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| Helping pharmacy & health communities improve access to Emergency Contraception (EC) |
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EC PHARMACY UPDATEEC pharmacy access legislation, SB 849, was introduced in the 2005 legislative session (bills can only be introduced every other year). Amendments were made to SB 849 to add a physician assistant as an authorizer and to address record-keeping and rule-making.EC pharmacy access legislation, SB 849 For the past several years the Board of Pharmacy and the Oregon State Pharmacists Association (OSPA) have been involved in efforts to simplify the restrictions on collaborative protocols and thereby permit pharmacists to initiate EC. Similar legislation, SB 677, was proposed in the 2003 session but died. Health advocates had a major role in attempting to move this legislation and the Board of Pharmacy and Pharmacists Association were less visibly involved. In April 1999 the Oregon Board of Pharmacy and the Oregon Medical Association explored the concept of a pilot project where pharmacies would initiate EC. However, the Oregon Pharmacy Act did not provide the appropriate framework to support this type of project, and the concept died. During the 2001 legislative session, OSPA proposed broad enabling legislation similar to Washington State that would allow pharmacists under protocol to initiate drug therapy including EC. This legislation was opposed by the Oregon Medical Association, Kaiser Permanente and the Oregon Association of Hospitals and Health Systems. In November 2002, representatives from the Oregon Office of Family Health, the Oregon Health and Science University, and Columbia University School of Public Health presented at the American Public Health Association’s 130th Annual Meeting on Improving Access to Emergency Contraception using Oregon PRAMS (Pregnancy Risk Assessment Monitoring System) data. They highlighted that one barrier to increased use of EC in Oregon has been that very few retail pharmacists were stocking EC. They concluded, “Many women would benefit if mores states passed laws allowing pharmacist counseling, referral, and prescription of emergency contraception.” EC awareness training aimed at health care professionals occurred in the Portland metropolitan area. The State Department of Human Services also contracted with Population Services International to train providers throughout the state including 36 agencies and 128 clinics. Planned Parenthood of the Columbia/Williamette (PPCW) in Portland, OR, offers women a way to access EC through the PPCW website. A nurse practitioner contacts the patient by phone to review the information submitted and answer questions. Since the program’s launch in 2002, almost 600 women have received an EC prescription. Additional papers from the Oregon Department of Human Services, Office of Family Health, on the need for advance prescriptions, knowledge of EC and pregnancy intendedness, and EC in emergency departments have been or will be published.
CONTACTSJim Thompson Jeanne Atkins Kenneth Rosenberg, MD, MPH Michele Stranger-Hunter
USEFUL LINKSOregon Board of Pharmacy Oregon State Pharmacists Association Oregon State Legislature Planned Parenthood Health Services of Southwestern Oregon Planned Parenthood of the Columbia/Willamette, Inc. NARAL Pro-Choice Oregon
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. OREGON Pharmacists with special training, working in any practice setting, may engage in patient-specific protocol agreements with physicians or other prescribers. No external Board review is required. Collaborative drug therapy management must be initiated by prescription order for each individual patient by the participating practitioner. Training requirements for the pharmacist are stated in the protocol, which is valid for two years. Therapeutic substitution is not allowed. The scope of practice is defined within the protocol and must include –
Pharmacists who complete other required training may administer immunizations, by any route of delivery, to those 18years and older. Pharmacists must follow written protocols approved by the Oregon Health Division for administration of vaccines and the treatment of severe adverse events, keep detailed records, and provide information to the Board. Statutory authority: Or. Rev. Stat. § 689.005, § 689.015, § 689.645 Regulatory authority: Or. Admin. R. 855-041-0400, 855-041-0500, 855-006-0010
OREGON STATUTE Chapter 689 - Pharmacists; Drug Outlets; Drug Sales GENERAL PROVISIONS 689.005 Definitions. As used in this chapter: (1) “Administer” means the direct application of a drug or device whether by injection, inhalation, ingestion, or any other means, to the body of a patient or research subject by:
689.015 “Practice of pharmacy” defined. The “practice of pharmacy” means the interpretation and evaluation of prescription orders; the compounding, dispensing, labeling of drugs and devices (except labeling by a manufacturer, packer or distributor of nonprescription drugs and commercially packaged legend drugs and devices); the administering of vaccines and immunizations pursuant to ORS 689.645; the administering of drugs and devices to the extent permitted under ORS 689.655; the participation in drug selection and drug utilization reviews; the proper and safe storage of drugs and devices and the maintenance of proper records therefor; the responsibility for advising, where necessary or where regulated, of therapeutic values, content, hazards and use of drugs and devices; the monitoring of therapeutic response or adverse effect to drug therapy; and the offering or performing of those acts, services, operations or transactions necessary in the conduct, operation, management and control of pharmacy. [1979 c.777 §4; 1999 c.350 §3] 689.035 Short title. This chapter shall be known as the “Oregon Pharmacy Act.” [1979 c.777 §1; 1985 c.565 §96]
OREGON REGULATIONS Chapter 855 - Board of Pharmacy Division 41 - Operation Of Pharmacies (Retail And Institutional Drug Outlets) Consulting Pharmacists And Operation Of Drug Rooms The Oregon Administrative Rules contain OARs filed through July 15, 2002
855-041-0400 Collaborative Drug Therapy Management (1) A pharmacist shall engage in collaborative drug therapy management only under a written protocol that includes;
(2) Collaborative drug therapy management is valid only when initiated upon the prescription order of a participating practitioner for each individual patient. (3) Nothing in this rule shall be construed to allow therapeutic substitution. (4) The collaborative drug therapy protocol must be kept on file in the pharmacy and made available to the Board of Pharmacy and to the Board of Medical Examiners upon request. Stat. Auth.: ORS 689.205 Stats. Implemented: 689.005(30) Hist.: f. & ef. 08-12-1998, f. & ef. 02-16-2000
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