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| Helping pharmacy & health communities improve access to Emergency Contraception (EC) |
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EC PHARMACY UPDATENARAL Pro-Choice Connecticut plans to survey pharmacies in the state in March 2005. Planned Parenthood of Connecticut has worked to establish communication lines with the Connecticut Pharmacy Association. Pharmacists for Choice has a chapter in Connecticut and supports improvements to EC access. Connecticut has two advocacy networks that could be mobilized in support of EC pharmacy access — the Coalition for Choice and the Connecticut Women’s Health Campaign, a 31 organization group convened by the State’s Permanent Commission on the Status on Women. The Coalition for Choice met in October 2004 to discuss EC related bills. The Connecticut Pharmacists Association (CPA) invited Planned Parenthood to provide information on EC as part of a women’s health training event for pharmacists held on September 29, 2003. Planned Parenthood covered mechanism of action, as well as issues such as teen access and conscience clauses. CPA has also been talking to legislators about EC in the context of several appropriate ways to expand collaborative practice authority. Pharmacists have expressed interest in prescribing privileges, but have been reluctant to pursue EC pharmacy legislation. Planned Parenthood of CT and NARAL Pro-Choice Connecticut conducted an informal statewide survey of pharmacists’ knowledge and attitudes in the summer of 2003. Click to view the survey instrument (DOC-60K). This study found that there are still concerns about how EC works and if it will be used as a regular method of birth control. In addition, 20% of pharmacists did not carry a dedicated product and a large majority of pharmacists believed EC was safe for teenagers.
CONTACTSMargherita Giuliano, R.Ph. Susan Yolen NARAL Pro-Choice Connecticut
USEFUL LINKSConnecticut Pharmacy Commission Connecticut Pharmacists Association Connecticut General Assembly Planned Parenthood of Connecticut Pro-choice Connecticut
PROTOCOL ENVIRONMENTPossible Environment: Revision to Existing Authority Required This state permits collaborative practice agreements or a similar agreement between physicians and pharmacists. However, some modification of existing statutes and/or regulations is required to allow pharmacists to initiate EC for the general community. Pharmacist initiation of EC would require:
PHARMACY PRACTICE ACTPharmacy Practice Act Regulatory and Statutory Authority Note: The text presented below has been prepared by the American Pharmacists Association for the Pharmacy Access Partnership and reflects legislation or regulation promulgated as of June 15, 2003. CONNECTICUT Pursuant to a new law effective October, 2002, only pharmacists employed in a hospital setting could enter into collaborative agreements with the treating physician to manage drug therapy (including administering drugs) of individual patients receiving inpatient services pursuant to a patient-specific protocol approved by the hospital. (As discussed in more detail below, this authority was just extended to pharmacists working in nursing homes.) The pharmacist must demonstrate relevant competencies as determined by the hospital. The pharmacist must notify the physician within 24 hours of discontinuing a drug therapy and report on the patent’s therapy every 30 days. All actions must be documented in the medical record. The scope of practice is outlined in the protocol which must contain detailed directions about what the pharmacist may do, including, most notably, the drug(s) to be managed;; the conditions under which the therapy can be implemented, modified, or discontinued; the events that require the pharmacist to contact the physician; and lab tests that can be ordered by the pharmacist. Any disease state listed in the protocol may be managed. The pharmacist must report to the physician at least every 30 days. Criteria used by institutions to determine competency to participate in collaborative drug therapy management must be filed with the Pharmacy Commission. The agreements and protocols must be in the patient’s medical record and available for inspection by the Public Health and Consumer Protection Departments. The Commissioner of Public Health may adopt implementing regulations, but as of June 15, 2003 had not done so. On June 26, 2003, the Governor signed Public Act 03-164, An Act Concerning Collaborative Practice Between Physicians and Pharmacists, that adds pharmacists employed by or under contract with a nursing home to those who can establish collaborative agreements with physicians to manage the drug therapy of patients. Each patient's collaborative drug therapy management must be based on a written protocol specific to that patient, developed by the treating physician in consultation with the pharmacist, and approved by the nursing home's active organized medical staff. The nursing home must determine that the pharmacist is competent to participate in each collaborative agreement, and file a copy of the criteria it uses to judge competence with the Commission of Pharmacy. Statutory Authority: Conn. Gen. Stat.§§ 20-571 and 20-631; Public Act 03-164 Regulatory Authority: Regulations not promulgated as of June 15, 2003.
CONNECTICUT STATUTE Connecticut General Statutes CHAPTER 400j PHARMACY Commission of Pharmacy, Powers and Duties Sec. 20-570. Title. Sections 20-570 to 20-639, inclusive, may be cited as the “Pharmacy Practice Act”. Sec. 20-571. Definitions. As used in sections 20-570 to 20-630 inclusive, unless the context otherwise requires: (1) “Administer” means the direct application of a drug or device to the body of a patient or research subject by injection, inhalation, ingestion or any other means; … (21) “Practice of pharmacy” or “to practice pharmacy” means the sum total of knowledge, understanding, judgments, procedures, securities, controls and ethics used by a pharmacist to assure optimal safety and accuracy in the distributing, dispensing and use of drugs and devices; (22) “Prescribing practitioner” means an individual licensed by the State of Connecticut, any other state of the United States, the District of Columbia, the Commonwealth of Puerto Rico or any territory or insular possession subject to the jurisdiction of the United States who is authorized to issue a prescription within the scope of the individual’s practice; Substitute Senate Bill No. 1151- Public Act No. 03-164 AN ACT CONCERNING COLLABORATIVE PRACTICE BETWEEN PHYSICIANS AND PHARMACISTS. Be it enacted by the Senate and House of Representatives in General Assembly convened: Section 1. Section 20-631 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2003): (a) (1) One or more pharmacists licensed under this chapter who are determined eligible in accordance with subsection (c) of this section, and employed by a hospital may enter into a written protocol-based collaborative drug therapy management agreement with one or more physicians licensed under chapter 370 to manage the drug therapy of individual patients receiving inpatient services in a hospital licensed under chapter 368v, in accordance with subsections (b) to (d), inclusive, of this section and subject to the approval of the hospital. Each patient's collaborative drug therapy management shall be governed by a written protocol specific to that patient established by the treating physician in consultation with the pharmacist. (2) One or more pharmacists licensed under this chapter who are determined eligible in accordance with subsection (c) of this section and employed by or under contract with a nursing home facility, as defined in section 19a-521, may enter into a written protocol-based collaborative drug therapy management agreement with one or more physicians licensed under chapter 370 to manage the drug therapy of individual patients receiving services in a nursing home facility, in accordance with subsections (b) to (d), inclusive, of this section and subject to the approval of the nursing home facility. Each patient's collaborative drug therapy management shall be governed by a written protocol specific to that patient established by the treating physician in consultation with the pharmacist. Each such protocol shall be reviewed and approved by the active organized medical staff of the nursing home in accordance with the requirements of section 19-13-D8t(i) of the Public Health Code. (b) A collaborative drug therapy management agreement may authorize a pharmacist to implement, modify or discontinue a drug therapy that has been prescribed for a patient, order associated laboratory tests and administer drugs, all in accordance with a patient-specific written protocol. In instances where drug therapy is discontinued, the pharmacist shall notify the treating physician of such discontinuance no later than twenty-four hours from the time of such discontinuance. Each protocol developed, pursuant to the collaborative drug therapy management agreement, shall contain detailed direction concerning the actions that the pharmacist may perform for that patient. The protocol shall include, but need not be limited to, (1) the specific drug or drugs to be managed by the pharmacist, (2) the terms and conditions under which drug therapy may be implemented, modified or discontinued, (3) the conditions and events upon which the pharmacist is required to notify the physician, and (4) the laboratory tests that may be ordered. All activities performed by the pharmacist in conjunction with the protocol shall be documented in the patient's medical record. The pharmacist shall report at least every thirty days to the physician regarding the patient's drug therapy management. The collaborative drug therapy management agreement and protocols shall be available for inspection by the Departments of Public Health and Consumer Protection. A copy of the protocol shall be filed in the patient's medical record. (c) A pharmacist shall be responsible for demonstrating, in accordance with this subsection, the competence necessary for participation in each drug therapy management agreement into which such pharmacist enters. The pharmacist's competency shall be determined by the hospital or nursing home facility for which the pharmacist is employed. A copy of the criteria upon which the hospital or nursing home facility determines competency shall be filed with the Commission of Pharmacy. (d) The Commissioner of Public Health, in consultation with the Commissioner of Consumer Protection, may adopt regulations, in accordance with chapter 54, concerning the minimum content of the collaborative drug therapy management agreement and the written protocol and as otherwise necessary to carry out the purpose of this section. Sec. 2. Section 20-635 of the general statutes is amended by adding subsection (e) as follows (Effective October 1, 2003): (NEW) (e) Records collected or maintained pursuant to this section shall not be required to be disclosed pursuant to subsection (a) of section 1-210 for a period of six months from the date such records were created pursuant to subsections (c) and (d) of this section and shall not be subject to subpoena or discovery or introduced into evidence in any judicial proceeding except as otherwise specifically provided by law. Approved June 26, 2003
CONNECTICUT REGULATIONS Not promulgated as of June 15, 2003.
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