This bill has been amended

Bill S7678-2013

Authorizes optometrists to prescribe and use phase three therapeutic pharmaceutical agents in the course of their practices

Authorizes optometrists certified to use therapeutic pharmaceutical agents for the treatment or prevention of ocular disease, to also use specified oral pharmaceutical agents in their practices; requires completion of a 30 hour phase three therapeutic pharmaceutical agent certification course; permits the commissioner of health to recommend other categories of drugs that may also be prescribed.

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  • May 28, 2014: REFERRED TO HIGHER EDUCATION

Memo

BILL NUMBER:S7678

TITLE OF BILL: An act to amend the education law, in relation to authorizing optometrists to prescribe and use limited categories of oral medicines

PURPOSE OR GENERAL IDEA OF BILL:

To allow licensed optometrists who are already certified to prescribe diagnostic and topical pharmaceutical agents to prescribe certain oral medications

SUMMARY OF SPECIFIC PROVISIONS:

Section one amends subdivision 1 of section 7101-a of the education law by adding a new paragraph (g) that provides the definition of phase three therapeutic pharmaceutical agents, to include those pharmaceutical agents listed and limitations on the duration of some prescriptions.

Section two amends subdivision 4 of section 7101-a of the education law by re-lettering paragraphs (c) and (d) of said subdivision paragraphs (d) and (e), and by adding a new paragraph (c). Paragraph (c) provides that optometrists must first be certified to prescribe diagnostic pharmaceutical agents and phase one and phase two therapeutic pharmaceutical agents and complete a thirty hour phase three therapeutic pharmaceutical agent certification course with a curriculum developed by a New York state-accredited college of optometry in collaboration with an accredited medical school and approved by the education department, before using or prescribing phase three pharmaceutical agents. The curriculum shall include instruction in pharmacology and drug interaction and be taught through clinical case scenarios and emphasize clinical decision making. The thirty hour course requirement shall not apply to certain specified optometrists.

Section three amends subdivision 5 of section 7101-a of the education law, as added by chapter 517 of the laws of 1995, by providing that the department shall suspend the certification for the use and prescribing of phase one and phase two therapeutic agents of any optometrist who fails to receive certification for phase three therapeutic pharmaceutical agents within three years of approval by the department of the thirty-hour certification course.

Section four amends the opening paragraph of subdivision 6 of section 7101-a of the education law, as added by chapter 517 of the laws of 1995, and adds new subdivisions 6-a and 6-b to require that an optometrist document, as soon as practicable, in the patient's record the prescription or use of an oral medication. In addition, within 72 hours of prescribing or using an oral medication, an optometrist shall notify the patient's primary care practitioner and document such notification concerning the agent used or prescribed, the dose, frequency of use and duration of prescription. The bill would also require that if a patient's condition does not result in an adequate clinical response with the use of an oral medication, an optometrist shall consult with the patient's primary care practitioner as soon as clinically prudent.

Section five amends subdivision 7 of section 7101-a of the education law, as added by chapter 517 of the laws of 1995, by providing that at least six hours of the thirty-six hours of continuing education that is required per triennial registration period shall relate specifically to systemic drug use and interaction.

Section six amends the opening paragraph of subdivision 8 of section 7101-a, as added by chapter 517 of the laws of 1995, to clarify the applicability of a separate notice to patients regarding the use of certain topical medications.

Section seven amends subdivision 10 of section 7101-a of the education law, as added by chapter 517 of the laws of 1995, to provide that optometrists certified to use and prescribe oral medications shall be authorized to use and prescribe those oral medications that are FDA approved and commercially available. In addition, optometrists certified for phase one, phase two or phase three therapeutic pharmaceutical agents shall be authorized to use and recommend all nonprescription medications, whether intended for topical or oral use, appropriate for the treatment of the eye and adnexa.

Section eight amends subdivision 12 of section 7101-a of the education law, as added by chapter 517 of the laws of 1995, to clarify that the commissioner of health shall recommend to the commissioner of education additions or deletions to the list of approved categories of medications used or prescribed by optometrists which are consistent with the standard of care in the diagnosis and treatment of diseases of the eye and adnexa.

Section nine provides the effective date.

JUSTIFICATION:

In 1995, the Legislature enacted a law authorizing a specialty certification for optometrists with training and experience to use topically applied therapeutic pharmaceutical agents for the treatment or prevention of ocular disease. By law, such certified optometrists are required to be held to the same standard of care in diagnosis, use of such agents, and treatment as that degree of skill and proficiency commonly exercised by a physician.

In the years since the 1995 legislation was enacted, New Yorkers have enjoyed enhanced access to and a higher quality of primary eye care services provided by optometrists who meet the qualifications set forth in the legislation. This new legislation extends the 1995 legislation another modest step by permitting optometrists to prescribe for their patients oral medications for the treatment of eye disease in some cases, and permit optometrists (who satisfy certain continuing education requirements) to prescribe oral medications solely in the context of treating eye disease.

The bill would further establish consistency over the categories of diagnostic, therapeutic and orals drugs that optometrists shall be authorized to use by providing that the Commissioner of Health shall recommend additions to or deletions from such categories based on whether they are the standard of care for the diagnosis and treatment of eye disease and adnexa.

Currently, 48 states and the District of Columbia allow optometrists to prescribe and use a range of oral pharmaceutical agents for ocular conditions. This bill mirrors certain provisions and restrictions in many of those other states to authorize the minimum authority needed for optometrists to appropriately treat their patients.

Optometric students at SUNY College of Optometry and optometric schools across the country are required to be thoroughly educated and trained in the prescription and use of these medications. The enactment of this legislation will provide New Yorkers access to the most effective and appropriate medications that are necessary in the treatment of ocular diseases and will ensure that the prescribing optometrist is fully prepared to fulfill this responsibility. This bill is significantly more narrow than previously introduced legislation in that it would conform New York's statute with that of other states and improve patient care by promoting greater communication among a patient's health care providers, enhancing the educational and training requirements for optometrists, and limiting the duration of certain oral drugs that are authorized to be used.

PRIOR LEGISLATIVE HISTORY:

Similar to A.363-B, 2011 and 2012 referred to higher education. Same as S.3027-B, 2011 and 2012 referred to higher education. Similar to A.3718, 2009 and 2010 referred to higher education. Same as S.2667, 2009 and 2010 referred to higher education. Similar to A.8001, 2007 and 2008 referred to higher education. Same as S.4519, 2007-2008 referred to higher education. Similar to A.4329A, 2005 and 2006 referred to higher education. Same as S.2719-A, 2005 and 2006. Similar to A.7223, 2003 and 2004 referred to higher education. Same as S.2761, 2003 and 2004 referred to higher education. Similar to A.8814, 2001 and 2002 referred to higher education. Same as S.4482, 2001 and 2002 referred to higher education.

FISCAL IMPLICATION:

None to the State.

EFFECTIVE DATE:

This act shall take effect on the one hundred twentieth day after it shall have become a law; provided that any rule or regulation necessary for the timely implementation of this act on its effective date shall be promulgated on or before such effective date.


Text

STATE OF NEW YORK ________________________________________________________________________ 7678 IN SENATE May 28, 2014 ___________
Introduced by Sen. LIBOUS -- read twice and ordered printed, and when printed to be committed to the Committee on Higher Education AN ACT to amend the education law, in relation to authorizing optome- trists to prescribe and use limited categories of oral medicines THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subdivision 1 of section 7101-a of the education law is amended by adding a new paragraph (g) to read as follows: (G) PHASE THREE THERAPEUTIC PHARMACEUTICAL AGENTS. PHASE THREE THERA- PEUTIC PHARMACEUTICAL AGENTS SHALL MEAN THOSE ORALLY ADMINISTERED DRUGS USED FOR THERAPEUTIC PURPOSES FOR THE TREATMENT OF DISEASES OF THE EYE AND ADNEXA AND SHALL BE LIMITED TO: (I) ANTIBIOTICS; (II) DECONGESTANTS/ANTI-ALLERGENIC/ANTIHISTAMINES; (III) ANTIGLAUCOMAS; PROVIDED HOWEVER, WHEN PRESCRIBED OR ADMINISTERED FOR THE TREATMENT OF ACUTE ANGLE CLOSURE GLAUCOMA, THE PRESCRIBING OPTO- METRIST SHALL MAKE ALL REASONABLE EFFORTS IMMEDIATELY THEREAFTER TO REFER THE PATIENT TO A LICENSED PHYSICIAN SPECIALIZING IN DISEASES OF THE EYE AND PROVIDE NOTIFICATION IN ACCORDANCE WITH SUBDIVISION SIX-A OF THIS SECTION; (IV) ANTIVIRALS; (V) ONE, THREE DAY SUPPLY OF ANALGESICS, BUT SHALL NOT INCLUDE THOSE LISTED IN SCHEDULES I AND II OF THE UNIFORM CONTROLLED SUBSTANCES ACT; (VI) NONSTEROIDAL ANTI-INFLAMMATORY DRUGS; (VII) ONE, FOURTEEN DAY SUPPLY OF CORTICOSTEROIDS. S 2. Paragraphs (c) and (d) of subdivision 4 of section 7101-a of the education law are relettered paragraphs (d) and (e) and a new paragraph (c) is added to read as follows: (C) BEFORE USING OR PRESCRIBING PHASE THREE THERAPEUTIC PHARMACEUTICAL AGENTS, AN OPTOMETRIST MUST BE CERTIFIED TO PRESCRIBE DIAGNOSTIC PHARMA- CEUTICAL AGENTS, AND PHASE ONE AND PHASE TWO THERAPEUTIC PHARMACEUTICAL AGENTS, AND HAVE COMPLETED A THIRTY HOUR PHASE THREE THERAPEUTIC PHARMA- CEUTICAL AGENT CERTIFICATION COURSE, WITH A CURRICULUM DEVELOPED BY AN ACCREDITED COLLEGE OF OPTOMETRY IN COLLABORATION WITH AN ACCREDITED
MEDICAL SCHOOL. THE CURRICULUM, WHICH SHALL BE APPROVED BY THE DEPART- MENT, SHALL INCLUDE, BUT NOT BE LIMITED TO, INSTRUCTION IN PHARMACOLOGY AND DRUG INTERACTION AND BE TAUGHT THROUGH CLINICAL CASE SCENARIOS AND EMPHASIZE CLINICAL DECISION MAKING. SUCH COURSE SHALL QUALIFY TOWARDS MEETING THE THIRTY-SIX HOURS OF CONTINUING EDUCATION PER TRIENNIAL REGISTRATION PERIOD REQUIRED BY SUBDIVISION SEVEN OF THIS SECTION. THIS REQUIREMENT FOR THE THIRTY HOUR PHASE THREE THERAPEUTIC PHARMACEUTICAL AGENT CERTIFICATION COURSE SHALL NOT APPLY TO THOSE OPTOMETRISTS WHO (I) GRADUATED FROM AN ACCREDITED COLLEGE OF OPTOMETRY SUBSEQUENT TO JANUARY FIRST, TWO THOUSAND FOUR AND (II) HAVE TAKEN AND SUCCESSFULLY PASSED EITHER THE TREATMENT AND MANAGEMENT OF OCULAR DISEASES PORTION OF THE NATIONAL BOARD OF EXAMINERS IN OPTOMETRY OR AN EXAMINATION ACCEPTABLE TO THE BOARD. S 3. Subdivision 5 of section 7101-a of the education law, as added by chapter 517 of the laws of 1995, is amended to read as follows: 5. Suspension of certification. The department shall suspend the certification for the use and prescribing of phase one therapeutic agents of any optometrist who fails to receive certification for phase two therapeutic pharmaceutical agents within three years of having been certified for phase one therapeutic pharmaceutical agents. THE DEPART- MENT SHALL SUSPEND THE CERTIFICATION FOR THE USE AND PRESCRIBING OF PHASE ONE AND PHASE TWO THERAPEUTIC AGENTS OF ANY OPTOMETRIST WHO FAILS TO RECEIVE CERTIFICATION FOR PHASE THREE THERAPEUTIC PHARMACEUTICAL AGENTS WITHIN THREE YEARS OF APPROVAL BY THE DEPARTMENT OF A THIRTY HOUR PHASE THREE THERAPEUTIC PHARMACEUTICAL AGENT CERTIFICATION COURSE PURSU- ANT TO PARAGRAPH (C) OF SUBDIVISION FOUR OF THIS SECTION. S 4. The subdivision heading of subdivision 6 of section 7101-a of the education law, as added by chapter 517 of the laws of 1995, is amended and two new subdivisions 6-a and 6-b are added to read as follows: Consultation WITH USE OF CERTAIN PHASE TWO THERAPEUTIC PHARMACEUTICAL AGENTS. 6-A. NOTIFICATION OF USE OF PHASE THREE THERAPEUTIC PHARMACEUTICAL AGENTS. AN OPTOMETRIST SHALL, AS SOON AS PRACTICABLE, DOCUMENT IN THE PATIENT'S RECORD THE PRESCRIPTION OF USE OF PHASE THREE THERAPEUTIC PHARMACEUTICAL AGENTS. WITHIN SEVENTY-TWO HOURS OF PRESCRIBING OR USING A PHASE THREE THERAPEUTIC PHARMACEUTICAL AGENT, AN OPTOMETRIST SHALL NOTIFY THE PATIENT'S PRIMARY CARE PRACTITIONER, AND DOCUMENT SUCH NOTIFICATION WITH THE FOLLOWING INFORMATION: (A) THE NAME OF SUCH AGENT; (B) THE DOSE; (C) THE FREQUENCY OF USE; AND (D) THE DURATION OF USE OR PRESCRIPTION; 6-B. CONSULTATION WITH USE OF PHASE THREE THERAPEUTIC PHARMACEUTICAL AGENTS. IF IN THE PROFESSIONAL JUDGMENT OF THE OPTOMETRIST, A PATIENT'S CONDITION DOES NOT RESULT IN AN ADEQUATE CLINICAL RESPONSE TO THE PHASE THREE THERAPEUTIC PHARMACEUTICAL AGENT THERAPY, THE OPTOMETRIST SHALL CONSULT WITH THE PATIENT'S PRIMARY CARE PRACTITIONER AS SOON AS CLIN- ICALLY PRUDENT. S 5. Subdivision 7 of section 7101-a of the education law, as added by chapter 517 of the laws of 1995, is amended to read as follows: 7. Continuing education. Each optometrist certified to use phase one [or], phase two OR PHASE THREE therapeutic pharmaceutical agents shall complete a minimum of thirty-six hours of continuing education per triennial registration period. The education shall be in the area of ocular disease and pharmacology, AT LEAST SIX HOURS OF WHICH SHALL RELATE SPECIFICALLY TO SYSTEMIC DRUG USE AND INTERACTION, and may
include both didactic and clinical components. Such educational programs shall be approved in advance by the department and evidence of the completion of this requirement shall be submitted with each application for license renewal as required by section sixty-five hundred two of this chapter. S 6. The subdivision heading of subdivision 8 of section 7101-a of the education law, as added by chapter 517 of the laws of 1995, is amended to read as follows: Notice to patient WITH USE OF CERTAIN PHASE TWO THERAPEUTIC PHARMACEU- TICAL AGENTS. S 7. Subdivision 10 of section 7101-a of the education law, as added by chapter 517 of the laws of 1995, is amended to read as follows: 10. Pharmaceutical agents. Optometrists who have been approved and certified by the department shall be permitted to use the following drugs: (a) Diagnostic pharmaceuticals. (b) Those optometrists having been certified for phase one therapeutic pharmaceutical agents shall be authorized [(i) to use and recommend all nonprescription medications appropriate for ocular disease whether intended for topical or oral use; and (ii)] to use and prescribe all phase one therapeutic pharmaceutical agents which are FDA approved and commercially available. In the event an optometrist treats a patient with topical antiviral or steroidal drugs and the patient's condition either fails to improve or worsens within five days, the optometrist shall notify a physician designated by the patient or, if none, by the treating optometrist. (c) Those optometrists having been certified for phase two therapeutic pharmaceutical agents shall be authorized to use and prescribe phase two therapeutic pharmaceutical agents which are FDA approved and commercial- ly available. (D) THOSE OPTOMETRISTS HAVING BEEN CERTIFIED FOR PHASE THREE THERAPEU- TIC PHARMACEUTICAL AGENTS SHALL BE AUTHORIZED TO USE AND PRESCRIBE PHASE THREE THERAPEUTIC PHARMACEUTICAL AGENTS WHICH ARE FDA APPROVED AND COMMERCIALLY AVAILABLE. (E) THOSE OPTOMETRISTS HAVING BEEN CERTIFIED FOR PHASE ONE, PHASE TWO OR PHASE THREE THERAPEUTIC PHARMACEUTICAL AGENTS SHALL BE AUTHORIZED TO USE AND RECOMMEND ALL NONPRESCRIPTION MEDICATIONS, WHETHER INTENDED FOR TOPICAL OR ORAL USE, APPROPRIATE FOR THE TREATMENT OF THE EYE AND ADNEXA. S 8. Subdivision 12 of section 7101-a of the education law, as added by chapter 517 of the laws of 1995, is amended to read as follows: 12. Responsibilities of the commissioner of health. [The] IN ORDER TO SATISFY THE REQUIREMENT THAT AN OPTOMETRIST AUTHORIZED TO USE PHARMA- CEUTICAL AGENTS FOR USE IN THE DIAGNOSIS, TREATMENT OR PREVENTION OF OCULAR DISEASE SHALL BE HELD TO THE SAME STANDARD OF CARE IN DIAGNOSIS, USE OF SUCH AGENTS, AND TREATMENT AS THAT DEGREE OF SKILL AND PROFICIEN- CY COMMONLY EXERCISED BY A PHYSICIAN IN THE SAME COMMUNITY, THE commis- sioner of health [may recommend to the commissioner additions or deletions to the department's regulations relating to optometric use of drugs except that such recommendations shall be limited only to addi- tions which have been determined to be equivalent to those drugs already authorized or deletions based upon a finding that the drugs are no long- er appropriate for their current use or for other similar reasons] SHALL RECOMMEND TO THE COMMISSIONER ADDITIONS OR DELETIONS TO THE LIST OF APPROVED CATEGORIES OF DIAGNOSTIC, THERAPEUTIC AND ORAL PHARMACEUTICAL
AGENTS WHICH ARE CONSISTENT WITH THE STANDARD OF CARE IN THE COMMUNITY FOR THE DIAGNOSIS AND TREATMENT OF DISEASES OF THE EYE AND ADNEXA. S 9. This act shall take effect on the one hundred twentieth day after it shall have become a law; provided that any rule or regulation neces- sary for the timely implementation of this act on its effective date shall be promulgated on or before such effective date.

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