§ 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;
(vi) dietary fluoride supplements;
(vii) influenza vaccines;
(viii) 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;
(ix) emergency prescribing of albuterol or glucagon while contemporaneously contacting emergency services; and
[ Subdiv. (b)(2)(A)(x) repealed effective March 31, 2022.]
(x) 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).
(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.
Terms Used In Vermont Statutes Title 26 Sec. 2031
- Board: means the Vermont State Board of Pharmacy. See
- clinical pharmacy: means :
- Collaborative practice agreement: means a written agreement between a pharmacist and a health care facility or prescribing practitioner that permits the pharmacist to engage in the practice of clinical pharmacy for the benefit of the facility's or practitioner's patients. See
- dispensing: means the preparation and delivery of a prescription drug pursuant to a lawful order of a practitioner in a suitable container appropriately labeled for subsequent administration to or use by a patient or other individual entitled to receive the prescription drug. See
- Drug: means :
- following: when used by way of reference to a section of the law shall mean the next preceding or following section. See
- Pharmacist: means an individual licensed under this chapter. See
- Practitioner: means an individual authorized by the laws of the United States or its jurisdictions or Canada to prescribe and administer prescription drugs in the course of his or her professional practice and permitted by that authorization to dispense, conduct research with respect to, or administer drugs in the course of his or her professional practice or research in his or her respective state or province. See
- State: when applied to the different parts of the United States may apply to the District of Columbia and any territory and the Commonwealth of Puerto Rico. See
(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; 2019, No. 178 (Adj. Sess.), § 11, eff. Oct. 1, 2020; 2019, No. 178 (Adj. Sess.), § 12a, eff. March 31, 2022; 2021, No. 20, § 262.)