88R654 KKR-F     By: Flores S.B. No. 749       A BILL TO BE ENTITLED   AN ACT   relating to the administration of a medication and the ordering and   administration of an immunization or vaccination by a pharmacist.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 551.003(33), Occupations Code, is   amended to read as follows:                (33)  "Practice of pharmacy" means:                      (A)  providing an act or service necessary to   provide pharmaceutical care;                      (B)  interpreting or evaluating a prescription   drug order or medication order;                      (C)  participating in drug or device selection as   authorized by law, and participating in drug administration, drug   regimen review, or drug or drug-related research;                      (D)  providing patient counseling;                      (E)  being responsible for:                            (i)  dispensing a prescription drug order or   distributing a medication order;                            (ii)  compounding or labeling a drug or   device, other than labeling by a manufacturer, repackager, or   distributor of a nonprescription drug or commercially packaged   prescription drug or device;                            (iii)  properly and safely storing a drug or   device; or                            (iv)  maintaining proper records for a drug   or device;                      (F)  performing for a patient a specific act of   drug therapy management delegated to a pharmacist by a written   protocol from a physician licensed in this state in compliance with   Subtitle B; [or]                      (G)  subject to Section 554.052(c-1), ordering or   administering an immunization or vaccination to a patient who is at   least three years of age; or                      (H)  if the patient is younger than three years of   age and is referred to a pharmacist by a physician, administering an   immunization or vaccination to a patient under a physician's   written protocol.          SECTION 2.  The heading to Section 554.004, Occupations   Code, is amended to read as follows:          Sec. 554.004.  ADMINISTRATION OF MEDICATION; ORDERING AND   ADMINISTRATION OF IMMUNIZATION OR VACCINATION.          SECTION 3.  Section 554.004(a), Occupations Code, is amended   to read as follows:          (a)  The board shall specify conditions under which a   pharmacist may administer medication and order or administer [,   including] an immunization or [and] vaccination. The conditions   for ordering or administering an immunization or vaccination must   ensure that:                (1)  [a licensed health care provider authorized to   administer the medication is not reasonably available to administer   the medication;                [(2)  failure to administer the medication, other than   an immunization or vaccination, might result in a significant delay   or interruption of a critical phase of drug therapy;                [(3)]  the pharmacist possesses the necessary skill,   education, and certification as specified by the board to order or    administer the immunization or vaccination [medication];                (2) [(4)]  within a reasonable time after   administering an immunization or vaccination that is prescribed by   a licensed health care provider [medication], the pharmacist   notifies the licensed health care provider responsible for the   patient's care that the immunization or vaccination [medication]   was administered;                [(5)  the pharmacist may not administer medication to a   patient at the patient's residence, except at a licensed nursing   home or hospital;                [(6)  the pharmacist administers an immunization or   vaccination under a physician's written protocol and meets the   standards established by the board;] and                (3) [(7)]  the authority of a pharmacist to administer   an immunization or vaccination [medication] may [not] be delegated   to a certified pharmacy technician.          SECTION 4.  Sections 554.052(a), (b), (c), and (c-1),   Occupations Code, are amended to read as follows:          (a)  The board by rule shall require a pharmacist to notify a   physician who prescribes an immunization or vaccination not later   than the 14th day [within 24 hours] after the date the pharmacist   administers the immunization or vaccination.          (b)  The board shall establish minimum education and   continuing education standards for a pharmacist who orders or   administers an immunization or vaccination. The standards must   include federal Centers for Disease Control and Prevention   training, basic life support training, and hands-on training in   techniques for administering immunizations and vaccinations.          (c)  Supervision by a physician is adequate if the delegating   physician:                (1)  is responsible for formulating or approving an   order or protocol, including the physician's order, standing   medical order, or standing delegation order, and periodically   reviews the order or protocol and the services provided to a patient   under the order or protocol;                (2)  [except as provided by Subsection (c-1),] has   established a physician-patient relationship with each patient who   is younger than three [under 14] years of age and referred the   patient to the pharmacist;                (3)  is geographically located to be easily accessible   to the pharmacy where an immunization or vaccination is   administered;                (4)  receives, as appropriate, a periodic status report   on the patient, including any problem or complication encountered;   and                (5)  is available through direct telecommunication for   consultation, assistance, and direction.          (c-1)  A pharmacist may order or administer an immunization   or [influenza] vaccination to a patient who is at least three [over   seven] years of age without an established physician-patient   relationship if the immunization or vaccination is:                (1)  authorized or approved by the United States Food   and Drug Administration or listed in the routine immunization   schedule recommended by the federal Advisory Committee on   Immunization Practices published by the federal Centers for Disease   Control and Prevention; and                (2)  ordered or administered in accordance with the   federal Advisory Committee on Immunization Practices   vaccine-specific recommendations.          SECTION 5.  This Act takes effect September 1, 2023.