Vermont § 2023 - Clinical pharmacy; prescribing

§ 2023. Clinical pharmacy; prescribing

• (a) In accordance with applicable rules adopted by the Board, a pharmacist may engage
  in the practice of clinical pharmacy, including prescribing as set forth in subsection
  (b) of this section, provided that a pharmacist shall not: (1) prescribe a regulated drug as defined in 18 V.S.A. § 4201; (2) prescribe a biological product as defined in 18 V.S.A. § 4601, other than an insulin medication, an influenza vaccine or vaccine to mitigate a
  significant public health risk, or, pursuant to a collaborative practice agreement,
  another vaccine; or (3) initiate antibiotic therapy, except pursuant to a collaborative practice agreement. (b) A pharmacist may prescribe in the following contexts: (1) Collaborative practice agreement. A pharmacist may prescribe, for the patient or patients of a prescribing practitioner
  licensed pursuant to this title, within the scope of a written collaborative practice
  agreement with that primary prescriber. (A) The collaborative practice agreement shall require the pharmacist and collaborating
  practitioner to contemporaneously notify each other of any change in the patient’s
  pharmacotherapy or known medical status. (B) Under a collaborative practice agreement, a pharmacist may select or modify antibiotic
  therapy for a diagnosed condition under the direction of the collaborating practitioner. (2) State protocol. (A) A pharmacist may prescribe, order, or administer in a manner consistent with valid
  State protocols that are approved by the Commissioner of Health after consultation
  with the Director of Professional Regulation and the Board and the ability for public
  comment: (i) opioid antagonists; (ii) epinephrine auto-injectors; (iii) tobacco cessation products; (iv) tuberculin purified protein derivative products; (v) self-administered hormonal contraceptives, including subcutaneous depot medroxyprogesterone
  acetate; (vi) dietary fluoride supplements; (vii) for patients 18 years of age or older, vaccinations recommended by the Centers for
  Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP)
  and administered consistently with the ACIP-approved immunization schedules, as may
  be amended from time to time; (viii) for patients five years of age or older, influenza vaccine, COVID-19 vaccine, and
  subsequent formulations or combination products thereof; (ix) in the event of a significant public health risk, an appropriate vaccine to mitigate
  the effects on public health after finding that existing channels for vaccine administration
  are insufficient to meet the public health need; (x) emergency prescribing of albuterol or glucagon while contemporaneously contacting
  emergency services; (xi) tests for COVID-19 for individuals by entities holding a Certificate of Waiver pursuant
  to the Clinical Laboratory Amendments of 1988 (42 U.S.C. § 263a). If a test for COVID-19, prescribed, ordered, or administered by a pharmacist in
  accordance with this section and the resulting State protocol incidentally detects
  influenza or human respiratory syncytial virus, a pharmacist shall advise the individual
  tested that the results indicate influenza or human respiratory syncytial virus infection
  and recommend to the individual to seek further care from an appropriate health care
  provider; (xii) tests for SARS-CoV for asymptomatic individuals or related serology for individuals
  by entities holding a Certificate of Waiver pursuant to the Clinical Laboratory Amendments
  of 1988 (42 U.S.C. § 263a); and (xiii) emergency contraception. (B)(i) State protocols shall be valid if signed by the Commissioner of Health and the Director
  of Professional Regulation, and the Board of Pharmacy shall feature the active protocol
  conspicuously on its website. (ii) The Commissioner of Health may invalidate a protocol if the Commissioner finds that
  the protocol’s continued operation would pose an undue risk to the public health,
  safety, or welfare and signs a declaration to that effect. Upon such a declaration,
  the Director shall remove the invalidated protocol from the Board website and shall
  cause electronic notice of the protocol’s discontinuation to be transmitted to all
  Vermont drug outlets. (3) Accessory devices. A pharmacist may prescribe accessory-type devices, such as spacers, needles, and diabetic
  testing supplies, where clinically indicated in the judgment of the pharmacist. (4) Prescriber-authorized substitution. A prescribing practitioner licensed pursuant to this title may authorize a pharmacist
  to substitute a drug with another drug in the same therapeutic class that would, in
  the opinion of the pharmacist, have substantially equivalent therapeutic effect even
  though the substitute drug is not a therapeutic equivalent drug, provided: (A) the prescriber has clearly indicated that drug product substitution is permissible
  by indicating “therapeutic substitution allowed” or similar designation; (B) the drug product substitution is intended to ensure formulary compliance with the
  patient’s health insurance plan or otherwise to minimize cost to the patient; (C) the patient’s voluntary, informed consent is obtained in writing; and (D) the pharmacist or designee notifies the prescriber which drug was dispensed as a substitute
  within five days of dispensing. (5) Over-the-counter availability. A pharmacist may prescribe over-the-counter drugs where appropriate to reduce costs
  to the patient, such as by drawing from a health savings account or flexible spending
  account. (6) Short-term extensions. (A) A pharmacist may extend a previous prescription in the absence of a collaborative
  practice agreement or a State protocol so long as the pharmacist provides only sufficient
  quantity to the patient until the patient is able to consult with another practitioner,
  not to exceed a five-day supply or the smallest available unit, and takes all reasonable
  measures to notify the patient’s primary care provider of record or the appropriate
  original prescriber, if the original prescriber is different from the primary care
  provider of record. (B) A short-term extension shall be provided on a one-time basis. (c) Board rules shall: (1) specify the required elements of a collaborative practice agreement; (2) prohibit conflicts of interest and inappropriate commercial incentives related to
  prescribing, such as reimbursement based on brands or numbers of prescriptions filled,
  renewing prescriptions without request by a patient, steering patients to particular
  brands or selections of products based on any commercial relationships, or acceptance
  of gifts offered or provided by manufactures in violation of 18 V.S.A. § 4631a; (3) define appropriate bounds of short-term extension prescribing; and (4) establish minimum standards for patient privacy in clinical consultation. (Added 2015, No. 173 (Adj. Sess.), § 6, eff. June 8, 2016; amended 2019, No. 178 (Adj. Sess.), § 11, eff. Oct. 1, 2020; 2021, No. 20, § 262; 2023, No. 15, § 11, eff. May 10, 2023; 2023, No. 77, § 8, eff. June 20, 2023.)