SB211: Bill Text

April 3, 2023 - Introduced by Senators Felzkowski, Cabral-Guevara, James and Marklein, cosponsored by Representatives Kitchens, Magnafici, Duchow, Tusler, Binsfeld, Sapik, Rodriguez, August, Born, Callahan, Dallman, Dittrich, Green, Hurd, S. Johnson, Knodl, Krug, Kurtz, Macco, Maxey, Michalski, Mursau, Nedweski, Novak, Oldenburg, Plumer, Rozar, Snyder, Spiros, Steffen, Subeck, Summerfield, Swearingen, Vos, Wittke and Sinicki. Referred to Committee on Health.

SB211,,2 An Act to amend 450.095 (title) and 450.095 (3); and to create 49.46 (2) (bg), 450.01 (16) (L), 450.095 (1) (ag) and (ar) and 450.095 (2m) of the statutes; relating to: permitting pharmacists to prescribe certain contraceptives, extending the time limit for emergency rule procedures, providing an exemption from emergency rule procedures, granting rule-making authority, and providing a penalty.

SB211,,3 Analysis by the Legislative Reference Bureau

This bill permits a pharmacist to prescribe and dispense hormonal contraceptive patches and self-administered oral hormonal contraceptives, subject to limitations described as follows.

The bill requires the Pharmacy Examining Board, after consultation with the Medical Examining Board, the Board of Nursing, and the Department of Health Services, to promulgate rules to establish standard procedures for the prescribing of contraceptives by pharmacists under the bill. The rules must include a self-assessment questionnaire, developed in consideration of guidelines established by the American Congress of Obstetricians and Gynecologists, that must be used by a pharmacist when prescribing a contraceptive. The rules must include certain requirements for pharmacists prescribing contraceptives, such as 1) requiring a report to the patient’s primary health care practitioner following a prescription, and 2) requiring the contraceptive to be dispensed as soon as practicable after the pharmacist issues the prescription order. In addition, the rules must prohibit a pharmacist from prescribing or dispensing a contraceptive to a patient unless 1) the patient has responded to the self-assessment questionnaire and undergone a blood pressure screening; 2) the use of the contraceptive is not contraindicated based upon the results of the questionnaire and screening; and 3) the patient acknowledges on the self-assessment questionnaire that a contraceptive is not protection against sexually transmitted diseases and that it is strongly recommended that the patient annually meet with a physician or other medical professional to discuss the patient’s hormonal contraceptive treatment and other routine preventive care. A pharmacist who prescribes contraceptives as permitted under the bill must comply with those rules, as well as any other rules promulgated by the Pharmacy Examining Board. Finally, under the bill, a pharmacist may prescribe a contraceptive only to a person who is at least 18 years of age.

The bill further requires DHS to ensure any contraceptives or contraceptive services covered under the Medical Assistance program are covered and reimbursed when prescribed, if a prescription is required under federal law, or provided by a pharmacist acting under the scope of his or her practice. The Medical Assistance program is a joint federal and state program that provides health services to individuals who have limited financial resources. The bill also requires DHS to certify pharmacists as providers of Medical Assistance services for the purposes of covering and reimbursing prescribed hormonal contraceptive patches and self-administered oral hormonal contraceptives.

For further information see the state fiscal estimate, which will be printed as an appendix to this bill.

SB211,,4 The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

SB211,1 Section 1. 49.46 (2) (bg) of the statutes is created to read:

SB211,,6 49.46 (2) (bg) The department shall ensure that any contraceptives, including contraceptive drugs or drug products, or contraceptive services that are covered under this subsection and for which reimbursement is made to any provider are covered and reimbursed when prescribed, if a prescription is required under federal law, or provided by a pharmacist acting under his or her scope of practice, including under s. 450.095 (2m). The department shall certify pharmacists as providers of Medical Assistance services for the purposes of covering and reimbursing under this paragraph services that are provided under s. 450.095 (2m).

SB211,2 Section 2. 450.01 (16) (L) of the statutes is created to read:

SB211,,8 450.01 (16) (L) Prescribing and dispensing hormonal contraceptive patches and self-administered oral hormonal contraceptives pursuant to s. 450.095 (2m).

SB211,3 Section 3. 450.095 (title) of the statutes is amended to read:

SB211,,10 450.095 (title) Duty to dispense Prescribing and dispensing contraceptives.

SB211,4 Section 4. 450.095 (1) (ag) and (ar) of the statutes are created to read:

SB211,,12 450.095 (1) (ag) “Hormonal contraceptive patch” means a transdermal patch applied to the skin of a patient, by the patient or by a practitioner, that releases a drug composed of a combination of hormones that is approved by the federal food and drug administration to prevent pregnancy.

SB211,,13 (ar) “Self-administered oral hormonal contraceptive” means a drug composed of a combination of hormones that is approved by the federal food and drug administration to prevent pregnancy and that the patient to whom the drug is prescribed may take orally.

SB211,5 Section 5. 450.095 (2m) of the statutes is created to read:

SB211,,15 450.095 (2m) (a) In accordance with rules promulgated by the board, a pharmacist may prescribe and dispense hormonal contraceptive patches and self-administered oral hormonal contraceptives to a person who is at least 18 years of age.

SB211,,16 (b) 1. The board shall, after consultation with the medical examining board, the board of nursing, and the department of health services, promulgate rules to establish standard procedures for the prescribing of hormonal contraceptive patches and self-administered oral hormonal contraceptives by pharmacists under this subsection.

SB211,,17 2. a. The rules promulgated under subd. 1. shall include a self-assessment questionnaire, developed in consideration of guidelines established by the American Congress of Obstetricians and Gynecologists, that must be used by a pharmacist as described in subd. 3. a.

SB211,,18 b. The self-assessment questionnaire shall state and the patient shall acknowledge on the self-assessment questionnaire that a hormonal contraceptive patch or a self-administered oral hormonal contraceptive is not protection against sexually transmitted diseases, which may have a significant negative impact on reproductive and general health.

SB211,,19 c. The patient shall acknowledge on the self-assessment questionnaire that it is strongly recommended that the patient annually meet with a physician or other medical professional to discuss the patient’s prescribed hormonal contraceptive treatment and other routine preventive care.

SB211,,20 3. The rules promulgated under subd. 1. shall require a pharmacist to do all of the following:

SB211,,21 a. Provide the self-assessment questionnaire described in subd. 2. to a patient prior to the pharmacist’s prescribing the hormonal contraceptive patch or self-administered oral hormonal contraceptive to the patient.

SB211,,22 b. Report to the patient’s primary care practitioner upon prescribing and dispensing the hormonal contraceptive patch or self-administered oral hormonal contraceptive.

SB211,,23 c. Provide the patient with a written record of the hormonal contraceptive patch or self-administered oral hormonal contraceptive prescribed and dispensed.

SB211,,24 d. Dispense the hormonal contraceptive patch or self-administered oral hormonal contraceptive to the patient as soon as practicable after the pharmacist issues the prescription order.

SB211,,25 4. The rules promulgated under subd. 1. shall prohibit a pharmacist from prescribing and dispensing a hormonal contraceptive patch or self-administered oral hormonal contraceptive to a patient unless all of the following apply:

SB211,,26 a. The patient has responded to the self-assessment questionnaire provided under subd. 3. a. and undergone a blood pressure screening.

SB211,,27 b. The use of the hormonal contraceptive patch or self-administered oral hormonal contraceptive by the patient is not contraindicated based upon the results of the questionnaire and screening.

SB211,,28 5. The rules promulgated under subd. 1. shall permit any qualified pharmacy employee to provide a self-assessment questionnaire required under subd. 3. a. and administer a blood pressure screening required under subd. 4. a. if a pharmacist reviews the results of the self-assessment questionnaire and the blood pressure screening before prescribing and dispensing any hormonal contraceptive patch or self-administered oral hormonal contraceptive to a patient.

SB211,6 Section 6. 450.095 (3) of the statutes is amended to read:

SB211,,30 450.095 (3) Any person who violates this section or any rules promulgated under this section may be required to forfeit not less than $250 nor more than $2,500 for each violation.

SB211,7 Section 7. Nonstatutory provisions.

SB211,,32 (1) The pharmacy examining board may promulgate emergency rules under s. 227.24 necessary to implement this act. Notwithstanding s. 227.24 (1) (c) and (2), emergency rules promulgated under this subsection remain in effect until May 1, 2025, or the date on which permanent rules take effect, whichever is sooner. Notwithstanding s. 227.24 (1) (a) and (3), the examining board is not required to provide evidence that promulgating a rule under this subsection as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to provide a finding of emergency for a rule promulgated under this subsection.

SB211,8 Section 8. Effective dates. This act takes effect on January 1, 2025, except as follows:

SB211,,34 (1) Section 7 (1) of this act takes effect on the day after publication.

SB211,,35 (end)