Ohio State Profile
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EC PHARMACY UPDATE
There is currently no known activity promoting direct pharmacy access to EC.
The Statewide Coalition on Contraceptive Equity attempted to pass contraceptive equity legislation but it died in 2003. This broad based coalition might be a foundation for future organizing around EC pharmacy access. The Family Planning Advocates of Ohio will continue to focus on contraceptive equity. They have had preliminary discussions with the sexual assault community about mobilizing around EC in the ER legislation. The sexual assault community has conducted EC training with nurses. Title X clinics make EC available to clients.
Staff at NARAL Pro-Choice Ohio are in the middle of a survey of the availability of EC in hospital emergency rooms. They are working with colleagues in the sexual assault community to ensure EC access for rape victims. NARAL is also working to increase EC awareness on a number of college campuses.
For press coverage in this state, click here.
CONTACTS
Ernest Boyd, P.D., C.A.E.
Executive Director
Ohio Pharmacists Association
2155 Riverside Drive
Columbus, OH 43221
(614) 586-1497
Fax (614) 586-1545
eboyd@ohiopharmacists.org
www.ohiopharmacists.org
Kellie Copeland
Executive Director
NARAL Pro-Choice Ohio
12000 Shaker Blvd.
Cleveland, OH 44120
216-283-2180
1-800-GO-NARAL
info@naralohio.org
www.naralohio.org
Gary Dougherty
Executive Director
Planned Parenthood Affiliates of Ohio
33 North Third St., Suite 315
Columbus, OH 43215
614-224-0761
Fax: 614-224-2420
garydougherty@ppao.org
www.ppao.org
Barbara Tobias, MD
Associate Professor Family Medicine
University of Cincinnati Department of Family Medicine
149 Health Professions Bldg Albert Sabin Way
Cincinnati, OH 45267-0582
513-558-4020
Fax: 513-558-3430
tobiasba@fammed.uc.edu
USEFUL LINKS
Ohio State Board of Pharmacy
http://pharmacy.ohio.gov/
Ohio Pharmacists Association
www.ohiopharmacists.org
Ohio Legislature
http://ohio.gov/government.stm
Federation for Community Planning
www.fcp.org
Planned Parenthood of Summit, Portage, and Medina Counties
www.ppinfo.org
Planned Parenthood of Stark County
www.plannedparenthood.org/ppsc/index.asp
Planned Parenthood Cincinnati Region
www.plannedparenthood.org/cinci/index.asp
Planned Parenthood of Greater Cleveland
www.plannedparenthood.org/cleveland/index.asp
Planned Parenthood of Central Ohio
www.plannedparenthoodcentralohio.org
Planned Parenthood of the Greater Miami Valley
www.ppgmv.org
Planned Parenthood of North Central Ohio
www.plannedparenthood.org/ppnco/index.asp
Planned Parenthood of Mahoning Valley
www.ppmv.org
NARAL Pro-Choice Ohio
www.naralohio.org
Family Planning Association of Northeast Ohio
www.fpaneo.org
PROTOCOL ENVIRONMENT
Possible 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:
- Modifying the requirement for patient-specific protocols
PHARMACY PRACTICE ACT
Pharmacy 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.
OHIO
Pharmacists in any practice setting may implement a patient-specific “consult agreement” that is signed by the physician, pharmacist and patient. Protocol authority shall be noted in the patient’s medical record, which may include the pharmacist monitoring and modifying the individual’s drug therapy, but not initiating it. The pharmacist must keep a patient record of all action taken and send a written report to the physician to be placed in the medical record. The physician may designate an alternate physician in the event that the primary physician is unavailable. Rules are to be adopted by the Boards of Pharmacy and Medicine to further define this section, but as of June 15th they had not been promulgated.
Scope of practice is within the agreement with no limitations on disease state management opportunities, though “definitive orders,” including medications and dosages, must be specified.
Statutory authority: Provided in the Pharmacy Practice Act section on “pharmacist’s management of drug therapy under consult agreement with physician,” Ohio Rev. Code Ann. § 4729.39, and the section on “administration of certain adult immunization by pharmacists.” Ohio Rev. Code Ann. § 4729.41
Regulatory authority: Provided in Definitions and section on adult immunizations, Ohio Admin Code § 4729-5-01, 5-36, and 5-37
OHIO STATUTE
§ 4729.39 Pharmacist's management of drug therapy under consult agreement with physician.
(A) A pharmacist may enter into a consult agreement with a physician authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery. Under a consult agreement, a pharmacist is authorized to manage an individual's drug therapy, but only to the extent specified in the agreement, this section, and the rules adopted under this section.
(B) All of the following apply to a consult agreement that authorizes a pharmacist to manage the drug therapy of an individual who is not a patient of a hospital, as defined in section 3727.01 of the Revised Code, or a resident in a long-term care facility, as defined in section 3729.01 of the Revised Code:
- (1) A separate consult agreement must be entered into for each individual whose drug therapy is to be managed by a pharmacist. A consult agreement applies only to the particular diagnosis for which a physician prescribed an individual's drug therapy. If a different diagnosis is made for the individual, the pharmacist and physician must enter into a new or additional consult agreement.
- (2) Management of an individual's drug therapy by a pharmacist under a consult agreement may include monitoring and modifying a prescription that has been issued for the individual. Except as provided in section 4729.38 of the Revised Code for the selection of generically equivalent drugs, management of an individual's drug therapy by a pharmacist under a consult agreement shall not include dispensing a drug that has not been prescribed by the physician.
- (3) Each consult agreement shall be in writing, except that a consult agreement may be entered into verbally if it is immediately reduced to writing.
- (4) A physician entering into a consult agreement shall specify in the agreement the extent to which the pharmacist is authorized to manage the drug therapy of the individual specified in the agreement.
- (5) A physician entering into a consult agreement may specify one other physician who has agreed to serve as an alternate physician in the event that the primary physician is unavailable to consult directly with the pharmacist. The pharmacist may specify one other pharmacist who has agreed to serve as an alternate pharmacist in the event that the primary pharmacist is unavailable to consult directly with the physician.
- (6) A consult agreement may not be implemented until it has been signed by the primary pharmacist, the primary physician, and the individual whose drug therapy will be managed or another person who has the authority to provide consent to treatment on behalf of the individual. Once the agreement is signed by all required parties, the physician shall include in the individual's medical record the fact that a consult agreement has been entered into with a pharmacist.
- (7) Prior to commencing any action to manage an individual's drug therapy under a consult agreement, the pharmacist shall make reasonable attempts to contact and confer with the physician who entered into the consult agreement with the pharmacist. A pharmacist may commence an action to manage an individual's drug therapy prior to conferring with the physician or the physician's alternate, but shall immediately cease the action that was commenced if the pharmacist has not conferred with either physician within forty-eight hours.
- A pharmacist acting under a consult agreement shall maintain a record of each action taken to manage an individual's drug therapy. The pharmacist shall send to the individual's physician a written report of all actions taken to manage the individual's drug therapy at intervals the physician shall specify when entering into the agreement. The physician shall include the pharmacist's report in the medical records the physician maintains for the individual.
- (8) A consult agreement may be terminated by either the pharmacist or physician who entered into the agreement. By withdrawing consent, the individual whose drug therapy is being managed or the individual who consented to the treatment on behalf of the individual may terminate a consult agreement. The pharmacist or physician who receives the individual's withdrawal of consent shall provide written notice to the opposite party. A pharmacist or physician who terminates a consult agreement shall provide written notice to the opposite party and to the individual who consented to treatment under the agreement. The termination of a consult agreement shall be recorded by the pharmacist and physician in the records they maintain on the individual being treated.
- (9) Except as described in division (B)(5) of this section, the authority of a pharmacist to manage an individual's drug therapy under a consult agreement does not permit the pharmacist to manage drug therapy prescribed by any other physician.
(C) All of the following apply to a consult agreement that authorizes a pharmacist to manage the drug therapy of an individual who is a patient of a hospital, as defined in section 3727.01of the Revised Code, or a resident in a long-term care facility, as defined in section 3729.01 of the Revised Code:
- (1) Before a consult agreement may be entered into and implemented, a hospital or long-term care facility shall adopt a policy for consult agreements. For any period of time during which a pharmacist or physician acting under a consult agreement is not physically present and available at the hospital or facility, the policy shall require that another pharmacist and physician be available at the hospital or facility.
- (2) The consult agreement shall be made in writing and shall comply with the hospital's or facility's policy on consult agreements.
- (3) The content of the consult agreement shall be communicated to the individual whose drug therapy will be managed in a manner consistent with the hospital's or facility's policy on consult agreements.
- (4) A pharmacist acting under a consult agreement shall maintain in the individual's medical record a record of each action taken under the agreement.
- (5) Communication between a pharmacist and physician acting under the consult agreement shall take place at regular intervals specified by the primary physician acting under the agreement.
- (6) A consult agreement may be terminated by the individual, a person authorized to act on behalf of the individual, the primary physician acting under the agreement, or the primary pharmacist acting under the agreement. When a consult agreement is terminated, all parties to the agreement shall be notified and the termination shall be recorded in the individual's medical record.
- (7) The authority of a pharmacist acting under a consult agreement does not permit the pharmacist to act under the agreement in a hospital long-term care facility at which the pharmacist is not authorized to practice.
(D) The state board of pharmacy, in consultation with the state medical board, shall adopt rules to be followed by pharmacists, and the state medical board, in consultation with the state board of pharmacy, shall adopt rules to be followed by physicians, that establish standards and procedures for entering into a consult agreement and managing an individual's drug therapy under a consult agreement. The boards shall specify in the rules any categories of drugs or types of diseases for which a consult agreement may not be established. Either board may adopt any other rules it considers necessary for the implementation and administration of this section. All rules adopted under this division shall be adopted in accordance with Chapter. of the Revised Code.
OHIO REGULATIONS
4729-5-01 Definitions. [Rule update effective 03/01/99]
As used in Chapter 4729. of the Revised Code:
- (A) “Practice of pharmacy” is as defined in division (B) of section 4729.01 of the Revised Code.
- …
- (F) “To participate with prescribers in reviews of drug utilization” means monitoring the appropriate use of drugs through communication with the prescriber(s) involved.
- …
- (J) “Preprinted order” is defined as a patient-specific, definitive set of drug treatment directives to be administered to an individual patient who has been examined by a prescriber and for whom the prescriber has determined that the drug therapy is appropriate and safe when used pursuant to the conditions set forth in the preprinted order. Preprinted orders may be used only for inpatients in an institutional facility as defined in Chapter 4729-17 of the Administrative Code.
- (K) “Standing order” will mean the same as the term “protocol”.
- (L) “Protocol” is defined as:
- (1) A definitive set of treatment guidelines that include definitive orders for drugs and their specified dosages which have been authorized by a prescriber as defined in rule 4729-5-15 of the Administrative Code and have been approved by the state board of pharmacy to be used by certified or licensed health care professionals when providing limited medical services to individuals in an emergency situation when the services of a prescriber are not immediately available; or
- (2) A definitive set of treatment guidelines that include definitive orders for drugs and their specified dosages which have been authorized by a prescriber as defined in rule 4729-5-15 of the Administrative Code and have been approved by the state board of pharmacy to be used by certified or licensed health care professionals when administering biologicals or vaccines to individuals for the purpose of preventing diseases.
- A protocol may be used only by licensed or certified individuals acting within the scope of their license or certification who have been adequately trained in the safe administration and use of the drugs and other procedures included in the protocol.
- Protocols submitted for approval by the state board of pharmacy may be reviewed with the medical and/or nursing board, as appropriate, prior to any approval by the state board of pharmacy.
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