribing practitioner or a specific test set forth in a collaborative drug therapy management agreement or collaborative drug therapy management policy.
A collaborative drug therapy management agreement or collaborative drug therapy management policy may specifically address issues that may arise during a medication reconciliation and concerns related to polypharmacy that enable an authorized qualified pharmacist or qualified pharmacists to sSB186 / File No.
A collaborative drug therapy management agreement or collaborative drug therapy management policy may specifically address issues that may arise during a medication reconciliation and concerns related to polypharmacy that enable an authorized qualified pharmacist or qualified pharmacists to [implement] initiate, modify, continue, discontinue or deprescribe drug therapy.
213 3 sSB186 File No.
In instances where drug therapy is discontinued or deprescribed, the qualified pharmacist or qualified pharmacists shall notify the [treating physician or advanced practice registered nurse] LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2022SB-00183 of 6 R02-SB.docx } Substitute Bill No.
213 [implement] initiate, modify, continue, discontinue or deprescribe drug therapy.
186 prescribing practitioner of such discontinuance or deprescribing [no] not later than twenty-four hours [from the time of such discontinuance or deprescribing] after such drug therapy is discontinued or deprescribed.
In instances where drug therapy is discontinued or deprescribed, the qualified pharmacist or qualified pharmacists shall notify the [treating physician or advanced practice registered nurse] prescribing practitioner of such discontinuance or deprescribing [no] not later than twenty-four hours [from the time of such discontinuance or deprescribing] after such drug therapy is discontinued or deprescribed.
Each collaborative drug therapy management agreement, [and protocols] collaborative drug therapy management policy, written protocol and collaborative drug therapy care plan shall be available for inspection by the [Departments] sSB186 / File No.
Each collaborative drug therapy management agreement, [and protocols] collaborative drug therapy management policy, written protocol and collaborative drug therapy care plan shall be available for inspection by the [Departments] Department of Consumer Protection and the Department of Public Health.
213 4 sSB186 File No.
213 Department of Consumer Protection and the Department of Public Health.
[(c)] (d) A pharmacist shall be responsible for demonstrating, in accordance with regulations adopted pursuant to subsection [(d)] (e) of thissection,the competence necessary for [participation]thepharmacist to participate in each collaborative drug therapy management agreement, [into which such pharmacist enters] collaborative drug therapy management policy and collaborative drug therapy care planin which such pharmacist seeks to participate by, among other things, demonstrating that such pharmacist has reviewed the latest edition of the "Pharmacists' Patient Care Process" published by the Joint Commission of Pharmacy Practitioners.
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2022SB-00184 of 6 R02-SB.docx } Substitute Bill No.
186 [(c)] (d) A pharmacist shall be responsible for demonstrating, in accordance with regulations adopted pursuant to subsection [(d)] (e) of thissection,the competence necessary for [participation]thepharmacist to participate in each collaborative drug therapy management agreement, [into which such pharmacist enters] collaborative drug therapy management policy and collaborative drug therapy care planin which such pharmacist seeks to participate by, among other things, demonstrating that such pharmacist has reviewed the latest edition of the "Pharmacists' Patient Care Process" published by the Joint Commission of Pharmacy Practitioners.
A medical director of a nursing home facility, as defined in section 19a-521, may establish protocols for a prescription drug formulary system in accordance with guidelines established by the American sSB186 / File No.
A medical director of a nursing home facility, as defined in section 19a-521, may establish protocols for a prescription drug formulary system in accordance with guidelines established by the American Society of Health-System Pharmacists and any applicable collaborative drug therapy management agreement or collaborative drug therapy management policy, as [described] defined in section 20-631, as LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2022SB-00185 of 6 R02-SB.docx } Substitute Bill No.
213 5 sSB186 File No.
186 amendedby thisact.
213 Society of Health-System Pharmacists and any applicable collaborative drug therapy management agreement or collaborative drug therapy management policy, as [described] defined in section 20-631, as amendedby thisact.
2 from passage 19a-521d Statement of Legislative Commissioners:
2 from passage 19a-521d GL Joint Favorable Subst.
In Section 1(b), "patients or a patient population" was changed to "patients, or a patient population," for clarity;
-LCO APP Joint Favorable LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2022SB-00186-6 of 6 R02-SB.docx }
in Section 1(c), "that" was bracketed and "the" was inserted after the closing bracket, and "caregiving institution" was changed to "care-giving institution", for consistency;
and in Section 1(e)(2), "and" was inserted before "the minimum" for clarity.
sSB186 / File No.
213 6 sSB186 File No.
213 GL Joint Favorable Subst.
-LCO sSB186 / File No.
213 7 sSB186 File No.
213 The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose.
In general, fiscal impacts are based upon a variety of informational sources, including the analyst’s professional knowledge.
Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.
OFA Fiscal Note State Impact:
Agency Affected Fund-Effect FY 23 $ FY 24 $ Consumer Protection, Dept.
GF - Cost 98,918 96,668 State Comptroller - Fringe GF - Cost 36,646 36,646 Benefits1 Note:
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GF=General Fund Municipal Impact:
None Explanation The bill allows the creation of collaborative drug therapy management policies andagreementsbetweenprescribing practitioners and pharmacists resulting in a cost to the Department of Consumer Protection(DCP)andtheOffice oftheState Comptroller.
DCPwillhave to hire one drug control agent for a total cost of $135,564 in FY 23 and $133,314 in FY 24 to review the collaborative drug therapy agreements and enforce the expanded scope of practice for pharmacists.
The Out Years The annualized ongoing fiscal impact identified above would continue into the future subject to inflation.
1The fringe benefit costs for most state employees are budgeted centrally in accounts administered by the Comptroller.
The estimated active employee fringe benefit cost associated with most personnel changes is 40.53% of payroll in FY 23.
2Total cost includes salary, other expenses, and fringe benefits.
sSB186 / File No.
213 8 sSB186 File No.
213 OLR Bill Analysis sSB 186 AN ACT CONCERNING COLLABORATIVE DRUG THERAPY MANAGEMENT AGREEMENTS AND POLICIES.
SUMMARY This bill makes various changes affecting collaborative drug therapy agreements between certain health care practitioners and pharmacists.
Specifically, it:
1.
expands the types of practitioners authorized to enter into these agreements to include any prescribing practitioner or caregiving institution (“providers”), instead of only state-licensed physicians and advanced practice registered nurses;
2.
expands the types of authorized arrangements between pharmacists and providers to include collaborative drug therapy management policies between pharmacists and caregiving institutions, instead of only collaborative drug therapy agreements between pharmacists and prescribing practitioners;
3.
expands pharmacists’ authority under these arrangements to include (a) managing drug therapy for patient populations, instead of only individual patients and (b) managing a therapeutic class of drugs, instead of only specified drugs;
and 4.
requires the Department of Consumer Protection (DCP) commissioner to amend regulations on pharmacist qualifications and requirements for these arrangements to include competency requirements and requirements for the minimum content of these arrangements.
Under the bill, “prescribing practitioners” are practitioners licensed in Connecticut or another U.S.
jurisdiction who have prescriptive sSB186 / File No.
213 9 sSB186 File No.
213 authority under their professional scope of practice.
“Care-giving institutions” are institutions that provide medical services and are licensed, operated, certified, or approved by the commissioners of public health (DPH), developmental services, or mental health and addiction services (e.g., hospitals, nursing homes, or assisted living facilities).
Lastly, the bill makes technical and conforming changes, including specifying that a nursing home’s medical director may enter into collaborative drug management policies.
EFFECTIVE DATE:
Upon passage PERMITTED ARRANGEMENTS The bill authorizes two types of formal arrangements between providers and qualified pharmacists, which must be based on either written protocols or a collaborative drug therapy care plan.
These arrangements include:
1.
“collaborative drug therapy management agreements” similar to those under current law (i.e., agreements between one or more pharmacists and prescribing practitioners to manage individual patients’, or a patient population’s, drug therapy);
and 2.
“collaborative drug therapy management policies” (i.e., written policies adopted by care-giving institutions under which one or more pharmacists manage individual patients’, or a patient population’s, drug therapy).
Under thebill,a “qualifiedpharmacist” isaDCP-licensed pharmacist who (1) is deemed competent under department regulations and (2) has reviewed the latest edition of the “Pharmacists’ Patient Care Process,” published by the Joint Commission of Pharmacy Practitioners.
“Collaborative drug therapy care plans” are written documents memorializing an agreed-upon approach to achieve a patient’s desired health outcome, as determined by the patient in collaboration with one sSB186 / File No.
213 10 sSB186 File No.
213 or more health care providers (“care plans”).
CONDITIONS FOR ENTERING INTO ARRANGEMENTS Provider-Patient Relationship The bill extends current law’s requirements for entering into collaborative drug therapy agreements to the new agreements, care plans, and policies the bill authorizes.
So, before entering into an agreement or care plan, or operating under a management policy, a practitioner must establish a provider-patient relationship with the patient or patients who will receive collaborative drug therapy.
By law, this is a relationship in which (1) the patient has made a medical complaint, provided his or her medical history, and received a physical examination and (2) there exists a logical connection between the medical complaint and history, physical examination, and any drug prescribed.
Diagnosis or Test The bill also requires that each patient’s collaborative drug therapy management be based on (1) a diagnosis made by the patient’s practitioner or (2) a specific test set out in an agreement or policy.
PHARMACISTS’ AUTHORITY Under the bill, pharmacists providing collaborative drug therapy management under an agreement or policy may, in keeping with the agreement or policy:
1.
initiate, modify, continue, discontinue, or deprescribe a patient’s prescribed drug therapy;
2.
order associated laboratory tests;
and 3.
administer drugs.
This scope of authority is generally the same as currently allowed for collaborative drug therapy arrangements, except the bill (1) authorizes pharmacists to initiate, rather than implement, a prescribed drug sSB186 / File No.
213 11 sSB186 File No.
213 therapy and (2) does not require the specification of the drugs to be managed (see below).
Asiscurrentlyrequiredforcollaborativedrugtherapyarrangements, agreements and policies may specifically address issues that come up during medication reconciliation (i.e., review of all of a patient’s current and new medications) or related to polypharmacy (i.e., the simultaneous use of multiple drugs by a patient).
The bill specifies that agreements and policies cannot authorize a pharmacist to establish a port to administer parenteral drugs (e.g., IV infusions).
AGREEMENT OR POLICY’S CONTENTS Under the bill, any written protocol or care plan developed under to a collaborative drug therapy agreement or policy must have detailed direction on the pharmacist’s permitted actions, including the (1) specific drug or drugs, (2) therapeutic class or classes of drugs, and (3) medical devices that the pharmacist may manage.
(The bill does not explicitly give pharmacists authority to manage medical devices.) As under current law, the written protocol or care plan must also specify:
1.
the terms and conditions under which drug therapy may be initiated, modified, continued, discontinued, or deprescribed;
2.
when a pharmacist must notify the prescribing practitioner;
3.
the laboratory tests that the pharmacist may order;
and 4.
the patient population it covers.
Under the bill, agreements, policies, protocols, and care plans must be made available to DCP and DPH for inspection, upon request, as current law requires for agreements and written protocols.
Notice to Practitioner and Medical Record Updates sSB186 / File No.
213 12 sSB186 File No.
213 Under the bill, if a pharmacist discontinues or deprescribes a drug, he or she must notify the prescribing practitioner within 24 hours.
Any actions the pharmacist takes must be documented in the patient’s medical record as specified by any applicable care-giving institution’s policies.
(The bill does not similarly require compliance with practitioners’ policies if they are not associated with a care-giving institution.) Additionally, any protocol (presumably, this includes agreements, policies, care plans, and other written protocols) must be filed in the patient’s medical record.
Current law requires pharmacists to (1) report any encounters within the agreement’s scope within 30 days or document them in a shared medical record and (2) file protocols in the patient’s medical record.
COMMITTEE ACTION General Law Committee Joint Favorable Yea 18 Nay 0 (03/15/2022) sSB186 / File No.
213 13
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Action History

  1. FAV. RPT., TAB. FOR CAL., SEN.

  2. NO NEW FILE BY COMM. ON Appropriations

  3. RPTD. OUT OF LCO

  4. FILED WITH LCO

  5. Joint Favorable

  6. REF. BY SEN. TO COMM. ON Appropriations

  7. FILE NO. 213

  8. SENATE CALENDAR NUMBER 169

  9. FAV. RPT., TAB. FOR CAL., SEN.

  10. RPTD. OUT OF LCO

  11. REFERRED TO Office of Legislative Research AND Office of Fiscal Analysis 03/29/22

  12. FILED WITH LCO

  13. Joint Favorable

  14. PUBLIC HEARING 0301

  15. REF. TO JOINT COMM. ON General Law

Sponsors

Sponsorship breakdown

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2 sponsors · 0 co-sponsors · 185 not signed on

Sponsors (2)

Co-sponsors (0)

None.

Not signed on (185)

185 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

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Frequently asked questions

Who sponsors SB 186?
SB 186 is sponsored by Winkler, Michael A. and Robin E. Comey (Democratic).
What is the current status of SB 186?
This bill died with 2022 Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track SB 186?
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