HD2 - The Dispensing of Drugs and Devices Pursuant to Pharmacy Collaborative Practice Agreements, Standing Orders, and Statewide Protocols (HJR 662, 2019)

Executive Summary:

House Joint Resolution (HJR) No. 662, introduced by Delegates Christopher P. Stolle, M.D. and Alfonso H. Lopez in the 2019 General Assembly session, directed the JCHC to study the dispensing of drugs and devices pursuant to prescriptions, pharmacy collaborative practice agreements (CPAs), standing orders, and statewide protocols in the Commonwealth. The Boards of Pharmacy and Medicine have oversight responsibility for CPAs. CPAs are agreements between a practitioner and a pharmacist and must include the condition that the pharmacist is authorized to address and protocols that are the accepted clinical standard of care.(*i) If the parties to the agreement wish to use non-standard protocols, they must receive approval from the Boards. The Boards do not receive copies of CPAs, and oversight consists of responding to complaints. At the time of the study, the Boards had received no requests for approval of nonstandard protocols nor complaints.

Presently in Virginia pharmacists may provide vaccines and dispense Naloxone without a physician prescription or being a party to a CPA. Several states have expanded the authority of pharmacists to provide certain medications without a physician’s prescription, such as smoking cessation products, hormonal birth control, and anti-viral medication for influenza, and Colorado recently authorized autonomous dispensing authority to pharmacists. The Indian Health Service and Veterans Health Administration have allowed autonomous dispensing authority to pharmacists for several years. Expanding pharmacists dispensing authority may increase access to health services, promote public health goals, and reduce emergency department visits for conditions such as influenza.

Several policy options were offered for JCHC consideration, including expanding pharmacists dispensing authority, striking the requirement for the Boards of Pharmacy and Medicine to approve non-standard protocols, include physician assistants and independently practicing nurse practitioners to act as practitioners in CPAs, and requesting that the Boards of Pharmacy and Medicine convene a workgroup to provide recommendations to the JCHC for conditions and drugs that can be added to the current statewide standing orders (such as antiviral drugs for influenza and hormonal birth control pills). The JCHC elected to introduce legislation to include physician assistants and independent nurse practitioners as parties to CPAs and to request that a workgroup be convened to submit recommendations to the JCHC regarding expanded statewide standing orders.
(*i) Defined in § 54.1-3300 of the Code of Virginia as: (i) any person licensed to practice medicine, osteopathy, or podiatry together with any person licensed, registered, or certified by a health regulatory board of the Department of Health Professions who provides health care services to patients of such person licensed to practice medicine, osteopathy, or podiatry and, (iii) any licensed physician assistant working under the supervision of a person licensed to practice medicine, osteopathy, or podiatry; or (iv) any licensed nurse practitioner working in accordance with the provisions... involved directly in patient care.