A Message from the Legislative Chair
Steph Luon, PharmD, BCACP, BCPS
It has been a monumental year for legislative changes to advance health system pharmacy practice in the state of Connecticut! This newsletter has previously shared the new legislation that went into effect on July 1st: SB 186 An Act Concerning Collaborative Drug Therapy Management Agreements and Policies. The changes enhance patient care as they enable pharmacists to engage in collaborative practice agreements (CPAs) with clinicians or groups of clinicians to manage populations of patients. It grants caregiving institutions authority to outline policies for how pharmacists and clinicians engage in CPAs and removes the requirement for each patient to be individually referred by a clinician.
Passage of this law eliminates the requirement that each clinician and pharmacist must sign a new agreement and a new referral order for each patient every time a change is made to medications included within the agreement. This adjustment enables pharmacists to provide care for more patients through a population-based approach to care and enables an oversight group or supervisor to sign on behalf of all clinicians and pharmacists within their span. With this change, pharmacists can now utilize their advanced training and medication expertise to enhance safety by supporting medication refills, proactively targeting patients with elevated A1Cs, supporting patients’ hyperglycemia management after organ transplantation, and providing additional timely support to patients navigating challenges in chemotherapy induced nausea and vomiting to name a few. As pharmacists are able to provide care to more patients, this improves quality of patient care, helps reduce hospital readmissions, reduces cost of care for patients and health systems, and enhances patient safety as they have more support and guidance to manage their healthcare journeys.
Within the image below (accessible at https://NASPA.us/resource/swp/), on the spectrum of advancement of pharmacist practice, before July 1, 2022, pharmacists from CT were in the most restrictive practice box. This made it more challenging for us to support patient care needs and to recruit highly qualified pharmacists to come to CT. With this new legislation, pharmacists prescribing is now permitted through population-specific CPAs.
The need for these advances is why I got involved in advocacy through CSHP. Now that they have gone into effect, and after 3 years as legislative chair, I am stepping down from this role.
What do you wish you could change about pharmacy practice? Do you want to lead our state towards more autonomous prescribing or improved reimbursement for pharmacy services, a tech check tech model, or to prohibit site of care restrictions?
If you or anyone you know are interested in leading the legislative committee as chair or co-chair, please reach out to email@example.com.
CSHP Legislative Update – March 2021
Submitted by Steph Luon, PharmD, and Cory Heck PharmD
We want to say THANK YOU to the members who provided oral testimony, submitted written testimony, and or spoke to your colleagues in support of RB 895 An Act Concerning Changes to Various Pharmacy Statutes. To review the testimony submitted for raised bill 895 click here. Each of you provided thoughtful examples to help legislators understand why this is so important to streamline our practice and enable us to care for even more patients. During the public hearing, no one spoke against this Bill, so we are hopeful it will be reviewed favorably by the house and senate and signed by the governor into law.
This legislative session we are pursuing minor modifications to facilitate practice within CDTM agreements. We are collaborating with the Connecticut Pharmacists Association, the Department of Consumer Protection and others on advancing pharmacy practice within CT. Recently, we met with leadership from the two major health systems in Connecticut to begin discussions surrounding the further advancement of pharmacy practice and work that needs to be done before the following legislative cycle. We plan to focus on the transition from patient-specific collaborative practice agreements to population health-based agreements. This would enable pharmacists to contribute to the provision of high quality patient care on a broader level for patients in CT. We also plan to pursue reimbursement strategies in the outpatient settings to make provision of these services more sustainable.
We are seeking members to join CSHP's Legislative Committee. We need your assistance! We will provide training; No experience is necessary. As a member of this committee, you have the opportunity to be involved in:
If you are interested in joining out committee and have not already done so, please email Steph.Luon@ynhh.org. We will be holding our first meeting within the next several weeks. We look forward to working with you!
Submitted by Thomas Buckley, RPh, MPH, CSHP Legislative Chair
The impact of the COVID-19 pandemic continues to affect healthcare and virtually every aspect of our lives.
At the time of this writing, the Connecticut General Assembly may be going back into a special session sometime this summer, although it is unclear what type of legislation may be deliberated. There have been multiple considerations of how pharmacy could be impacted and play a more expanded more role during the pandemic, with potential implications of a lasting impact after the pandemic period. The Governor’s office and the various health agencies have been contacted by numerous entities within and outside of the state, with potential pharmacy public health roles at both the local and state level. ASHP has created a document with a sample list of these roles that can be accessed here.
On April 8, 2020 the U.S. Department of Health and Human Services released a guidance that licensed pharmacists are authorized to order and administer FDA-approved COVID-19 tests, including serology tests. The guidance adds pharmacists as “covered persons” under the Public Readiness and Emergency Preparedness (PREP) Act, and frees them from liability “with respect to all claims for loss caused by, arising out of, relating to, or resulting from, the administration or use of FDA-authorized COVID-19 tests.” The guidance, issued by the Office of the Assistant Secretary for Health (OASH), states that pharmacists, “in partnership with other health care providers, are well-positioned to aid COVID-19 testing expansion.” OASH, which has jurisdiction to categorize professionals as “covered persons” under the PREP Act, highlights pharmacists’ established and trusting relationships with patients, connection to and ability to make referrals to medical providers and hospitals, and accessibility.
OASH’s April 8 guidance specifies that authority is granted to “licensed pharmacists,” and is therefore not expected to preempt state scope of practice laws. Point-of-care testing for COVID-19 is critical to the national pandemic response. Some states already permitted pharmacists, under their scope of practice or through collaborative practice agreements, to order and administer these tests. Pennsylvania, which previously allowed pharmacists to order and administer tests, has taken emergency measures to grant pharmacists explicit authority to order and administer COVID-19 tests. States like Florida, Illinois, Kentucky, and, most recently New York, issued executive orders that permit pharmacists to order and administer COVID-19 tests.
Just as this newsletter was going to press, the Connecticut Governor announced this Executive Order: Pharmacists are Permitted to Order and Administer Food and Drug Administration Approved Tests for COVID-19. It specifically that “pharmacists licensed pursuant to Chapter 400j of the Connecticut General Statutes are expressly permitted to order COVID-19 diagnostic tests consistent with Clinical Laboratory Improvement Amendments (CLIA), including serology tests that do not require venipuncture, that the Food and Drug Administration (FDA) has authorized.” Here is a link to the actual Executive Order: https://portal.ct.gov/-/media/Office-of-the-Governor/Executive-Orders/Lamont-Executive-Orders/Executive-Order-No-7KK.pdf?la=en
State-level COVID-19 response is a rapidly changing situation as local healthcare providers respond to patient surges and the demand for testing, so we will try to keep you informed with as much up-to-date information as possible. ASHP also provides an excellent COVID-19 resource center, which includes an “Assessment of Evidence for COVID-19-Related Treatments”, the updated 5/4/2020 version can be found here.
We are excited to have an active legislative advocacy team of Steph Luon, Cory Heck, and Tom Buckley. Please don’t hesitate to contact us with your questions, concerns, and most importantly with your willingness to reach out to our policymakers when needed.
Wed. April 8, 2020, the HHS issued new guidance under the Public Readiness and Emergency Preparedness Act authorizing licensed pharmacists to order and administer COVID-19 tests that the U.S. Food and Drug Administration has authorized.
HHS Secretary Alex Azar issued the following statement: "Giving pharmacists the authorization to order and administer COVID-19 tests to their patients means easier access to testing for Americans who need it. Pharmacists play a vital role in delivering convenient access to important public health services and information. The Trump Administration is pleased to give pharmacists the chance to play a bigger role in the COVID-19 response, alongside all of America's heroic healthcare workers."
HHS Assistant Secretary for Health Brett P. Giroir, M.D. issued the following statement: "In an effort to expand testing capabilities, we are authorizing licensed pharmacists to order and administer COVID-19 tests to their patients. The accessibility and distribution of retail and independent community-based pharmacies make pharmacists the first point of contact with a healthcare professional for many Americans. This will further expand testing for Americans, particularly our healthcare workers and first responders who are working around the clock to provide care, compassion and safety to others."
Please note per Tom Buckley, CSHP Legislative Chair: This is federal authorization. Connecticut has not yet released anything with regard to procedure, regulation or reimbursement. The Governor announced that CVS will be having 2 drive-through testing sites in CT within a week or so (Stamford and New London). We don't know if pharmacists will be ordering and administering at these sites.
OASH's Guidance for Licensed Pharmacists, COVID-19 Testing, and Immunity under the PREP Act is available here - PDF.
FDA's Emergency Use Authorizations for diagnostic and therapeutic medical devices to diagnose and respond to public health emergencies is available here.
Priorities for testing patients with suspected COVID-19 infection are available here - PDF.
CSHP's Legislative Committee reports that the Dept of Consumer Protection released new modifications to some regulations today. One of them is the change in pharmacist/tech ratios in "Institution outpatient, inpatient and satellite pharmacies". Please see the attached announcement
At the time of this writing, it looks like all remaining public hearings for this session will be canceled; however, written testimony can still be submitted for any bill in a committee that is still actively reviewing bills. This includes the Public Health Committee, and CSHP has been working with that committee to see if our revised language changes for the collaborative practice law could be included in a bill that involves clinical practice changes for other health professionals.
In addition to that advocacy effort, we have been responding to a great deal of legislation that has an impact on our profession. You can find the talking points document that was prepared in collaboration with our Pharmacy Day partners at this link. This has been a particularly active short session for healthcare-related bills, and we have both given our support and opposition to a number of raised bills. These include support of the vaccine religious exemption bill, support of a diabetes bill for the affordability of insulin, and opposition to a drug importation bill.
Finally, we have reached out to our state legislators with potential ways that CSHP and our professionals can assist with the coronavirus crisis. We gave them this document from ASHP that details policy recommendations to state lawmakers how pharmacists can effectively support prevention and response efforts for outbreaks such as the COVID-19. These include actions that relate to our collaborative practice law changes, such as ensuring that pharmacists are authorized under our state pharmacy practice act to order point-of-care testing for infectious diseases, and can initiate time-sensitive therapies, such as antivirals. This also includes ensuring that pharmacists are reimbursed for direct patient care services related to the prevention and treatment of infectious diseases, which could be extremely impactful for future reimbursement advocacy efforts.
The 2020 Connecticut legislative session is a “short” session, meaning it is only active from February 5th to May 6th. During these short, non-budget sessions, it is challenging to introduce new legislation, especially if it incurs any impact to the state budget. The state operates a two-year budget, which is deliberated during the “long” session or odd years. There is opportunity to modify current legislation or even introduce new legislation which would not impact the budget. We are currently discussing potential legislative opportunities to modify and update the current collaborative practice and immunization administration laws, and possibly re-visit tobacco cessation legislation. We, of course, will also be actively monitoring any proposed legislation that affects pharmacy practice. Finally, we are also building the framework to discuss introducing legislation next year focusing on reimbursement for pharmacist services. This will indeed be an exciting time to be involved in transforming your profession. Advocacy begins from the ground up – which means it starts with you!
We look forward to your participation.
Thomas Buckley, CSHP Legislative Chair
Submitted by Thomas Buckley, RPH, MPH; CSHP Legislative Chair
The 2019 Connecticut General Assembly came to a close in early June, and finished with a flurry of bills passed that affects pharmacy practice. In addition to monitoring over 3000 bills introduced in this session, CSHP raised and coordinated the effort for 2 specific bills. Both of these bills had numerous live and written testimony in support of passage from CSHP members, and we can be very proud of our efforts to raise the awareness of pharmacy practice in legislators’ minds.
Our bill to permit pharmacists to prescribe tobacco cessation therapy was raised and received a public hearing, but it ran out of time on the legislative calendar to come to a vote in the public health committee. However, our bill to expand collaborative drug therapy management to include APRNs, in addition to physicians, did pass and will become effective October 1, 2019 (Senate Bill 921). The language to expand collaborative practice was included in the overall APRN bill that affects their scope of practice, as Section 22 of SB 921. The impact of granting APRNs authority to collaborate with pharmacists through protocols will be reflected primarily in ambulatory care clinic settings, where APRNs are having an increasing role in primary care. This bill should result in significantly more protocol-driven medication management by pharmacists in various settings around the state.
Of the many legislators who supported this bill, these legislators should be thanked for their efforts – please make an effort to email or call them to thank them for their support of pharmacy practice:
Senator Mary Abrams: http://www.senatedems.ct.gov/abrams-contact
Rep. Chris Perone: Chris.Perone@cga.ct.gov
Rep. Jonathan Steinberg: Jonathan.Steinberg@cga.ct.gov
Rep. William Petit: https://www.cthousegop.com/Petit/
Rep. Vincent Candelora: https://www.cthousegop.com/Candelora/
Note: The flu vaccine bill to administer to age 12+ did not pass. If you've questions, please contact Tom Buckley. Thomas.firstname.lastname@example.org
submitted by Thomas Buckley, CSHP Legislative Chair
With one month to go in the Connecticut legislative session, there are a number of bills that we are following and are close to being at the end of their journeys. SB 921, the APRN scope of practice bill that includes allowing pharmacists to collaborate with APRNs (in addition to physicians) in the current collaborative practice (CDTM) law, has passed the Senate and is awaiting action in the House. You can help assure this bill is passed by calling or emailing your State House member and urge them to pass it in the House chamber. Here is the link to the legislation, which includes the history of the bill and the bill language. The pharmacist/APRN collaborative practice language in this bill is Section 22. https://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&which_year=2019&bill_num=921
HB 6543, the bill allowing pharmacists to prescribe tobacco cessation products, received a public hearing in the Public Health Committee. Despite outstanding oral testimony and presence at the hearing by our members, and numerous written testimonies submitted, due to the Public Health Committee’s full agenda, the bill failed to make it out of committee, and we will advocate for prescriptive authority next year.
Two other bills we are following are ready to be voted on in the Senate. SB 94 allows pharmacists to administer influenza vaccine to children ages 12-17, with the consent of their parent or guardian. SB 48 requires brand name drug manufacturers to make available samples to generic drug manufacturers so they can conduct testing required to support an application for generic drug approval.
The effort to legalize recreational marijuana is comprised of multiple bills in various committees. We continue to monitor this activity and its potential impact on current medical marijuana pharmacist dispensaries. As of early May, three legislative committees have passed companion bills that would legalize, regulate and tax cannabis for use in ages 21 and older. There is still a great deal of policy details that needs to be worked on, and it’s unclear if full passage would occur before the end of the regular session. The legislative session ends on June 5, and we will be continually apprised of legislative updates.
CSHP has become a member of Patient Access to Pharmacists’ Care Coalition (PAPCC), a coalition spearheaded by ASHP that is working to obtain nationwide provider status for pharmacists in the Medicare program. For information about PAPCC, go to http://pharmacistscare.org To see who are current members of the coalition (more being added each day), go to http://pharmacistscare.org/about-papcc/
Since 1948, the Connecticut Society of Health-System Pharmacists has represented the professional interests and provided professional development for CT pharmacists, educators and pharmacists in training.
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