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| Helping pharmacy & health communities improve access to Emergency Contraception (EC) |
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EC PHARMACY UPDATEMontana has an optimal environment for allowing pharmacists initiation of EC. A physician in Bozeman, Montana has expressed interest in entering into EC collaborative practice agreements, but no pharmacists have come forward as yet. The Montana Pharmacy Association has offered EC certification and pharmacist education, with active participation from the University of Montana, School of Pharmacy. Most family planning organizations have arrangements with local pharmacies, which dispense EC under prescriptions. The pharmacist’s role in providing EC was featured in an article (PDF-40K) in The New Montana Pharmacist, July 2003. General work around EC access has been grassroots and led by the State Health Department. A separate Statewide Reproductive Rights Coalition was formed around 1993, and formalized around 1998. The coalition includes: American Civil Liberties Union (ACLU), Blue Mountain Clinic, National Abortion Rights Action League NARAL Pro-Choice Montana, InterMountain Planned Parenthood, Montana Women’s Lobby, Montana Women’s Vote Project, Business & Professional Women’s (BPW), American Association of University Women (AAUW), Human Rights Network, and Working for Equality and Economic Liberation (WEEL). The NARAL Pro-Choice Montana Foundation has worked on educational and organizing projects to encourage pharmacists to develop a collaborative agreement with a physician to dispense EC. The Foundation also works to ensure that local EC providers are listed (PDF-36K) on various websites and hotlines and to increase awareness and availability of EC through student health centers. They also have developed an EC pharmacy survey (DOC24K) and sent letters to pharmacists (DOC-28K) thanking them for stocking EC.
CONTACTSJim Smith Allyson Hagen Raquel Castellanos Miller
USEFUL LINKSMontana Board of Pharmacy Montana State Legislature Blue Mountain Clinic NARAL Pro-Choice Montana
PROTOCOL ENVIRONMENTOptimal Environment: No Revision to Authority Necessary Existing statutes and regulations would accommodate pharmacists’ initiation of emergency contraception, generally under a collaborative practice agreement (protocol) with a prescriber. Regulations would require filing a copy of the protocol with the Board of Pharmacy. Pharmacist initiation of EC requires would require development of a protocol and securing prescriber authorization.
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. MONTANA One or more pharmacists may enter into patient-specific “collaborative pharmacy practice agreements” with one or more prescribers to engage in “drug therapy management”, a broad term that is not defined by regulation. The agreement, which must be filed with the Board, shall set forth the types of decisions, procedures and activities the pharmacist may engage in pursuant to a protocol, including initiating or modifying drug therapy, and administering drugs, under certain conditions or limitations authorized by the prescriber. The agreement “may” also include the specific diseases and drugs involved, decision criteria and plan. The agreement must also set forth:
The Board reserves the right to approve standard protocols for interested parties to use to then be placed on file. The Board’s regulations define pharmacies in family planning clinics and similar entities as Class IV facilities which may only dispense “oral contraceptives; injectable long-term contraceptives; progestational drugs; diaphragms; contraceptive jellies; creams, and foams; IUD's; condoms; vaginal creams, ointments, and suppositories used in the routine treatment of vaginal disorders.” Statutory authority: Provided in definitions related to collaborative and pharmacy practice, Mont Code Ann. § 37-7-101 Regulatory authority: Provided in rules governing administration of vaccines, Mont. Admin. Reg. 24.174.503, and collaborative practice, Mont. Admin. Reg. 24.174.524.
MONTANA STATUTE TITLE 37. PROFESSIONS AND OCCUPATIONS CHAPTER 7. PHARMACY 37-7-101. Definitions. As used in parts 1 through 7 of this chapter, the following definitions apply:
… (4) “Collaborative pharmacy practice” means the practice of pharmacy by a pharmacist who has agreed to work in conjunction with one or more prescribers, on a voluntary basis and under protocol, and who may perform certain patient care functions under certain specified conditions or limitations authorized by the prescriber. (5) “Collaborative pharmacy practice agreement” means a written and signed agreement between one or more pharmacists and one or more prescribers that provides for collaborative pharmacy practice for the purpose of drug therapy management of patients. … (21) “Pharmaceutical care” means the provision of drug therapy and other patient care services intended to achieve outcomes related to the cure or prevention of a disease, elimination or reduction of a patient's symptoms, or arresting or slowing of disease process. … (26) “Practice of pharmacy” means:
* * * History: En. Sec. 2, Ch. 175, L. 1939; amd. Sec. 1, Ch. 33, L. 1951; amd. Sec. 2, Ch. 241, L. 1971; amd. Sec. 148, Ch. 350, L. 1974; amd. Sec. 1, Ch. 439, L. 1977; R.C.M. 1947, 66-1502; amd. Sec. 7, Ch. 22, L. 1979; amd. Sec. 3, Ch. 379, L. 1981; amd. Sec. 1, Ch. 247, L. 1983; amd. Sec. 1, Ch. 219, L. 1991; amd. Sec. 36, Ch. 429, L. 1995; amd. Sec. 3, Ch. 388, L. 2001; amd. Sec. 116, Ch. 483, L. 2001.
MONTANA REGULATIONS Dept. of Labor and Industry Chapter 174 - Board of Pharmacy 24.174.524 COLLABORATIVE PRACTICE AGREEMENT REQUIREMENTS (1) Prior to initially engaging in collaborative practice, a pharmacist must provide the board with an executed written and electronic copy of the collaborative practice agreement. (2) The collaborative practice agreement must include:
(3) Patient records shall be maintained by the pharmacist for a minimum of seven years and may be maintained in an automated system pursuant to ARM 24.174.818(3).. (History: 37-7-101, 37-7-201, MCA; IMP, 37-7-101, 37-7-201, MCA; NEW, 2002 MAR p. 794, Eff. 2/1/02.) 24.174.503 ADMINISTRATION OF VACCINES BY PHARMACISTS (1) A pharmacist may administer vaccines to persons 18 years of age or older provided that:
(2) The pharmacist must give the appropriate vaccine information statement to the patient or the patient's legal representative with each dose of vaccine covered by these forms and counsel the patient accordingly. (3) The pharmacist must maintain written policies and procedures for disposal of used or contaminated supplies. (4) The pharmacist must report any adverse events to the primary care provider identified by the patient and to the CDC. (5) A pharmacist administering any vaccine shall maintain the following information in the patient's medical records for a period of at least three years:
(6) The authority of a pharmacist to administer immunizations may not be delegated. (7) The pharmacist must provide a certified true copy of the certificate to the board for endorsement on their pharmacist license. (History: 37-7-101, 37-7-201, MCA; IMP, 37-7-101, 37-7-201, MCA; NEW, 2002 MAR p. 794, Eff. 2/1/02.) 24.174.813 CLASS IV FACILITY (1) A Class IV facility shall be administered in compliance with the following standards: (History: 37-7-201, MCA; IMP, 37-7-201, 37-7-321, MCA; NEW, Eff. 3/21/71; AMD, Eff. 8/4/76; AMD, Eff. 1/31/77; AMD, 1980 MAR p. 126, Eff. 1/18/80; TRANS, from Dept. of Prof. & Occup. Lic., Ch. 274, L. 1981, Eff. 7/1/81; AMD, 1983 MAR p. 344, Eff. 4/29/83; TRANS, from Commerce, 2002 MAR p. 904.)
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