Bill S1494A-2013

Provides for the dispensing of emergency contraception under certain circumstances and conditions

Provides for the dispensing of emergency contraception under certain circumstances and conditions.

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  • Jan 24, 2014: PRINT NUMBER 1494A
  • Jan 24, 2014: AMEND AND RECOMMIT TO HIGHER EDUCATION
  • Jan 8, 2014: REFERRED TO HIGHER EDUCATION
  • Apr 16, 2013: HELD IN COMMITTEE
  • Feb 26, 2013: NOTICE OF COMMITTEE CONSIDERATION - REQUESTED
  • Jan 9, 2013: REFERRED TO HIGHER EDUCATION

Memo

BILL NUMBER:S1494A

TITLE OF BILL: An act to amend the education law, the insurance law and the public health law, in relation to providing for dispensing emergency contraception under certain conditions

PURPOSE OR GENERAL IDEA OF BILL:

This legislation will help to reduce the number of unintended pregnancies by increasing access to emergency contraception for women in New York State.

SUMMARY OF SPECIFIC PROVISIONS:

Section one provides that this act shall be cited as the "unintended pregnancy prevention act."

Section two describes legislative findings.

Section three amends subdivision six of section 6527 of the education law and provides that a licensed physician may prescribe and order a non-patient specific regimen to a registered professional nurse for emergency contraception, to be administered to or dispense to be selfadministered by the patient. Section three also provides that a licensed physician may prescribe and order a non-patient specific regimen to a licensed pharmacist, for dispensing emergency contraception, to be selfadministered by the patient.

Section four amends subdivision three of section 6807 of the education law by adding licensed midwife to the list of practitioners who may prescribe or order a non-patient specific regimen which allows a pharmacist to dispense drugs and devices to a registered professional nurse who may possess and administer such drugs and devices. Current law only allows a licensed physician or certified nurse practitioner to prescribe and order a non-patient specific regimen. A new subdivision four is also added to section 6807 of the education law and provides that a licensed pharmacist may dispense a non-patient specific regimen of emergency contraception, to be self-administered by the patient, which was prescribed or ordered by a licensed physician, certified nurse practitioner, or licensed midwife.

Section five amends the education law by adding a new section 6831: emergency contraception; non-patient specific prescription or order. Subdivision one defines the terms "emergency contraception" and "prescriber." Subdivision two provides that sections 6527, 6909 or 6951 of this title of the education law applies to the administering or dispensing of emergency contraception by a registered professional nurse or licensed pharmacist pursuant to a prescription or non-patient specific regimen made by prescribers as outlined in three sections of the education law. Subdivision three provides that the administering or dispensing of emergency contraception by a registered professional nurse or licensed pharmacist shall be done in accordance with professional stand ards of practice and in accordance with written procedures and protocols. Subdivision four outlines the contents of written material that must be provided to the patient. Such written material shall be developed or approved by the commissioner in consultation with the Department of Health (DOH) and the American College of Obstetricians and Gynecologists (ACOG).

Section six amends paragraphs (a) and (b) of subdivision four of section 6909 of the education law. Paragraph (a) provides that emergency contraception is added to the list for which a certified nurse practitioner may already prescribe and order a non-patient specific regimen to a registered professional nurse. Paragraph (b) provides that, in addition to a registered professional nurse, a certified nurse practitioner may also prescribe or order a non-patient specific regimen to a licensed pharmacist, for dispensing emergency contraception.

Section seven amends subdivision five of section 6909 of the education law by adding a licensed midwife to those practitioners who may already prescribe and order a non-patient specific regimen to a registered professional nurse.

Section eight amends section 6951 of the education law by adding a new subdivision four which provides that a licensed midwife may prescribe and order a non-patient specific regimen to: a registered professional nurse for emergency contraception to be administered to or dispensed to be self-administered by the patient and a licensed pharmacist for dispensing emergency contraception, to be self-administered by the patient..

Sections nine, ten, and eleven amend three sections of the insurance law to mandate that under these articles any insurance policy that covers emergency contraception shall also cover emergency contraception when provided by a non-patient-specific prescription.

Section twelve adds a new paragraph (j) to subdivision one of section 207 of the public health law to broaden the education and outreach program to include information on emergency contraception and its safety, efficacy, appropriate use and availability.

Section thirteen provides that this act shall take effect on the 180th day after it shall have become law, provided that the commissioner of education is authorized to promulgate any and all rules and regulations and Lake any other measures necessary to implement this act.

JUSTIFICATION:

EC is Safe: In February of 1997, the Food and Drug Administration (FDA) announced that certain combinations of estrogen and progestin were safe and effective for use as postcoital emergency contraception (EC). Administered in pill form, EC is a higher dosage or standard birth control pills that serve to prevent pregnancy after unprotected intercourse, including when birth control fails or in cases of sexual assault. EC can

reduce the risk of pregnancy from 755 to 69% if the first dose is taken within 72 hours of unprotected intercourse. EC is almost seven times more effective if taken within the first 24 hours of unprotected intercourse. "EC will not cause an abortion; it is not the same as RU-486 (also known as Mifepristane or the medical abortion pill). In 1999, the FDA prescription use Plan B (which is Levonorgestrel, a form of progesterone) is, currently, the only brand of emergency contraception packaged for that use. In 2007, Plan B was approved by the BOA for over the counter sale if a person is eighteen years or older. However, young women in New York State currently face barriers to accessing EC, as current law requires that a traditionally licensed source, such as a physician, prescribe EC. This bill would allow New York State pharmacists and registered professional. nurses to dispense EC from a non-patient specific order, written by either a licensed physician, certified nurse practitioner or licensed midwife, bypassing the frequent difficulties encountered in obtaining medical appointments at offices with limited hours, long waits, or inconvenient Locations. By accessing EC in this manner, young women will have the opportunity to ask questions and have them answered by a healthcare professional who will also provide a fact sheet and a verbal explanation about EC. Currently, a pharmacist may refuse to dispense any medication if he or she reasonably feels that it would endanger someone. This same discretion would apply to EC.

EC Will Significantly Lower the Number of Abortions: In New York State, there were 111,212 induced abortions in 2010, of which 6,355 were performed on girls ages seventeen and under, according to the New York Stare Department of Health (NYSDOH), Medical experts, including the American College of Obstetricians and Gynecologists (AGOG), believe that increased access to EC will reduce the number of abortions in New York by at least one half. Increased access to EC will not only reduce the number of abortions young women have, but reduce the cost and health risks associated with pregnancy, childbirth and abortion. A commonsense, risk-benefit analysis indicates that increased access to EC will enable young women to pursue a better, healthier future by preventing an unintended pregnancy in a safe and timely fashion.

EC Will Positively Impact the Lives of Young Women: Victims of sexual assault are most often younger women and adolescents. According to Tjaden and Thoennes, researchers from the National institute of Justice, "Rape is primarily a crime against youth," A study conducted by National Violence Against Women reported 54% of rape victims were between the ages of 12 and 17. Similarly, the National Women's Study found that 62% of sexual assault victims were under seventeen years of age. Every two years, Youth Risk Behavior. Survey (YRES) conducts a study of high school students in grades nine through twelve throughout the entire country. In 1997 and in 1999, a question was added to the Massachusetts survey regarding teen violence One in five girls reported being sexually or physically abused by a dating partner and of those females, one in ten was sexually abused. The statistics support the fact that there is a tremendous need for prevention of unintended pregnancies in very young women. A misconception about EC is that by giving women, especially young women, access to EC the rate of sexually transmitted infections.

(STIs) will increase and it will lead to more risky sexual behavior. However, a study providing EC to 2,117 young women ages 15 to 24, reported in the January 5, 2005 issue of the Journal of the American Medical Association (JAMA), concludes that giving young women access to EC does not negate the ability of women to act responsibly. The study confirmed that EC does not increase promiscuity or unprotected sex among women, nor does it cause women to abandon their regular birth control methods. Moreover, other methods of birth control such as condoms and spermicides may already be purchased over the counter in pharmacies, grocery stores, or convenience stores.

EC Will be Covered by Insurance: This legislation provides that if an insurance Policy covers contraception when it is provided pursuant to a prescription, that same policy shall cover emergency contraception.

Education and Outreach Programs are Effective: In 1998, Washington State began to conduct public relations and promotional activities to increase public awareness of emergency contraception and of the national emergency contraception hotline (1-388-NOT-2-LATE). Calls from Washington State to the hotline increased ten-fold, an average of 1,160 per month, after the campaign was launched, indicating that outreach programs are effective. This legislation adds emergency contraception to the list of health related issues for which the Commissioner of Health shall conduct education and outreach programs. Making the public aware of the safety, efficacy, appropriate use, and availability of EC is important to the health and safety of women in New York.

Conclusion: EC is designed to be just chat: emergency contraception, to be used when other methods of contraception fail or in cases of rape, incest, or human error. Many pregnancies, births and abortions are far more dangerous to a woman's health, especially a young woman's health, than SC. By allowing women the chance to prevent an unintended pregnancy, the abortion rate will drop, healthcare costs will decrease and young women will not have to start their adult lives with the difficult decision of whether to have a baby often as a single mother), have an abortion, or give a baby up for adoption. By allowing young women access to EC, they will have the opportunity to have a healthier and more promising future.

LEGISLATIVE HISTORY:

2011-2012: S.592/A.85 2009-2010: S.1410-A.(Schneiderman) A.627-A (Paulin) 2008 - Referred to Higher Education 2007 - Referred to Higher Education

FISCAL IMPLICATIONS:

None.

EFFECTIVE DATE:

This act shall take effect 180 days after it becomes law provided the commissioner of education is authorized to promulgate any and all rules, regulations and measures necessary for implementation on or before such date.


Text

STATE OF NEW YORK ________________________________________________________________________ 1494--A 2013-2014 Regular Sessions IN SENATE (PREFILED) January 9, 2013 ___________
Introduced by Sens. KRUEGER, AVELLA, HASSELL-THOMPSON, HOYLMAN, LATIMER, MONTGOMERY, PARKER, PERKINS, SERRANO, STAVISKY -- read twice and ordered printed, and when printed to be committed to the Committee on Higher Education -- recommitted to the Committee on Higher Education in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said commit- tee AN ACT to amend the education law, the insurance law and the public health law, in relation to providing for dispensing emergency contra- ception under certain conditions THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Short title. This act shall be known and may be cited as the "unintended pregnancy prevention act". S 2. Legislative findings. The United States Food and Drug Adminis- tration (FDA) has declared emergency contraceptive pills to be safe and effective in preventing pregnancy when used within 72 hours after unpro- tected intercourse. The American College of Obstetricians and Gynecolo- gists and the American College of Nurse-Midwives state that emergency contraception (EC) is so safe, and using it quickly is so important, that it should be available over the counter, without a prescription. They also emphasize the need for unimpeded access to EC for all women of reproductive age. However, although there are no medical reasons to limit provision of EC, the FDA only approved non-prescription access for women 18 years and older. Additionally, the FDA imposed requirements for proving the patient's identity with government-issued identification documents. The need remains, however, to provide access to women who have difficulty obtaining the required identification documents and to women under the age of 17 years. Minors in New York State have long been legally entitled to full access, without parental consent, to all repro-
ductive health care and services, including EC. Providing direct access to EC for younger women will also make it more likely that they will receive appropriate and timely professional attention, support and assistance. The legislature deems it necessary to create a structure for simplify- ing access to EC for these women, while respecting and preserving the prescribing scopes of practice of physicians, nurse practitioners, and midwives, the treating and case-finding scope of practice of registered professional nurses, and the dispensing scope of practice of pharma- cists. This act does not alter the scopes of such professions, nor does this legislation interfere with non-prescription access to EC where it is otherwise lawful. The legislature also finds that this legislation is necessary to ensure that women do not lose insurance coverage for EC solely because it has become available without a prescription. Losing coverage would be a major obstacle to access, which would undermine the important health objectives of the FDA and the legislature. S 3. Subdivision 6 of section 6527 of the education law, as added by chapter 573 of the laws of 1999, paragraph (c) as added by chapter 221 of the laws of 2002 and paragraph (d) as added by chapter 429 of the laws of 2005, is amended to read as follows: 6. A licensed physician may prescribe and order a non-patient specific regimen [to a registered professional nurse], pursuant to regulations promulgated by the commissioner, and consistent with the public health law, [for] TO: (a) A REGISTERED PROFESSIONAL NURSE FOR: (I) administering immunizations[.]; [(b)] (II) the emergency treatment of anaphylaxis[.]; [(c)] (III) administering purified protein derivative (PPD) tests[.]; [(d)] (IV) administering tests to determine the presence of the human immunodeficiency virus[.]; (V) EMERGENCY CONTRACEPTION, TO BE ADMINISTERED TO OR DISPENSED TO BE SELF-ADMINISTERED BY THE PATIENT, UNDER SECTION SIXTY-EIGHT HUNDRED THIRTY-ONE OF THIS TITLE; OR (B) A LICENSED PHARMACIST, FOR DISPENSING EMERGENCY CONTRACEPTION, TO BE SELF-ADMINISTERED BY THE PATIENT, UNDER SECTION SIXTY-EIGHT HUNDRED THIRTY-ONE OF THIS TITLE. S 4. Subdivision 3 of section 6807 of the education law, as added by chapter 573 of the laws of 1999, is amended and a new subdivision 4 is added to read as follows: 3. A pharmacist may dispense drugs and devices to a registered profes- sional nurse, and a registered professional nurse may possess and admin- ister, drugs and devices, pursuant to a non-patient specific regimen prescribed or ordered by a licensed physician, LICENSED MIDWIFE, or certified nurse practitioner, pursuant to regulations promulgated by the commissioner and the public health law. 4. A LICENSED PHARMACIST MAY DISPENSE A NON-PATIENT SPECIFIC REGIMEN OF EMERGENCY CONTRACEPTION, TO BE SELF-ADMINISTERED BY THE PATIENT, PRESCRIBED OR ORDERED BY A LICENSED PHYSICIAN, CERTIFIED NURSE PRACTI- TIONER, OR LICENSED MIDWIFE, UNDER SECTION SIXTY-EIGHT HUNDRED THIRTY-ONE OF THIS ARTICLE. S 5. The education law is amended by adding a new section 6831 to read as follows: S 6831. EMERGENCY CONTRACEPTION; NON-PATIENT SPECIFIC PRESCRIPTION OR ORDER. 1. AS USED IN THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS, UNLESS THE CONTEXT REQUIRES OTHERWISE:
(A) "EMERGENCY CONTRACEPTION" MEANS ONE OR MORE PRESCRIPTION OR NON-PRESCRIPTION DRUGS, USED SEPARATELY OR IN COMBINATION, IN A DOSAGE AND MANNER FOR PREVENTING PREGNANCY WHEN USED AFTER INTERCOURSE, FOUND SAFE AND EFFECTIVE FOR THAT USE BY THE UNITED STATES FOOD AND DRUG ADMINISTRATION, AND DISPENSED OR ADMINISTERED FOR THAT PURPOSE. (B) "PRESCRIBER" MEANS A LICENSED PHYSICIAN, CERTIFIED NURSE PRACTI- TIONER OR LICENSED MIDWIFE. 2. THIS SECTION APPLIES TO THE ADMINISTERING OR DISPENSING OF EMERGEN- CY CONTRACEPTION BY A REGISTERED PROFESSIONAL NURSE OR LICENSED PHARMA- CIST PURSUANT TO A PRESCRIPTION OR ORDER FOR A NON-PATIENT SPECIFIC REGIMEN MADE BY A PRESCRIBER UNDER SECTION SIXTY-FIVE HUNDRED TWENTY-SEVEN, SIXTY-NINE HUNDRED NINE OR SIXTY-NINE HUNDRED FIFTY-ONE OF THIS TITLE. THIS SECTION DOES NOT APPLY TO ADMINISTERING OR DISPENSING EMERGENCY CONTRACEPTION WHEN LAWFULLY DONE WITHOUT SUCH A PRESCRIPTION OR ORDER. 3. THE ADMINISTERING OR DISPENSING OF EMERGENCY CONTRACEPTION BY A REGISTERED PROFESSIONAL NURSE OR LICENSED PHARMACIST SHALL BE DONE IN ACCORDANCE WITH PROFESSIONAL STANDARDS OF PRACTICE AND IN ACCORDANCE WITH WRITTEN PROCEDURES AND PROTOCOLS AGREED TO BY THE REGISTERED PROFESSIONAL NURSE OR LICENSED PHARMACIST AND THE PRESCRIBER OR A HOSPI- TAL (LICENSED UNDER ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW) THAT PROVIDES GYNECOLOGICAL OR FAMILY PLANNING SERVICES. 4. (A) WHEN EMERGENCY CONTRACEPTION IS ADMINISTERED OR DISPENSED, THE REGISTERED PROFESSIONAL NURSE OR LICENSED PHARMACIST SHALL PROVIDE TO THE PATIENT WRITTEN MATERIAL THAT INCLUDES: (I) THE CLINICAL CONSIDER- ATIONS AND RECOMMENDATIONS FOR USE OF THE DRUG; (II) THE APPROPRIATE METHOD FOR USING THE DRUG; (III) INFORMATION ON THE IMPORTANCE OF FOLLOW-UP HEALTH CARE; (IV) INFORMATION ON THE HEALTH RISKS AND OTHER DANGERS OF UNPROTECTED INTERCOURSE; AND (V) REFERRAL INFORMATION RELAT- ING TO HEALTH CARE AND SERVICES RELATING TO SEXUAL ABUSE AND DOMESTIC VIOLENCE. (B) SUCH WRITTEN MATERIAL SHALL BE DEVELOPED OR APPROVED BY THE COMMISSIONER IN CONSULTATION WITH THE DEPARTMENT OF HEALTH AND THE AMER- ICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS. S 6. Subdivision 4 of section 6909 of the education law, as added by chapter 573 of the laws of 1999, paragraph (a) as amended and paragraph (c) as added by chapter 221 of the laws of 2002 and paragraph (d) as added by chapter 429 of the laws of 2005, is amended to read as follows: 4. A certified nurse practitioner may prescribe and order a non-pa- tient specific regimen [to a registered professional nurse], pursuant to regulations promulgated by the commissioner, consistent with subdivision three of section [six thousand nine] SIXTY-NINE hundred two of this article, and consistent with the public health law, [for] TO: (a) A REGISTERED PROFESSIONAL NURSE FOR: (I) administering immunizations[.]; [(b)] (II) the emergency treatment of anaphylaxis[.]; [(c)] (III) administering purified protein derivative (PPD) tests[.]; [(d)] (IV) administering tests to determine the presence of the human immunodeficiency virus[.]; (V) EMERGENCY CONTRACEPTION, TO BE ADMINISTERED TO OR DISPENSED TO BE SELF-ADMINISTERED BY THE PATIENT, UNDER SECTION SIXTY-EIGHT HUNDRED THIRTY-ONE OF THIS TITLE; OR (B) A LICENSED PHARMACIST, FOR DISPENSING EMERGENCY CONTRACEPTION, TO BE SELF-ADMINISTERED BY THE PATIENT, UNDER SECTION SIXTY-EIGHT HUNDRED THIRTY-ONE OF THIS TITLE.
S 7. Subdivision 5 of section 6909 of the education law, as added by chapter 573 of the laws of 1999, is amended to read as follows: 5. A registered professional nurse may execute a non-patient specific regimen prescribed or ordered by a licensed physician, LICENSED MIDWIFE, or certified nurse practitioner, pursuant to regulations promulgated by the commissioner. S 8. Section 6951 of the education law is amended by adding a new subdivision 4 to read as follows: 4. A LICENSED MIDWIFE MAY PRESCRIBE AND ORDER A NON-PATIENT SPECIFIC REGIMEN PURSUANT TO REGULATIONS OF THE COMMISSIONER, CONSISTENT WITH THIS SECTION AND THE PUBLIC HEALTH LAW, TO: (A) A REGISTERED PROFESSIONAL NURSE FOR EMERGENCY CONTRACEPTION, TO BE ADMINISTERED TO OR DISPENSED TO BE SELF-ADMINISTERED BY THE PATIENT, UNDER SECTION SIXTY-EIGHT HUNDRED THIRTY-ONE OF THIS TITLE; OR (B) A LICENSED PHARMACIST, FOR DISPENSING EMERGENCY CONTRACEPTION, TO BE SELF-ADMINISTERED BY THE PATIENT, UNDER SECTION SIXTY-EIGHT HUNDRED THIRTY-ONE OF THIS TITLE. S 9. Section 3216 of the insurance law is amended by adding a new subsection (n) to read as follows: (N) ANY POLICY UNDER THIS ARTICLE THAT COVERS CONTRACEPTION WHEN PROVIDED PURSUANT TO A PRESCRIPTION SHALL COVER EMERGENCY CONTRACEPTION AS DEFINED IN PARAGRAPH (A) OF SUBDIVISION ONE OF SECTION SIXTY-EIGHT HUNDRED THIRTY-ONE OF THE EDUCATION LAW, WHEN PROVIDED PURSUANT TO AN ORDINARY PRESCRIPTION OR ORDER UNDER SECTION SIXTY-EIGHT HUNDRED THIR- TY-ONE OF THE EDUCATION LAW AND WHEN LAWFULLY PROVIDED OTHER THAN THROUGH A PRESCRIPTION OR ORDER. S 10. Section 3221 of the insurance law is amended by adding a new subsection (t) to read as follows: (T) ANY POLICY UNDER THIS ARTICLE THAT COVERS CONTRACEPTION WHEN PROVIDED PURSUANT TO A PRESCRIPTION, SHALL COVER EMERGENCY CONTRACEPTION AS DEFINED IN PARAGRAPH (A) OF SUBDIVISION ONE OF SECTION SIXTY-EIGHT HUNDRED THIRTY-ONE OF THE EDUCATION LAW, WHEN PROVIDED PURSUANT TO AN ORDINARY PRESCRIPTION OR ORDER UNDER SECTION SIXTY-EIGHT HUNDRED THIR- TY-ONE OF THE EDUCATION LAW AND WHEN LAWFULLY PROVIDED OTHER THAN THROUGH A PRESCRIPTION OR ORDER. S 11. Section 4304 of the insurance law is amended by adding a new subsection (n) to read as follows: (N) ANY POLICY UNDER THIS ARTICLE THAT COVERS CONTRACEPTION WHEN PROVIDED PURSUANT TO A PRESCRIPTION, SHALL COVER EMERGENCY CONTRACEPTION AS DEFINED IN PARAGRAPH (A) OF SUBDIVISION ONE OF SECTION SIXTY-EIGHT HUNDRED THIRTY-ONE OF THE EDUCATION LAW, WHEN PROVIDED PURSUANT TO AN ORDINARY PRESCRIPTION OR ORDER UNDER SECTION SIXTY-EIGHT HUNDRED THIR- TY-ONE OF THE EDUCATION LAW AND WHEN LAWFULLY PROVIDED OTHER THAN THROUGH A PRESCRIPTION OR ORDER. S 12. Subdivision 1 of section 207 of the public health law is amended by adding a new paragraph (j) to read as follows: (J) EMERGENCY CONTRACEPTION, INCLUDING INFORMATION ABOUT ITS SAFETY, EFFICACY, APPROPRIATE USE AND AVAILABILITY. S 13. This act shall take effect on the one hundred eightieth day after it shall have become a law; and sections nine, ten and eleven of this act shall apply to policies and contracts issued, renewed, modi- fied, altered or amended on or after such effective date. The commis- sioner of education is authorized to promulgate any and all rules and regulations and take any other measures necessary to implement this act on its effective date on or before such effective date.

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