House Amendment 1
H 3988 - Session 125 (2023-2024)
Pharmacists and pharmacy technicians

The Committee on Medical, Military, Public and Municipal Affairs proposes the following amendment (LC-3988.WAB0002H):

Amend the bill, as and if amended, SECTION 1, by striking Section 40-43-30(73)(e) and (f) and inserting:

   (e) initiation, ordering, and administration of flu and COVID tests. Pharmacists may delegate the task of administering tests provided for in this subsection to a trained pharmacy technician or pharmacy intern, but the pharmacist must perform any interpretation of the results;
   (f) reporting of a person's flu or COVID test results and the referral of that patient for follow up care to the healthcare provider identified by the patient or if none is identified, to an appropriate health care provider; or

Amend the bill further, by adding an appropriately numbered SECTION to read:

SECTION X. Section 40-43-40(A) and (B) of the S.C. Code is amended to read:

 Section 40-43-40. (A) There is created the State Board of Pharmacy to be composed of nineten members, appointed by the Governor with advice and consent of the Senate, one of whom must be a lay member from the State at large, one of whom must be a state-certified pharmacy technician from the State at-large, one of whom must be a pharmacist from the State at large, and seven of whom must be pharmacists representing each of the seven congressional districts. However, if no hospital pharmacist is selected to represent any of the seven congressional districts, the Governor shall appoint a hospital pharmacist as the pharmacist at large.
 (B) The pharmacist at large, the state-certified pharmacy technician, and the lay member shall serve coterminously with the appointing Governor and until their successors are appointed and qualify. The certified pharmacy technician must be actively engaged as a certified pharmacy technician. The board shall conduct an election to nominate three pharmacists from each congressional district to be submitted to the Governor for consideration for appointment. The Governor shall appoint one pharmacist to represent each congressional district from among the nominees submitted for that district. The election shall provide for participation by all pharmacists currently licensed and residing in the congressional district for which the nomination is being made. The pharmacists must be residents of the congressional district they represent, licensed, in good standing to practice pharmacy in this State, and actively engaged in the practice of pharmacy in this State. The members of the board representing the seven congressional districts shall serve terms of six years and until their successors are appointed and qualify. No member may serve more than two successive terms of office except that a member serving an unexpired term may be reelected and reappointed for two successive terms.

Amend the bill further, SECTION 4, by striking Section 40-43-190(B) and (C) and inserting:

 Section 40-43-190. (A)(1) Upon recommendation of the Joint Pharmacist Administered Vaccines Committee, the Board of Medical Examiners shall determine whether a specific vaccine is appropriate for administration by a pharmacist without a written order or prescription of a practitioner pursuant to this section. If a vaccine is approved, the Board of Medical Examiners shall issue a written protocol for the administration of vaccines by pharmacists without an order or prescription of a practitioner.
  (2) The administration of vaccines as authorized in this section must not be to a person under the age of eighteensixteen years; provided, however, that:
   (a) the influenza vaccine may be administered to a person twelve years of age or older pursuant to protocol issued by the Board of Medical Examiners;
   (b) the influenza vaccine may be administered to a person under the age of twelve pursuant to protocol issued by the Board of Medical Examiners upon recommendation of the Joint Pharmacist Administered Vaccines Committee; and
   (c)a pharmacist who has completed the training described in subsection (B)(1) may administer other vaccines approved by the Centers for Disease Control to a person of any age pursuant to a written order or prescription of a practitioner for a specific patient of that practitioner; and
   (d) if the person receiving a vaccine is under the age of eighteen years, a pharmacist must inform the patient and their caregiver of the importance of mental health and routine well care visits with a pediatrician or other licensed primary care provider and refer patients as appropriate.
  (3) The written protocol must further authorize pharmacists to administer without an order or prescription of a practitioner those medications necessary in the treatment of adverse events. These medications must be used only in the treatment of adverse events and must be limited to those delineated within the written protocol.
  (4) The Board of Medical Examiners must issue the written protocol upon its approval of the vaccine for administration pursuant to this section.
  (5) A pharmacist who has completed the training described in subsection (B)(1) may administer a vaccine approved by the Centers for Disease Control pursuant to written order or prescription of a practitioner for a specific patient of that practitioner.




 (B) The written protocol must provide that:
  (1) A pharmacist seeking authorization to administer a vaccine approved pursuant to this section shall successfully complete a course of training accredited by the Accreditation Council for Pharmacy Education or a similar health authority or professional body approved by the Board of Pharmacy and the Board of Medical Examiners. Training must comply with current Centers for Disease Control guidelines and must include study materials, hands-on training, and techniques for administering vaccines and must provide instruction and experiential training in the following content areas:
   (a) mechanisms of action for vaccines, contraindications, drug interactions, and monitoring after vaccine administration;
   (b) standards for adult vaccination practices;
   (c) basic immunology and vaccine protection;
   (d) vaccine-preventable diseases;
   (e) recommended vaccination schedules;
   (f) vaccine storage management;
   (g) biohazard waste disposal and sterile techniques;
   (h) informed consent;
   (i) physiology and techniques for vaccine administration;
   (j) prevaccine and postvaccine assessment and counseling;
   (k) vaccination record management;
   (l) management of adverse events, including identification, appropriate response, emergency procedures, documentation, and reporting;
   (m) understanding of vaccine coverage by federal, state, and local entities;
   (n) needle stick management.
  (2) A pharmacist administering vaccinations without an order or prescription of a practitioner pursuant to this section shall:
   (a) obtain the signed written consent of the person being vaccinated or that person's guardian;
   (b) maintain a copy of the vaccine administration in that person's record and provide a copy to the person or the person's guardian;
   (c) notify that person's designated physician or primary care provider of a vaccine administered;
   (d) report administration of all vaccinations to the South Carolina Immunization Registry in compliance with regulations established by the Department of Health and Environmental Control as the department may require; provided, however, that the phase-in schedule provided in Regulation 61-120 for reporting vaccinations does not apply to vaccinations administered pursuant to this section;
   (e) maintain a current copy of the written protocol at each location at which a vaccination is administered pursuant to this section.
  (3) A pharmacist may not delegate the administration of vaccines to a pharmacy technician or certified pharmacy technician.
  (4) A pharmacy intern or pharmacy technician may administer vaccinations under the direct supervision, as defined in Section 40-43-84(C), of a pharmacist who has completed vaccination training as required by item (1) if the pharmacy intern or pharmacy technician:
   (a) is certified through a basic life support or CPR provider-level course that is jointly approved by the Board of Medical Examiners and the Board of Pharmacy and completes this course of training described in item (1); and
   (b) completes this course of training described in item (1).if a pharmacy technician, the pharmacy technician must be:
    (i) state-certified; or
    (ii) nonstate-certified but administered vaccinations and received training pursuant to the federal Public Readiness and Emergency Preparedness (PREP) Act prior to the effective date of this section and registers with the Board of Pharmacy as an authorized vaccination provider.
  (5) A pharmacist or pharmacy technician administering vaccinations shall, as part of the current continuing education requirements pursuant to Section 40-43-130, complete no less than one hour of continuing education each license year regarding administration of vaccinations.

Amend the bill further, SECTION 5, by striking Section 40-43-200 and inserting:

 Section 40-43-200. (A) There is created a Joint Pharmacist Administered Vaccines Committee as a committee to the Board of Medical Examiners which consists of seven members with experience regarding vaccines. The committee is comprised of two physicians selected by the Board of Medical Examiners, two pharmacists selected by the Board of Pharmacy, and two advanced practice nurse practitioners selected by the Board of Nursing. One member of the Department of Health and Environmental Control designated by the director of the department also shall serve on the committee. Members of the committee may not be compensated for their service on the board and may not receive mileage, per diem, and subsistence as otherwise authorized by law for members of state boards, committees, and commissions.

Amend the bill further, SECTION 5, by striking Section 40-43-200(C) and inserting:

 (C) The committee shall assist and advise the Board of Medical Examiners in determining whether a specific vaccine is appropriate for administration by a pharmacist without a written order or prescription of a practitioner pursuant to Section 40-43-190. For a specific vaccine recommended by the committee to the Board of Medical Examiners, the committee also must submit a proposed written protocol for the purpose of authorizing pharmacists to administer the vaccine as authorized by Section 40-43-190. The committee must submit its initial recommendations to the board no later than four months after the passage of this act, and periodically thereafter as determined by the committee.

Amend the bill further, by striking SECTION 6 and inserting:

SECTION 6.  The Joint Pharmacist Administered Vaccines Committee must submit its initial recommendations to the board no later than four months after the passage of this act, and periodically thereafter as determined by the committee.