Includes nurse practitioners as a provider of services for purposes of collaborative drug therapy management and makes the authorization for pharmacists to perform such management permanent

Section one of the bill would amend section 6801-a of the Education Law as follows:

* Deletes reference to a "demonstration program" in the title of the section;

* Adds nurse practitioners (NPs) to the legislation to allow NPs to enter into collaborative agreements with pharmacists by which drug therapies would be reviewed, evaluated and managed;

* Authorizes CDTM to occur in all hospitals and other Article 28 facilities, such as nursing homes and clinics; and

* Permits the State Education Department in consultation with the Department of Health, to include up to fifteen community practice sites as authorized locations for the provision of CDTM.

Section two of the bill would repeal the expiration date of the prior statute and make the provisions permanent.

Existing law

Section 6801-a established the CDTM Demonstration Program and authorized physicians and pharmacists in teaching hospitals (including clinics associated with them) to engage in collaborative drug therapy management. The existing law authorizes pharmacists and physicians, pursuant to protocols entered into between them, to adjust and manage a drug regimen of a patient, including adjusting drug strength, frequency of administration and route of administration. If authorized by the protocol, the substitution of a different drug may also be permitted. In addition, requirements relating to follow up with the patient's treating physicians, the qualifications of the pharmacists and various other requirements and limitations exist in the current law.

Justification

Legislation was enacted in 2011 to establish the Collaborative Drug Therapy Management Demonstration Program, by which pharmacists, working in collaborative agreements with physicians, could adjust, manage, evaluate and implement drug therapies for patients in certain settings. The current law only applies to teaching hospitals and their affiliated outpatient and freestanding clinics A report on the results of the current statute will be issued in late 2013 or early 2014 but all preliminary reports have indicated that the legislation has been successfully implemented by eligible facilities and the collaboration between pharmacists and physicians has been very much in the interest of promoting the best interests of their patients. This bill would extend the current program to all Article 28 licensed health care facilities (hospitals, clinics and residential health care facilities) as well as permit the practice on a more limited basis in certain community based settings. The bill would also permit nurse practitioners to engage in the collaborative agreements with pharmacists.

Adverse drug reactions or adverse drug events (ADRs or ADEs) are reported to be among the leading causes of death in the United States, behind only heart disease, cancer and stroke. The most updated information on ADRs suggests that these earlier estimates may actually understate the problem. A recent comprehensive study of medication errors, estimated that as many as 2.7 million medication errors occur each year in hospitals in the United States, adversely affecting 130,000 patients. Studies have shown that at least 28% of these errors were preventable. Nearly half of the errors made were the result of errors in the prescribing process. These errors are not only potentially dangerous to patients, they are extremely costly to the health care system, resulting in additional and unnecessary expenditures of as much as $177 billion per year. Of this amount, seventy percent was attributed to unnecessary hospital admissions or prolonged hospital stays due to medication errors.

Virtually every other state permits CDTM, most of which authorize the practice in many more settings than permitted under the current New York State law and the results have been uniformly positive: CDTM along with pharmacist provided drug information services, adverse drug reaction monitoring, drug protocol management and medial rounds participation by pharmacists have all shown to make a statistically significant contribution to the reduction of medication errors. The expansion of the statute to additional settings and the authorizing of Nurse Practitioners as collaborating practitioners is warranted not only by the success of the New York State initiative, but based on the records of other states.

Legislative history

Chapter 21 of the Laws of 2011

Fiscal implications

None

Effective date

The one hundred twentieth day after which it shall have become law.