Nevada State Regulatory Update April 2019
Collaborative Practice Agreements
Through collaborative practice agreements, the Nevada Legislature expanded the scope of services that Nevada registered pharmacists can provide to patients, including as part of an interdisciplinary team. The requirements of a valid collaborative practice agreement are found in Nevada Revised Statutes (NRS) 639.2623 and NRS 639.2627, which allow pharmacists to engage in the collaborative practice of pharmacy and in collaborative drug therapy management, pursuant to a collaborative practice agreement.
Through a collaborative practice agreement, a pharmacist may engage in the collaborative practice of pharmacy, or in collaborative drug therapy management, where a pharmacist may initiate, monitor, modify, or discontinue patients' drug therapies. To enter into a valid collaborative practice agreement, a practitioner must be licensed and in good standing in the state of Nevada.
The practitioner must also maintain an ongoing relationship with the patient, who must give informed, written consent before the pharmacist may provide services to that patient pursuant to the collaborative practice agreement.
Additionally, the collaborative practice agreement must specify the disease state(s) a pharmacist may help treat, the types of decisions a pharmacist may make, and the procedure(s) a pharmacist may carry out, pursuant to the collaborative practice agreement. The agreement must also include a description as to how a practitioner will communicate any necessary medical information and diagnosis to the pharmacist and monitor clinical outcomes. Further, the agreement must state that the practitioner is authorized to override the agreement to protect the patient and accomplish treatment goals. The pharmacist must also comply with the requirements documented in the collaborative practice agreement concerning how a pharmacist must document, maintain records, and communicate with the practitioner and patients regarding patient care, treatment, and adverse effects. Collaborative practice agreements are only effective for up to one year after the effective date. These agreements must be submitted to the Nevada State Board of Pharmacy for approval in both a written and electronic form before they are effective.
Sample Collection by a Pharmacist
A registered pharmacist may use a fingerstick or an oral or nasal swab to perform Clinical Laboratory Improvement Amendments-waived tests per NRS 639.0747 and NRS 652.210. For example, a registered pharmacist can now perform tests for blood glucose levels, the international normalized ratio, influenza, and strep throat. Registered pharmacists are still not allowed to collect urine or stool specimens.
What does this mean to pharmacists practicing in the state of Nevada?
- Pharmacists can function as an integral part of the healthcare team and have limited prescriptive authority as part of a collaborative practice agreement with a physician. Pharmacists practicing under a CPA must meet all protocol requirements as stated above, including proper patient condition assessment, analysis and monitoring.
- Pharmacists can also collect patient specimens by either fingerstick, oral or nasal swab. Ensure that proper technique for collection is used, and that all documentation is completed.
Nevada State Regulatory Summary- 2018
The following laws, summarized below, were enacted by the Nevada legislature during the 2018 session:
AB 249 and SB 233 Revision to Contraceptive Prescription Guidance Effective January 1, 2018
A pharmacist to dispense up to a 12-month supply of drugs for contraception if:
- The patient has previously received a three-month supply of the same drug;
- The patient has previously received a nine-month supply of the same drug or a supply of the same drug for the balance of the plan year in which the three-month supply was prescribed, whichever was less;
- The patient is insured by the same health insurance plan;
- A provider of health care has not specified in the prescription that a different supply of the drug is necessary.
SB 131 Provision of Prescription Readers Upon Patient Request
A retail pharmacy must provide a prescription reader at the request of a patient or directions or advice on obtaining a prescription reader.
AB 474 Controlled Substance (CS) Prescription Requirements Revision Effective January 1, 2018
Each prescription for a CS must now also include:
- the practitioner's Drug Enforcement Administration (DEA) number,
- the patient's date of birth,
- the days' supply of the CS. The prescriber may choose to assign a day's supply that is of longer duration than what is calculated.
- the International Classification of Diseases, Tenth Revision (ICD-10) code that corresponds to the diagnosis for which the CS is prescribed.
Prescribing limits on an initial prescription for a CS:
- Must be intended to be used for no more than 14 days, and
- Must not exceed 90 morphine milligram equivalents (MMEs) daily for opiate naive (never received an opioid prescription or most recent course was completed more than 19 days prior to initial prescription).
What do these new regulations mean for pharmacists practicing within the state of Nevada?
- Pharmacists can now play a larger role in patient care and adherence through the provision of long-term refill supplies of oral contraception to their qualifying patients. As a result, pharmacists will play a larger role in the communication and follow-up with those patients to identify potential issues, such as side effects, promoting long term patient care.
- Pharmacists must be aware of prescription reader offerings, if a patient requests a device, including device types, and how to obtain.
- Policies must be implemented to include the new requirements on controlled substance prescriptions, what the pharmacist can change during dispensing, and new prescribing limits for opioid prescriptions. Please refer to the CDC's conversion chart for MMEs, which can be found at CDC Opioid Conversion Chart.
For full regulatory language, refer to the Nevada Board of Pharmacy.