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| Helping pharmacy & health communities improve access to Emergency Contraception (EC) |
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EC PHARMACY UPDATEThere is currently no known activity promoting direct pharmacy access to EC. This issue has not yet been raised with the Mississippi Pharmacists Association or with the State Board of Pharmacy. The Mississippi State Department of Health is in the process of rewriting protocols for its health clinics to include provision of EC. They have partnered with the sexual assault coalition to increase EC awareness and access in hospital emergency rooms. A state Women’s Resource Network was an active force on women’s issues several years ago. Activity declined and it is now part of the Governor’s office. Currently, the Alabama Planned Parenthood affiliate provides assistance in part of the state. Student health centers on college campuses refer students to the state health department clinics for EC.
CONTACTSBarry Chase S.E. (Bo) Dalton, R.Ph. Shawna Davie
USEFUL LINKSMississippi Board of Pharmacy The Mississippi Legislature Mississippi State Department of Health Planned Parenthood of Louisiana and the Mississippi Delta
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. MISSISSIPPI One or more pharmacists in any practice setting are authorized to enter into a collaborative agreement with one or more practitioners to initiate or modify drug therapy (or order lab tests) according to written guidelines or protocols previously established and approved by the Pharmacy Board and the Medical Board that is patient-specific. (A protocol for institutional setting practice does not need to be patient-specific.) Protocols are valid for one year and the patient must be notified by the pharmacist and the practitioner of the agreement. The pharmacist is required to be certified and to have completed 16 hours of continuing education in six areas, including specific disease states, patient care plans and protocol management. The pharmacist must get recertified every two years. The scope of practice is outlined in the protocol, which must include:
There is no limitation on disease state management activities. The Board of Medical Licensure has promulgated nearly identical regulations outlining the physician’s responsibilities to supervise a pharmacist pursuant to an approved protocol. Statutory authority: Provided in definitions of “administration,” “practice of pharmacy,” and “written guideline or protocol,” Miss. Code Ann. § 73-21-73 Regulatory authority: Provided in Board of Pharmacy Practice Regulations, definitions section and section governing “Initiation and Modification of Drug Therapy Under Protocol,” Miss. Reg. Article XXXVI, and Board of Medical Licensure Regulations, section governing “Supervision of Pharmacists,” Miss. Reg. Article XIV.
MISSISSIPPI STATUTE MISSISSIPPI PHARMACY PRACTICE ACT 73-21-73. Definitions. As used in this chapter, unless the context requires otherwise: (a) “Administer” shall mean the direct application of a prescription drug pursuant to a lawful order of a practitioner to the body of a patient by injection, inhalation, ingestion or any other means. … (aa) “Practice of pharmacy” shall mean a health care service that includes, but is not limited to, the compounding, dispensing, and labeling of drugs or devices; interpreting and evaluating prescriptions; administering and distributing drugs and devices; the compounding, dispensing and labeling of drugs and devices; maintaining prescription drug records; advising and consulting concerning therapeutic values, content, hazards and uses of drugs and devices; initiating or modifying of drug therapy in accordance with written guidelines or protocols previously established and approved by the board; selecting drugs; participating in drug utilization reviews; storing prescription drugs and devices; ordering lab work in accordance with written guidelines or protocols as defined by paragraph (ii) of this section; providing pharmacotherapeutic consultations; supervising supportive personnel and such other acts, services, operations or transactions necessary or incidental to the conduct of the foregoing. (bb) “Practitioner” shall mean a physician, dentist, veterinarian, or other health care provider authorized by law to diagnose and prescribe drugs. … (ff) “Provider” or “primary health care provider” shall include a pharmacist who provides health care services within his or her scope of practice pursuant to state law and regulation. … (jj) “Written guideline or protocol” shall mean an agreement in which any practitioner authorized to prescribe drugs delegates to a pharmacist authority to conduct specific prescribing functions in an institutional setting, or with individual patients, provided that a specific protocol agreement is signed on each patient and is filed as required by law or by rule or regulation of the board. SOURCES: Laws, 1983, ch. 414, Sec. 2; 1984, ch. 354, Sec. 1; 1991, ch. 527, Sec. 2; 1993, ch. 416, Sec. 3; 1994, ch. 513, Sec. 1; 1995, ch. 513, Sec. 1, eff from and after July 1, 1995
MISSISSIPPI REGULATIONS MISSISSIPPI STATE BOARD OF PHARMACY REGULATIONS SECTION 1 BOARD REGULATIONS DEFINITIONS As used in these regulations unless the context requires otherwise: 1. “Administer” shall mean the direct application of a prescription drug pursuant to a lawful order of a practitioner to the body of a patient by injection, inhalation, ingestion or any other means. … 37. “Pharmaceutical Care/Pharmacist Care” is the provision of drug therapy by a pharmacist and other pharmacist care services intended to achieve outcomes which improve the patient's quality of life as it is related to the cure or prevention of a disease, elimination or reduction of a patient's symptoms, or arresting or slowing of a disease process. 38. “Pharmacist” shall mean an individual health care provider licensed by this state to engage in the practice of pharmacy. This recognizes a pharmacist as a learned professional who is authorized to provide patient services. … 41. “Practice of pharmacy” shall mean a health care service that includes, but is not limited to, the compounding, dispensing, and labeling of drugs or devices; interpreting and evaluating prescriptions; administering and distributing drugs and devices; maintaining prescription drug records; advising and consulting concerning therapeutic values, content, hazards and uses of drugs and devices; initiating or modifying of drug therapy in accordance with written guidelines or protocols previously established and approved by the Board; selecting drugs; participating in drug utilization reviews; storing prescription drugs and devices; ordering lab work in accordance with written guidelines or protocols as defined by Section 73-21-73, paragraph (jj), Mississippi Code of 1972, Annotated; providing pharmacotherapeutic consultations; supervising supportive personnel and such other acts, services, operations or transactions necessary or incidental to the conduct of the foregoing. … 62. “Written guideline or protocol” shall mean an agreement in which any practitioner authorized to prescribe drugs, delegates to a pharmacist authority to conduct specific prescribing functions in an institutional setting, or with individual patients, provided that a specific protocol agreement is signed on each patient and is filed as required by law or by rule or regulation of the Board. ARTICLE XXXVI - PHARMACEUTICAL HEALTH CARE/INITIATION AND/OR MODIFICATION OF DRUG THERAPY UNDER PROTOCOL 1. Pharmacists may provide pharmaceutical health care to patients by initiating and/or modifying prescription drug therapy after a written protocol, indicating approval by a licensed practitioner who is authorized to prescribe prescription drugs, has been placed on file at the office of the Board. Any such protocol must define the agreement by which the practitioner delegates this authority and any such authority granted must be within the scope of the practitioner's prescribing authority and current practice. Any modification of the agreement must be treated as a new protocol. For purposes of this ARTICLE “written protocol” shall mean an agreement in which any practitioner authorized to prescribe drugs delegates to a pharmacist authority to conduct specific initiation and/or modification of drug therapy functions in an institutional setting. In a community pharmacy out-patient setting, a specific protocol agreement shall be signed on each patient for whom a practitioner delegates any authority to initiate or modify drug therapy. 2. Unless specifically authorized by the Board, no person shall initiate or modify drug therapy under a protocol agreement unless he/she is certified and possesses the following qualifications:
Pharmacists shall, on a biennial basis, obtain re-certification in each disease state by successfully completing a Board approved continuing education program consisting of not less than six (6) hours focusing on nationally recognized updates. Pharmacists who have successfully completed any Board approved study course(s) focusing on disease state management and protocols or re-certification, shall send to the Board office copies of any documents certifying such. 3. Protocol agreements shall meet the following requirements:
State Board of Medical Licensure Rules and Regulations Governing the Supervision of Pharmacists Rule XVI. The Supervision of Pharmacists (Rev. Date April 2003.) Authority: Chapter 25 and 27, Title 73, Mississippi Code (1972) Annotated Preamble: To optimize the favorable professional working relationship that already exists between the State of Mississippi's physician and pharmacist communities, the following is directed. * * * B. DEFINITIONS AS USED IN THESE REGULATIONS: * * * 3. “Pharmacist” means any person licensed to practice pharmacy in the State of Mississippi, who has met all requirements of Article XXXVI of the rules and regulations of the Mississippi State Board of Pharmacy to either (i) accept patients referred by a physician, (ii) initiate or modify drug therapy, or (iii) order lab work, all in accordance with Written Guidelines or Protocols as hereinafter defined. 4. “Written Guidelines or Protocols” means an agreement in which a physician authorized to prescribe drugs delegates to a pharmacist authority to consult with a patient or to conduct specific prescribing functions in an institutional setting, or with individual patients, provided that a specific Protocol agreement is signed on each patient and is filed with the Mississippi State Board of Pharmacy as required by Mississippi Code Annoted § 73-21-73(jj) and is filed with this [Medical] Board. C. BOARD REVIEW - PROTOCOL FORMAT 1. Before any physician shall execute a protocol to supervise a pharmacist in the care or consultation with a patient, or initiation and/or modification of prescription drug therapy, and/or ordering lab work, the supervising physician must jointly execute a Written Guideline or Protocol with the pharmacist and thereafter file the same with the Mississippi State Board of Medical Licensure. 2. No Protocol agreement authorizing the care or consultation with a patient, or initiation and/or modification of prescription drug therapy shall be executed by a physician unless the Protocol shall meet at a minimum the following requirements:
3. No Protocol agreement authorizing the ordering of lab work by a pharmacist shall be executed by a physician unless the Protocol shall meet at a minimum the following requirements:
* * * E. TERMINATION OR CHANGES IN THE PROTOCOL Any physician desirous of termination or amending the supervisory protocol with a pharmacist shall so notify in writing, the pharmacist, the Mississippi State Board of Pharmacy and the Mississippi Stat Board of Medical Licensure to the attention of the Executive Director. The notification shall include the name of the pharmacist, the desired change, and proposed effective date of change. F. VIOLATION OF REGULATIONS/DISAPPROVAL OF SUPERVISION Any violation of the Rules and Regulations as enumerated above shall constitute unprofessional conduct in violation of Mississippi Code Annotated §73-25-29(8), as amended. G. EFFECTIVE DATE OF REGULATION The above rules and regulations pertaining to Supervising Physicians shall become effective September 23, 1999.
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