First Regular Session
Sixty-second General Assembly
LLS NO. 99-0380.01 Pam Cybyske SENATE BILL 99-082
STATE OF COLORADO
BY SENATOR Lacy;
also REPRESENTATIVE Dean.
HEALTH, ENVIRONMENT, WELFARE & INSTITUTIONS
A BILL FOR AN ACT
101 CONCERNING COLLABORATIVE DRUG THERAPY MANAGEMENT
102 AGREEMENTS BETWEEN PHYSICIANS AND PHARMACISTS IN
103 LONG-TERM CARE SETTINGS.
Bill Summary
(Note: This summary applies to this bill as introduced and does
not necessarily reflect any amendments that may be subsequently
adopted.)
Allows physicians and pharmacists to enter into collaborative drug
therapy management agreements ("agreement") to manage drug therapy
for patients in long-term care settings.
Establishes terms and conditions that are required to be present in
each agreement. The agreement is required to:
Be signed by all parties to the agreement;
Establish the scope of activities that the pharmacist may
perform;
Clearly define limitations on the pharmacist's activities;
Outline documentation procedures required by the
pharmacist;
Disclose the existence of any financial arrangement
between the physician and pharmacist for the activities
specified in the agreement;
Prohibit a pharmacist from employing a physician for the
purpose of establishing collaborative agreements;
Contain a provision allowing for the immediate termination
of the agreement by either the physician or the pharmacist;
Establish requirements for the physician's examination of
the patient before and during the term of the agreement;
and
Be reviewed and renewed at least annually.
[ ] denotes HOUSE amendment. { } denotes SENATE amendment.
Capital letters indicate new material to be added to existing statute.
Dashes through the words indicate material to be deleted from existing statute.
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Clarifies that a pharmacist does not need a license to practice
medicine to enter into an agreement.
1 Be it enacted by the General Assembly of the State of Colorado:
2 SECTION 1. Part 1 of article 22 of title 12, Colorado Revised
3 Statutes, is amended BY THE ADDITION OF A NEW SECTION to
4 read:
5 12-22-131. Collaborative drug therapy management
6 agreements. (1) AS USED IN THIS SECTION, UNLESS THE CONTEXT
7 OTHERWISE REQUIRES:
8 (a) "COLLABORATIVE DRUG THERAPY MANAGEMENT AGREEMENT"
9 MEANS A VOLUNTARY WRITTEN AGREEMENT BETWEEN A PHYSICIAN OR
10 GROUP OF PHYSICIANS AND A PHARMACIST OR GROUP OF PHARMACISTS
11 THAT PERMITS A PHARMACIST OR GROUP OF PHARMACISTS TO MANAGE
12 DRUG THERAPY FOR PATIENTS IN LONG-TERM CARE SETTINGS.
13 (b) "HOSPICE PATIENTS" MEANS INDIVIDUALS WHO ARE RECEIVING
14 HOSPICE CARE FROM AN ENTITY LICENSED AND REGULATED BY THE
15 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT PURSUANT TO
16 SECTIONS 25-1-107 (1) (l) (I) AND 25-3-101, C.R.S.
17 (c) "LONG-TERM CARE FACILITY" MEANS A FACILITY THAT IS
18 LICENSED AND REGULATED AS A SKILLED NURSING FACILITY OR NURSING
19 CARE FACILITY BY THE DEPARTMENT OF PUBLIC HEALTH AND
20 ENVIRONMENT PURSUANT TO SECTIONS 25-1-107 (1) (l) (I) AND 25-3-101,
21 C.R.S.
22 (2) A COLLABORATIVE DRUG THERAPY MANAGEMENT AGREEMENT
23 ENTERED INTO IN THIS STATE SHALL:
24 (a) BE SIGNED BY ALL COLLABORATING PHYSICIANS AND
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1 PHARMACISTS OR THE GROUP REPRESENTATIVES OF SUCH PHYSICIANS OR
2 PHARMACISTS WHO ENTER INTO THE AGREEMENT;
3 (b) SPECIFY THE TERMS AND CONDITIONS FOR THE COLLABORATIVE
4 DRUG THERAPY MANAGEMENT BETWEEN THE COLLABORATING PHYSICIAN
5 AND THE PHARMACIST. SUCH TERMS AND CONDITIONS SHALL INCLUDE,
6 BUT SHALL NOT BE LIMITED TO, THE FOLLOWING:
7 (I) A WRITTEN STATEMENT BY THE COLLABORATING PHYSICIAN
8 SPECIFYING THE SCOPE OF THE ACTIVITIES THE PHARMACIST MAY PERFORM
9 PURSUANT TO THE COLLABORATIVE AGREEMENT;
10 (II) LIMITS ON THE ACTIVITIES OF THE PHARMACIST SHALL BE
11 STATED AND CLEARLY DEFINED AND SHALL REQUIRE THAT THE
12 PHARMACIST NOT EXCEED SUCH LIMITS WITHOUT THE EXPRESS
13 AUTHORIZATION OF THE COLLABORATING PHYSICIAN;
14 (III) PROCEDURES FOR DOCUMENTATION BY THE PHARMACIST OF
15 SUCH PHARMACIST'S ACTIVITIES IN THE MANAGEMENT OF THE DRUG
16 THERAPY;
17 (IV) REQUIREMENTS FOR THE COLLABORATING PHYSICIAN'S
18 EXAMINATION AND ASSESSMENT OF THE PATIENT BEFORE AND DURING THE
19 COLLABORATIVE DRUG THERAPY MANAGEMENT;
20 (V) A PROVISION FOR REVIEW AND RENEWAL OF THE AGREEMENT
21 TO BE PERFORMED AT LEAST ANNUALLY;
22 (VI) A PROVISION ALLOWING FOR THE IMMEDIATE TERMINATION
23 OF THE AGREEMENT BY THE COLLABORATING PHYSICIAN OR PHARMACIST;
24 AND
25 (VII) OTHER APPROPRIATE PROCEDURES, PROTOCOLS, AND SUCH
26 OTHER TERMS AS MAY BE ESTABLISHED BY RULES PROMULGATED BY THE
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1 BOARD.
2 (c) DISCLOSE THE EXISTENCE OF ANY FINANCIAL ARRANGEMENT
3 BETWEEN THE COLLABORATING PHYSICIAN AND PHARMACIST FOR THE
4 ACTIVITIES SPECIFIED IN THE AGREEMENT.
5 (3) THE PARTICIPATING PHARMACIST SHALL NOT EMPLOY
6 PHYSICIANS FOR THE PURPOSE OF ESTABLISHING COLLABORATIVE DRUG
7 MANAGEMENT AGREEMENTS.
8 (4) COLLABORATIVE DRUG THERAPY MANAGEMENT AGREEMENTS
9 SUBJECT TO THE REQUIREMENTS OF THIS SECTION SHALL ONLY BE FOR THE
10 PROVISION OF DRUG THERAPY IN LONG-TERM CARE SETTINGS WHERE THE
11 PATIENT IS UNDER THE DIRECT CARE OF A PHYSICIAN. LONG-TERM CARE
12 SETTINGS INCLUDE FACILITIES WHERE PATIENTS ARE UNDER LONG-TERM
13 CARE OR ARE HOSPICE PATIENTS.
14 (5) THE PROVISION AND PERFORMANCE OF DRUG THERAPY
15 MANAGEMENT DUTIES UNDER AN AGREEMENT SHALL BE IN ACCORDANCE
16 WITH POLICIES, PROCEDURES, OR PROTOCOLS OF ANY FACILITY WHERE
17 SUCH AGREEMENTS ARE TO BE PERFORMED.
18 SECTION 2. 12-22-122 (1), Colorado Revised Statutes, is
19 amended to read:
20 12-22-122. Prescription required - exception. (1) Except as
21 provided in section SECTIONS 12-22-131 AND 18-18-414, C.R.S., and
22 subsection (2) of this section, an order is required prior to dispensing any
23 prescription drug. Orders shall be readily retrievable within the
24 appropriate statute of limitations.
25 SECTION 3. 12-36-106 (3), Colorado Revised Statutes, is
26 amended BY THE ADDITION OF A NEW PARAGRAPH to read:
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1 12-36-106. Practice of medicine defined - exemptions from
2 licensing requirements - repeal. (3) Nothing in this section shall be
3 construed to prohibit, or to require a license under this article with respect
4 to, any of the following acts:
5 (v) THE RENDERING OF COLLABORATIVE DRUG THERAPY
6 MANAGEMENT FOR PATIENTS IN LONG-TERM CARE SETTINGS BY
7 PHARMACISTS PURSUANT TO SECTION 12-22-131.
8 SECTION 4. Part 1 of article 36 of title 12, Colorado Revised
9 Statutes, is amended BY THE ADDITION OF A NEW SECTION to
10 read:
11 12-36-106.4. Collaborative drug therapy management
12 agreements with pharmacists. A PHYSICIAN LICENSED TO PRACTICE
13 MEDICINE IN COLORADO ACCORDING TO THIS ARTICLE MAY ENTER INTO
14 COLLABORATIVE DRUG THERAPY MANAGEMENT AGREEMENTS FOR
15 PATIENTS IN LONG-TERM CARE FACILITIES PURSUANT TO SECTION
16 12-22-131.
17 SECTION 5. Effective date - applicability. (1) This act shall
18 take effect September 1, 1999, unless a referendum petition is filed during
19 the ninety-day period after final adjournment of the general assembly that
20 is allowed for submitting a referendum petition pursuant to article V,
21 section 1 (3) of the state constitution. If such a referendum petition is
22 filed against this act or an item, section, or part of this act within such
23 period, then the act, item, section, or part, if approved by the people, shall
24 take effect on the date of the official declaration of the vote thereon by
25 proclamation of the governor.
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1 (2) The provisions of this act shall apply to collaborative drug
2 therapy management agreements executed on or after the|~ applicable
|~ 3 effective date of this act.