By: Frank H.B. No. 4051       A BILL TO BE ENTITLED   AN ACT   relating to the authority of certain healthcare providers to order   and provide or dispense limited prescription drugs.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 483.001(11), Health and Safety Code, is   amended to read as follows:                (11)  "Practice of pharmacy" has the meaning assigned   by Section 551.003, Occupations Code [means:                      [(A)  provision of those acts or services   necessary to provide pharmaceutical care;                      [(B)  interpretation and evaluation of   prescription drug orders or medication orders;                      [(C)  participation in drug and device selection   as authorized by law, drug administration, drug regimen review, or   drug or drug-related research;                      [(D)  provision of patient counseling;                      [(E)  responsibility for:                            [(i)  dispensing of prescription drug orders   or distribution of medication orders in the patient's best   interest;                            [(ii)  compounding and labeling of drugs and   devices, except labeling by a manufacturer, repackager, or   distributor of nonprescription drugs and commercially packaged   prescription drugs and devices;                            [(iii)  proper and safe storage of drugs and   devices; or                            [(iv)  maintenance of proper records for   drugs and devices.  In this subdivision, "device" has the meaning   assigned by Subtitle J, Title 3, Occupations Code; or                      [(F)  performance of a specific act of drug   therapy management for a patient delegated to a pharmacist by a   written protocol from a physician licensed by the state under   Subtitle B, Title 3, Occupations Code].          SECTION 2.  Section 151.002, Occupations Code, is amended by   adding Subdivisions (3-a) and (13-a) to read as follows:                (3-a)  "Dispense" has the meaning assigned by Section   551.003.                (13-a)  "Provision" means the supply of one or more   unit doses of a drug, medicine, or dangerous drug.          SECTION 3.  The heading to Section 157.002, Occupations   Code, is amended to read as follows:          Sec. 157.002.  GENERAL DELEGATION OF ADMINISTRATION, [AND]   PROVISION, AND DISPENSING OF DANGEROUS DRUGS.          SECTION 4.  Sections 157.002(a), (b), (e), and (g),   Occupations Code, are amended to read as follows:          (a)  In this section, "administering" [:                [(1)  "Administering"] means the direct application of   a drug to the body of a patient by injection, inhalation, ingestion,   or any other means.                [(2)  "Provision" means the supply of one or more unit   doses of a drug, medicine, or dangerous drug.]          (b)  A physician may delegate to any qualified and properly   trained person acting under the physician's supervision the act of   administering [or providing] dangerous drugs in the physician's   office, as ordered by the physician, that are used or required to   meet the immediate needs of the physician's patients or the act of   providing or dispensing dangerous drugs as ordered by the physician   to the physician's patients.  The administration, [or] provision,   or dispensing of the dangerous drugs must be performed in   compliance with laws relating to the practice of medicine and state   and federal laws relating to those dangerous drugs.          (e)  The administration, [or] provision, or dispensing of   the drugs may be delegated through a physician's order, a standing   medical order, a standing delegation order, or another order   defined by the board.          (g)  A drug or medicine provided or dispensed under   Subsection (b) or (c) must be:          (1)  supplied in a child-resistant container unless the   patient request it not be in a child-resistant container or the   product is exempt from requirements of the Poison Prevention   Packaging Act of 1970;          (2)  dispensed in a container with a label on the container   that contains the name of the drug, the date the prescription is   dispensed, the name of the prescribing practitioner, the quantity   dispensed, dosage and route of administration, date after which the   prescription should not be used or beyond-use-date, and appropriate   ancillary instructions such as storage instructions or cautionary   statements printed in an easily readable font size;          (3)  stored prior to dispensing in a location with a   temperature range compatible with the proper storage of each drug,   including refrigeration where required, and secured against theft   or diversion of prescription drugs and locked to prohibit   unauthorized access when the physician is not on-site; and          (4)  dispensed with written consumer information or written   directions to obtain written information online that provides the   therapeutic use of the drug and the names of generically equivalent   drugs.          (h)  A physician dispensing a drug under this subchapter   must:          (1)  complete a drug utilization review prior to dispensing   for therapeutic duplication, drug-to-disease contraindications,   drug-to-drug interactions, correct dosage, and drug-to-allergy   interactions;          (2)  maintain records of dispensed medications including   patient information, prescription details and dispensing   information including the dispensing physicians name and office   address where drugs were dispensed from;          (3)  counsel the patient on proper use of a prescription drug   or device; and          (4)  perform a final check on all prescriptions filled onsite   for the accuracy and completeness of the prescription.          [supplied in a suitable container labeled in compliance with   applicable drug laws.  A qualified and trained person, acting under   the supervision of a physician, may specify at the time of the   provision or dispensing of the drug the inclusion on the container   of the date of the provision or dispensing and the patient's name   and address.]          SECTION 5.  The heading to Chapter 158, Occupations Code, is   amended to read as follows:   CHAPTER 158.  AUTHORITY OF PHYSICIAN TO PROVIDE OR DISPENSE CERTAIN   DRUGS AND SUPPLIES          SECTION 6.  Sections 158.001(a) and (c), Occupations Code,   are amended to read as follows:          (a)  A physician licensed under this subtitle may provide   [supply] a patient with any drug, remedy, or clinical supply   necessary to meet the patient's immediate needs.          (c)  This chapter does not prohibit a physician from   providing [supplying] to a patient, free of charge, a drug provided   to the physician by a drug manufacturer for an indigent   pharmaceutical program if, in the physician's opinion, it is   advantageous to the patient, in adhering to a course of treatment   prescribed by the physician, to receive the drug.          SECTION 7.  Section 158.002(a), Occupations Code, is amended   to read as follows:          (a)  This chapter does not prohibit a physician from   providing [supplying] a pharmaceutical sample to a patient free of   charge if, in the physician's opinion, it is advantageous to the   patient, in adhering to a course of treatment prescribed by the   physician, to receive the sample.          SECTION 8.  The heading to Section 158.003, Occupations   Code, is amended to read as follows:          Sec. 158.003.  DISPENSING OF DANGEROUS DRUGS TO CERTAIN   PATIENTS IN CERTAIN RURAL AREAS.          SECTION 9.  Section 158.003, Occupations Code, is amended by   adding Subsection (a-1) to read as follows:          (a-1)  This section applies only to a physician providing   care under workers' compensation insurance coverage, as defined by   Section 401.011, Labor Code.          SECTION 10.  Chapter 158, Occupations Code, is amended by   adding Section 158.004 to read as follows:          Sec. 158.004.  PROVISION AND DISPENSING OF DANGEROUS DRUGS.     (a)  In this section, "reimbursement for cost" means an additional   charge, separate from that imposed for the physician's professional   services, that includes the cost of a drug product and all other   actual costs to the physician incidental to providing dispensing   service.  The term does not include a separate fee imposed for the   act of dispensing a drug itself.          (b)  This section does not apply to a physician providing   care under workers' compensation insurance coverage, as defined by   Section 401.011, Labor Code.          (c)  A physician may:                (1)  provide or dispense dangerous drugs to the   physician's patients; and                (2)  be reimbursed for the cost of providing or   dispensing those drugs without obtaining a license under Chapter   558.          (d)  A physician may not provide or dispense under this   section a controlled substance listed in Schedules II through V as   established under Subchapter B, Chapter 481, Health and Safety   Code.          (e)  A physician who provides or dispenses dangerous drugs   under this section shall oversee compliance with the laws of this   state and federal law relating to those dangerous drugs.          (f)  Before providing or dispensing dangerous drugs under   this section, a physician must notify the patient that the   prescription for the dangerous drug may be filled at a pharmacy.     With respect to dangerous drugs provided or dispensed in a   physician's office, the notification requirement of this   subsection may be satisfied by a written notice placed   conspicuously in the office.          (g)  Not later than the 30th day after the date a physician   first provides or dispenses dangerous drugs under this section, the   physician shall notify the Texas State Board of Pharmacy and the   board that the physician is providing or dispensing dangerous drugs   under this section. The Texas State Board of Pharmacy and the board   shall jointly adopt a form by which a physician may provide   notification as required by this subsection.          (h)  A physician who notifies the board under Subsection (g)   that the physician is providing or dispensing dangerous drugs under   this section and who intends to continue to provide or dispense   dangerous drugs under this section shall include notice of that   intent in any subsequent registration permit renewal application   submitted to the board. The board by rule shall prescribe the form   of a registration permit renewal application in accordance with   this subsection.          SECTION 11.  Section 551.003(31) and (33), Occupations Code,   is amended to read as follows:                (31)  "Pharmacy" means a facility at which a   prescription drug or medication order is received, processed, or   dispensed under this subtitle, Chapter 481 or 483, Health and   Safety Code, or the Comprehensive Drug Abuse Prevention and Control   Act of 1970 (21 U.S.C. Section 801 et seq.). The term does not   include:                      (A)  a narcotic drug treatment program that is   regulated under Chapter 466, Health and Safety Code; or                      (B)  a location where:                            (i)  a physician provides or dispenses a   dangerous drug under Section 158.003 or 158.004; or                            (ii)  a person provides or dispenses a   dangerous drug under a physician's supervision in accordance with   Section 157.002(b).                (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)  administering an immunization or vaccination   under a physician's written protocol; or                      (H)  ordering or furnishing a prescription drug to   treat an acute condition in accordance with Section 562.058.          SECTION 12.  Section 551.004, Occupations Code, is amended   by adding Subsection (a-1) and amending Subsection (b) to read as   follows:          (a-1)  For purposes of Subsection (a)(1), "retailing of   prescription drugs" does not include the collection of a   reimbursement for cost, as defined by Section 158.003(a) or   158.004(a).          (b)  This subtitle does not prevent:                (1)  a practitioner from:                      (A)  administering a drug to a patient of the   practitioner; or                      (B)  providing or dispensing dangerous drugs   under Section 158.003 or 158.004; or                (2)  a person from providing or dispensing a dangerous   drug under a physician's supervision in accordance with Section   157.002(b).          SECTION 13.  Section 558.001, Occupations Code, is amended   by amending Subsection (c) and adding Subsection (d) to read as   follows:          (c)  Except as provided by Subsection (d), a [A] person may   not dispense or distribute prescription drugs unless the person:                (1)  is a pharmacist; or                (2)  is otherwise authorized by this subtitle to   dispense or distribute prescription drugs.          (d)  A physician or person acting under the physician's   supervision may provide or dispense dangerous drugs in accordance   with Section 157.002(b), 158.003, or 158.004.          SECTION 14.  Subchapter B, Chapter 562, Occupations Code, is   amended by adding Section 562.058 to read as follows:          Sec. 562.058.  ORDERING AND FURNISHING CERTAIN PRESCRIPTION   DRUGS.  (a)  In this section:                (1)  "Acute condition" means a condition or disease   that begins abruptly, intensifies rapidly, and is generally not   long-lasting.                (2)  "Waived clinical laboratory test" means a clinical   laboratory test that is classified as waived under federal   regulations issued under the Clinical Laboratory Improvement   Amendments of 1988 (42 U.S.C. Section 263a).          (b)  Notwithstanding any other law, a pharmacist may order   and furnish to a patient a prescription drug to treat an acute   condition that is:          (1)  identified through performance of one of the following   tests, if the test is a waived clinical laboratory test:                (A)  a rapid strep test or rapid antigen detection test   used in the identification of group A streptococcus (GAS);                (B)  a rapid influenza diagnostic test used in the   identification of influenza types A and B; or                (C)  a rapid diagnostic test for SARS-CoV-2 or a   related virus used in the identification of COVID-19 or a related   illness[.]; or          (2)  for treatment of minor, uncomplicated infections,   including lice, skin conditions, such as ringworm and athlete's   foot, and urinary tract infections.          (c)  The board shall adopt rules to permit a pharmacist to   order and furnish a prescription drug under this section to a   patient.          (d)  A pharmacist who orders and furnishes a prescription   drug under this section must provide notice to the patient's   primary care physician, as identified by the patient if the patient   has a primary care physician, not later than the 14th day after the   date the drug is ordered and furnished by the pharmacist.          (e)  The board by rule shall establish requirements to ensure   that a pharmacist possesses the necessary skill and training to   order and furnish prescription drugs under this section.          SECTION 15.  The heading to Chapter 563, Occupations Code,   is amended to read as follows:   CHAPTER 563.  [PRESCRIPTION REQUIREMENTS;] DELEGATION OF   ADMINISTRATION, [AND] PROVISION, AND DISPENSING OF DANGEROUS DRUGS          SECTION 16.  Sections 563.051(a) and (c), Occupations Code,   are amended to read as follows:          (a)  A physician may delegate to any qualified and properly   trained person acting under the physician's supervision the act of   administering [or providing] dangerous drugs in the physician's   office, as ordered by the physician, that are used or required to   meet the immediate needs of the physician's patients or the act of   providing or dispensing dangerous drugs, as ordered by the   physician, to the physician's patients.  The administration, [or]   provision, or dispensing of the dangerous drugs must be performed   in compliance with laws relating to the practice of medicine and   state and federal laws relating to those dangerous drugs.          (c)  The administration, [or] provision, or dispensing of   the drugs may be delegated through a physician's order, a standing   medical order, a standing delegation order, or another order   defined by the Texas Medical [State] Board [of Medical Examiners].          SECTION 17.  Section 563.052, Occupations Code, is amended   to read as follows:          Sec. 563.052.  SUITABLE CONTAINER REQUIRED.  A drug or   medicine provided or dispensed under this subchapter must be   provided or dispensed [supplied] in a suitable container labeled in   compliance with applicable drug laws.  A qualified and trained   person, acting under the supervision of a physician, may specify at   the time of the provision or dispensing of the drug the inclusion on   the container of the date of the provision or dispensing and the   patient's name and address.          SECTION 18.  The heading to Section 563.053, Occupations   Code, is amended to read as follows:          Sec. 563.053.  DISPENSING OF DANGEROUS DRUGS TO CERTAIN   PATIENTS IN CERTAIN RURAL AREAS.          SECTION 19.  Section 563.053, Occupations Code, is amended   by adding Subsection (a-1) to read as follows:          (a-1)  This section applies only to a physician providing   care under workers' compensation insurance coverage, as defined by   Section 401.011, Labor Code.          SECTION 20.  The heading to Subchapter B, Chapter 563,   Occupations Code, is repealed.          SECTION 21.  Not later than January 1, 2026, the Texas State   Board of Pharmacy shall adopt the rules required under Section   562.058, Occupations Code, as added by this Act.          SECTION 22.  Not later than January 1, 2026, the Texas   Medical Board shall adopt the rules required under Section 558.001,   Occupations Code, as added by this Act.          SECTION 23.  This Act takes effect September 1, 2025.