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Pharmacy Laws and Regulations in Texas: Recent Updates to the Texas Pharmacy Act and the Texas Board of Pharmacy Rules

INTRODUCTION

This educational program provides information on legislation passed in the 86th and 87th Texas Legislative Sessions that significantly affect pharmacists and amendments to the Texas State Board of Pharmacy (TSBP) Rules adopted between June 2019 and June 2022. Recent legislation and amendments expand the role of pharmacists in patient care, add pharmacists to the list of health care providers, authorize payment for pharmacist-provided patient care services, and expand patient access to insulin. Comprehensive pharmacy benefit manager (PBM) reform was also passed in 2021. Additional rules adopted by TSBP clarify operational standards for pharmacies. Pharmacy rules and laws are found in the Texas Pharmacy Act (TPA), which is Chapters 551 through 569 of the Texas Occupations Code,1 and the Texas Pharmacy Rules, which are found in Chapters 281 through 315 of the Texas Administrative Code (TAC).2

The information in this program was current as of July 2022. Many changes relevant to pharmacists and pharmacy technicians result from actions by the Texas State Legislature, which meets biennially. Regular Sessions begin at noon on the second Tuesday in January of odd-numbered years and end during the last week of May or the first week of June.3 The Texas Constitution limits the regular session to 140 calendar days.3

As in most states, the Texas Legislature is bicameral with a House of Representatives and a Senate. The 150 members of the Texas House of Representatives are elected for a 2-year terms from each of the State’s House Districts.3 In the upper chamber of the legislature, 31 Senators are elected for a 4-year term from each of the State’s Senate Districts.4Online information describes how a bill becomes law in Texas.

The majority of information in this program reflects actions taken by the TSBP in response to or as a direct result of laws passed by the Texas legislature in 2019 and 2021. The TSBP provides online summaries of pharmacy-related actions by the Texas legislature.5

Check the Pharmacy Rules and Laws for updates concerning specific practice areas. The TSBP lists recently adopted rule changes on their website by quarter.6 The TSBP also publishes a quarterly memorandum of adopted and proposed rules from the Board.7 All proposed and adopted changes to pharmacy law in Texas are published in the Texas Register, the weekly bulletin for rule-making within the state. The Texas Register can be accessed on the website of the Office of the Secretary of State of Texas.8

CONTINUING PHARMACY EDUCATION REQUIREMENTS

Every 2 years, pharmacists licensed in the state of Texas must complete at least 30 contact hours (3.0 continuing pharmacy education units [CEUs]) of continuing education to apply for license renewal. Those hours vary if a pharmacist is reinstating their license according to changes made to 22 TAC §281.66 that became effective on June 6, 2022.9 Pharmacy technicians licensed in the state of Texas must complete at least 20 contact hours (2.0 continuing education units [CEUs]) of continuing pharmacy education every 2 years to apply for license renewal. One of the hours (0.1 CEU) must relate to Texas pharmacy laws or rules.10

As of the renewal cycle after August 31, 2020, and before September 1, 2023, pharmacists continuing education must include at least11:

  • 1 hour (0.1 CEU) related to Texas pharmacy laws or rules
  • 1 hour (0.1 CEU) annually (2 hours per biennium) related to best practices, alternative treatment options, and multimodal approaches to pain management as specified in §481.0764 of the Texas Health and Safety Code
  • 1 hour (0.1 CEU) related to mental health awareness (requirement is specific to renewals after August 31, 2021, and before September 1, 2023)
  • 2 hours (0.2 CEU) related to approved procedures of prescribing and monitoring controlled substances that are obtained by September 1, 2021, and reported on the next renewal after September 1, 2021

For renewals received after August 31, 2020, and before September 1, 2022, pharmacists and pharmacy technicians must have completed the human trafficking prevention course required in §116.002 of the Texas Occupations Code.8 The purpose of these requirements, as stated in Board Rule §295.8, is to enhance the professional competency of licensed pharmacists and protect the health and welfare of the citizens of Texas.8

PHARMACIST INVOLVEMENT IN PATIENT CARE

Collaborative Practice Agreements and Payment for Pharmacist Services

Collaborative practice agreements (CPAs) create a formal relationship between a pharmacist and a prescriber, usually a physician but sometimes a nurse practitioner, physician assistant, or another type of prescriber. The CPA allows the prescriber to delegate certain patient care functions to the pharmacist, in addition to the pharmacist’s typical scope of practice, under negotiated conditions within the agreement.12 Delegated patient care functions may include initiating, modifying, or discontinuing drug therapy and ordering and interpreting laboratory tests.12 Using a CPA can make care more efficient by reducing repetitive communications among the pharmacist–prescriber team (e.g., by decreasing the number of refill requests, prescription modification requests, or other therapy change requests).12 Using CPAs can improve patient access to care, health outcomes, and care coordination.12

CPAs have become more common since collaborative care was first established in Washington State in 1979. Legislation or regulations for pharmacist practice CPAs exist in all U.S. states except Delaware.13 Section §295.13 of the TAC governs drug therapy management by a pharmacist under written protocol of a physician.14 During the 86th Texas Legislative Session in 2019, several bills were passed that affected this section.15 Senate Bill (SB) 1056 amended the Occupations Code to clarify that a physician may delegate to any properly qualified and trained pharmacist the implementation and modification of a patient’s drug therapy under protocol.15 This means all qualified and trained pharmacists can now be part of team-based care through collaborative practice protocols, including those in community and long-term care pharmacy settings. SB 1056 also specified that a pharmacist must maintain a copy of the protocol for inspection until the 7th anniversary of the protocol’s expiration date, at a minimum.14

House Bill (HB) 2425 amended the Occupations Code to allow physicians to delegate to a pharmacist practicing in a federally qualified health center (FQHC) the implementation and modification of a patient’s drug therapy under protocol, including the authority to sign a prescription drug order for dangerous drugs. 5 Pharmacists who practice in an FQHC are now able to adjust and manage a patient’s drug therapy, including signing a prescription drug order. Prior to passage of HB 2425, only pharmacists in hospitals, hospital-based clinics, and academic health care institutions had this authority.15 Patients in medically underserved areas will have expanded access to care as a result.

Payment for pharmacist-provided clinical pharmacy services goes hand in hand with expanded pharmacist scope of practice, including services provided under collaborative practice protocols. Payment for a pharmacist’s resources and time dedicated to improving patient care and outcomes is necessary for these services to be sustainable. Pharmacists are not recognized as providers under federal Medicare Part B and cannot directly bill that program for most of the clinical services they have been trained to provide.16 Collaborations with other health professionals, state insurers, private insurers, and health systems can allow pharmacists to develop more sustainable clinical programs in their practices. An additional avenue to achieve provider status and payment for services is at the state level, where 3 conditions must be met17:

  1. Designation of pharmacists as health care provider in state law
  2. Optimized scope of practice within the state pharmacy practice act
  3. Payment for services included within the State Insurance Code

The first and third of these conditions were addressed during the 86th Texas Legislative Session.15 HB 1757 amended the Insurance Code for commercial health plans in Texas by adding pharmacists to the list of health care practitioners and allowing an insured beneficiary to select a pharmacist to provide the services within the health insurance policy that are within the pharmacist’s scope of practice. Being listed as a practitioner means an insurer may not discriminate against pharmacists for payment or reimbursement for services performed in the scope of that pharmacist’s license if the same services or procedures are provided and covered by another listed health care practitioner. Additionally, HB 3441 amended the Insurance Code to prohibit a health benefit plan issuer or PBM of a health benefit plan from denying reimbursement to a pharmacist for the provision of a service or procedure within the scope of the pharmacist’s license that would be covered by the insurance policy or other coverage agreement if the service or procedure were provided by a physician, advanced practice nurse, or physician assistant.15 Examples of types of services that may be covered under this provision include medication management, administering CLIA-waived tests (e.g., flu, cholesterol, blood glucose, A1c), diabetes self-management, and other patient education programs. Both changes became effective for health plans issued or renewed on or after January 1, 2020. Pharmacists in Texas now have expanded collaborative practice authority and avenues for payment for their services.

Medication Therapy Management Services in Medicaid

Medication therapy management (MTM) is a distinct service or group of services that optimize therapeutic outcomes for individual patients that are independent of, but can occur in conjunction with, provision of a medication product.18 That definition is included in the regulations written to implement the Medicare Prescription Drug Improvement and Modernization Act of 2003, which expanded coverage of MTM services for some beneficiaries.18 Since then, MTM services have expanded beyond Medicare Part D and are included in commercial and government insurance plans.19

Research demonstrates that MTM can improve clinical outcomes and provider prescribing while offering economic benefits.20 As of March 2020, 11 states had some form of coverage for pharmacist-provided MTM services in their Medicaid programs. An additional 9 states had some MTM components incorporated into their Medicaid program.19 After passage during 2021’s 87th Texas Legislative Session, HB 2658 made a number of changes to the Texas Medicaid program, including directing the Texas Health and Human Services Commission (HHSC) to collaborate with managed care organizations to implement MTM services with a goal of lower costs and reducing adverse drug events for recipients.21 Because of broad language in HB 2658, it is unclear what the final MTM program will look like, and at the time this program was prepared, HHSC was still developing the program.

Expanded Patient Access to Insulin and Prescription Drug Savings

The issue of patient access to insulin has recently received global and national attention. The 100th anniversary of the discovery of insulin was celebrated in 2021, with recognition of an event that changed the prognosis for patients with diabetes.22

Numerous factors contribute have complicated patient access to insulins across the medication life cycle. These include consolidation among manufacturers and policy changes in the United States requiring manufacturer coverage of Medicare beneficiary costs for insulin.22,23 Yale University researchers recently published a study analyzing data from the 2017 to 2018 Medical Expenditures Panel Survey on Americans who use insulin, their insurance coverage (if any), and their risk of extreme financial burden. They found that 14.1% of insulin users, equating to 1.2 million people, reached catastrophic spending during the course of the year, meaning at least 40% of their postsubsistence income was spent on insulin. Medicare beneficiaries accounted for nearly two-thirds of these patients; 15.3% were Medicaid beneficiaries (61% less likely to experience catastrophic insulin expenses, compared with Medicare beneficiaries). Researchers noted that both income and insurance coverage affect patient spending on insulin.24,25

During 2021, the Texas Legislature passed SB 827 prohibiting health benefit plans and PBMs subject to Texas Department of Insurance (TDI) oversight from imposing a cost-share requirement on patients for insulin that exceeds $25 per prescription (30-day supply), regardless of the type or amount of insulin.21 PBMs must also include on their formularies at least 1 insulin product from each therapeutic class. The rule became effective on January 1, 2022, for contracts renewed or entered into after that date.

HB 1935 was also passed authorizing pharmacists to provide an emergency 30-day refill of insulin or insulin-related supplies or equipment, an extension of the previously required 72-hour supply.21 Health benefit plans and PBMs are required to reimburse pharmacies for providing these refills. This rule became effective January 1, 2022, for health plans issued or renewed after that date. The TSBP adopted amendments to TAC §291.34 in November 2021 implementing the bill.7 Pharmacy technicians should be familiar with these new insulin provisions and triage patients to pharmacists when needed and assisting in meeting the requirements set by the Board.

Under these amendments, pharmacists may use their professional judgment in refilling a prescription for insulin or insulin-related supplies without the prescriber’s authorization if they (1) have been unable to contact the prescriber after “reasonable effort” and (2) are given documentation that the patient was previously prescribed insulin or insulin-related supplies.26 Pharmacists should assess the patient and determine if the emergency refill is appropriate. They must document the patient visit, noting what documentation was provided documenting the prior use, and make a reasonable attempt to inform the prescriber of the emergency refill. Insulin-related equipment or supplies may not exceed the lesser of a 30-day supply or the smallest available package.26

Prescription Drug Savings Program for the Uninsured

Legislation passed in 2021, HB 18, established the Texas Cares Program to provide prescription drugs at a reduced cost to Texans without insurance.21 Texas HHSC is directed to form a trust fund with federal funds and to contract with a PBM or other entity to negotiate rebates for drugs covered under the program. The rebate would be credited when the patient pays for the prescription at a pharmacy’s pick-up or out window point of sale, providing a discounted amount for final patient payment.

While the bill carried a September 1, 2021, effective date, the extensive rule development needed for the program has delayed implementation. In its analysis, the Texas Pharmacists Association anticipated that the program “will primarily benefit uninsured patients taking brand name medications, such as insulin or EpiPens, where the price of the drug is exponentially inflated by PBM rebate demands.”

COMPREHENSIVE PBM REFORM

Texas joined 30 other states in 2021 in enacting PBM reform legislation.27 PBMs are for-profit companies that manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers, and other payers. Unlike other health care entities, PBMs are not subject to federal industry-wide regulation. They are subject to a patchwork of state regulations, which have been growing in the past several years.27 Many states have implemented or are seeking to implement PBM reforms such as licensure/registration, fair pharmacy audit, antisteering practices, and generic drug pricing legislation to address a lack of transparency in PBM practices.28

Three large companies lead the PBM market: Express Scripts, CVSHealth, and OptumRx. These PBMs cover an estimated 78% of Americans with prescription benefits that are managed by a PBM.28 Industry consolidation, rising prescription drug costs (not including the net rebates given to PBMs), and patient access are contributing factors to the growth in comprehensive PBM reform legislation.27, 28 Insurance premiums have decreased in some states that have implemented various reforms. Use of a reverse auction approach saved $2.5 billion in New Jersey over 5 years.27,29

HB 1763 amends the Texas insurance code to protect patients who receive prescription drug benefits through a commercial plan subject to TDI oversight. It creates these conditions for contracts renewed or entered into after September 1, 202121:

  • Prohibits PBM clawbacks that reduce the amount paid to a pharmacy for a prescription weeks or months after a prescription is filled
  • Allows local pharmacies to mail and deliver prescriptions if requested by the patient
  • Prohibits PBMs from steering patients to PBM-owned specialty pharmacies by requiring accreditations or certifications above those required by state and federal law
  • Prohibits PBMs from paying affiliated retail or mail-service pharmacies more than they pay other pharmacies in a network
  • Clarifies that pharmacists must have access to PBM contracts handled through a pharmacy services administrative organization
  • Provides legal protections for pharmacies against retaliatory actions by PBMs for lodging appeals or complaints against PBMs

HB 1919 amends the Texas insurance code to put restrictions on PBM’s ability to steer patients to pharmacies they own.21 PBMs cannot use online or patient-specific messaging or reduced cost-sharing to incent patients to use their pharmacies. They also cannot use patient-specific prescription information for commercial purposes. Patient consent is required for any prescription transfers. HB 1919 also creates safeguards to put the patient’s best interests over PBM profits.21

Protection From PBM Wholesale Invoice Audits

HB 1455 prohibits PBMs that conduct wholesale invoice audits from auditing a pharmacy’s claims from another PBM or health plan.15 PBMs are also prohibited from finding an audit discrepancy:

  • If the National Drug Code (NDC) for the dispensed drug is in a quantity that is a subunit or multiple of the drug purchased by the pharmacist or pharmacy as supported by a wholesale invoice
  • The correct quantity of the drug was dispensed according to the prescription
  • The dispensed drug shares all but the last 2 digits of the NDC of the drug reflected on the supplier invoice

PBMs are required to accept copies of supplier invoices possessed by the audited pharmacy as validity of a claim, subject to the validation by pharmacy purchase order and payment of supplier invoice.15 The law became effective on September 1, 2019.

Prior Authorization and Utilization Review Reforms

An additional bill, HB 3459, addressed prior authorization (PA) and utilization review (UR) by health plans subject to TDI oversight.21 Physicians and other providers are exempt from PA requirements for a medication or particular health services if they have submitted at least 5 PA requests for the same medication or service in the previous year and 80% of the PAs were approved by the health benefit plan. The UR must be conducted by a Texas-licensed physician in the same or similar specialty to the physician who is subjected to the UR.

This new PA exemption could save pharmacists’ and pharmacy technicians’ time when having to process PA requests through physician practices and expedite a patient’s receipt of their medication. UR provisions became effective September 1, 2021, and PA provisions became effective on January 1, 2022.21

OPERATIONAL CHANGES

Prescription Monitoring Programs, Controlled Substances, and Dextromethorphan

The Texas Prescription Monitoring Program (PMP) collects and monitors prescription data for all Schedule II, III, IV, and V Controlled Substances (CS) dispensed by pharmacies in Texas or to Texas residents from pharmacies located in other states.30 All pharmacies that are licensed in Texas to dispense controlled substances are required to report information about dispensed Schedule II, III, IV and V controlled substance prescriptions to the PMP database within 1 business day of the complete filling of the prescription.30 Since March 1, 2020, pharmacists and prescribers other than veterinarians have been required to check a patient’s PMP history before prescribing or dispensing opioids, benzodiazepines, barbiturates, or carisoprodol.31 A $500 administrative penalty for a violation of failing to consult the PMP was adopted on August 4, 2020.32

On February 2, 2021, the TSBP adopted amendments to §315.15 specifying that the duty to consult the PMP is limited to prescriptions for outpatients.33 Additionally, TSBP clean-up bills HB 2847 and SB 683 updated sections of the TPA and the Controlled Substance Act (CSA).15 Effective September 1, 2019, pharmacies must submit a “zero” report if they do not dispense any controlled substances during a 7-day period. Pharmacist interns were given access to the PMP as were pharmacy technician trainees as delegates.

Safe disposal of Schedule II controlled substances was addressed in HB 2088.15 Effective January 1, 2020, a pharmacist who dispenses Schedule II controlled substances must provide written notice on the safe disposal of controlled substances to the patient unless the dispensing pharmacy is authorized to take back those drugs for disposal, regularly accepts those drugs for safe disposal, or provides at no cost to the patient either a mail-in pouch to dispose of the drugs or chemicals to render the unused drugs unusable. The written notice must include information on locations where Schedule II controlled substance prescription drugs are accepted for safe disposal, or alternatively provide the address of an internet website specified by the TSBP that provides a link to a searchable database of locations where Schedule II controlled substance prescription drugs are accepted for safe disposal. The written notice may be provided to the patient in an electronic format, such as by e-mail, if the patient or patient's agent requests the notice in an electronic format and the request is documented.34

Electronic prescribing of controlled substances became effective in Texas on January 1, 2021.15 Just prior to the rule’s effective date, the TSBP clarified circumstances under which a controlled substance prescription is not required to be issued electronically as well as the process for prescribers to request waivers to the rule. Prescriptions may be issued in writing due to temporary technological or electronic failure or if the medication is to be dispensed by a pharmacy located outside of Texas.34

Addressing dextromethorphan abuse, HB 1518 prohibits the over-the-counter (OTC) sale of dextromethorphan to individuals under the age of 18 years, effective September 1, 2019.15 A business establishment must require a driver’s license or other form of identification containing the customer’s photograph and age before dispensing, distributing, or selling OTC dextromethorphan. If a person’s outward appearance allows for reasonable presumption that they are older than 27, identification does not need to be requested. Pharmacists may dispense dextromethorphan by prescription for valid medical purposes to someone younger than 18 years of age.

Licensure, Ratios, and Pharmacist Technician Duties

The 2019 to 2022 period was an active one for changes in licensure, ratios, and allowable duties for Texas pharmacy personnel.

In 2019, the Texas legislature took action regarding licensure of health professionals who are convicted of certain sex-related and violent behaviors. HB 1899 requires the TSBP to revoke a pharmacist license or deny a license application for an applicant who35

  • Is required to register as a sex offender;
  • Has been previously convicted of or placed on deferred adjudication community supervision for the commission of a felony offense involving the use or threat of force; or
  • Has been previously convicted of or placed on deferred adjudication community supervision for sexual assault, aggravated assault, aggravated sexual assault, or injury to a child, elderly individual, or disabled individual, or another similar state or federal law, committed when the applicant held a license in this state or another state, in the course of providing services to a patient.

Enabling regulations of this law are in TAC §281.69.36

In another change, TSBP may no longer take disciplinary action against a pharmacist, pharmacy technician, or pharmacy technician trainee for failing to repay a student loan in accordance with SB37.35

Pharmacist, pharmacy technician, and pharmacist technician trainee license fee increases were adopted by the TSBP in August 2021.

Under HB 3496, sworn disclosure statements are required for applicants for pharmacy licenses other than those for classes B and C (nuclear and institutional pharmacies, respectively) and with the exception of publicly traded companies or pharmacies wholly owned by a retail grocery store chain.35 In some circumstances, a surety bond may be required. The bill amended Section 565.002(a) of the TPA to specify that the TSBP may discipline an applicant or pharmacy license holder if the Board finds that they engaged in fraud, deceit, or misrepresentation as defined by Board rule in dispensing drugs for nontherapeutic purposes. A new section 565.0591 was added to the TPA that TSBP notify a pharmacy that has ceased to operate for a period of 30 days or more that the license will be revoked for a violation of Section 565.002(a)(7) of the TPA and inform the license holder of the right to a hearing to contest the revocation. The rule became effective January 1, 2020.

Another change, adopted in 2021, allows military spouses, in addition to military service members and military veterans residing in Texas, to present a copy of a permanent change of station order as proof of residency. It also adds the recently formed U.S. Space Force to the definition of armed forces of the United States.37

Rules were adopted by TSBP to remove the ratio of pharmacists to pharmacist interns.38 Pharmacist-to-pharmacist technician ratios were also expanded and eliminated in some pharmacy types. Ratios were increased to 1:6 from 1:4 in community and nuclear pharmacies.39,40 Ratios were eliminated in central prescription drug or medication order processing pharmacies; they were 1:8 before the change.41

Amendments to §291.121 expanded a pharmacist technician’s nonjudgmental duties within a remote pharmacy to include receiving oral prescription drug orders for dangerous drugs.42 Within community, satellite, and central prescription drug or medication order processing pharmacies, this expansion applies to both pharmacy technicians and pharmacy technician trainees.41-43 These licensees were also given authority to reduce oral prescription orders to writing manually or electronically and to give or receive prescription transfers for dangerous drugs.

Automated Medication Supply Systems

Amendments to §291.76 and §291.151 allow a licensed nurse authorized by the pharmacist to load an automated medication supply system within a freestanding ambulatory surgery center and freestanding emergency medical care facility.44

Valid Prescription From Telemedicine or Teledentistry Visit

The TSBP adopted amendments to §291.29 in accordance with HB 2056 to establish the validity of a prescription issued as a result of telemedicine medical services or teledentistry dental services.45 The new rule says validity is determined by the same standards that would apply to the issuance of in-person prescriptions. A valid prescription from telemedicine or teledentistry services must be issued for a legitimate medical purpose by a practitioner as part of a practitioner–patient relationship as set out in Texas Occupations Code §111.005 and meet all other applicable laws before prescribing, dispensing, delivering, or administering a dangerous drug or controlled substance can occur.46

CONCLUSION

Laws and regulations governing the practice of pharmacy in the state of Texas are continually reviewed by the TSBP and amended as needed or warranted according to changes in education requirements, practice site conditions, or patient care needs. Some changes are important and affect the daily operations of pharmacists and pharmacy technicians in many settings, while others are little more than vocabulary clarifications or grammatical changes to existing laws and rules. However, the purpose of the changes is to provide for the safest and best care possible for patients in Texas.

Texas pharmacy personnel can consult online versions of the Texas Pharmacy Act and the Texas Pharmacy Rules for current laws and regulations. Staying up to date with changes—both big and small—is a necessary part of pharmacy practice and ensures that pharmacists are operating within the law using contemporary knowledge and practice standards.

REFERENCES

  1. 1 Texas Pharmacy Act. Accessed June 26, 2022. https://www.pharmacy.texas.gov/Rules_Pharmacy_Act.asp
  2. Texas Pharmacy Rules. Accessed June 26, 2022. https://www.pharmacy.texas.gov/Rules_Pharmacy_Rules.asp
  3. How a bill becomes law. The Texas House of Representatives website. Accessed June 27, 2022. https://house.texas.gov/about-us/bill/
  4. Texas Senators of the 87th legislature. Texas Senate website. Accessed June 27, 2022. https://senate.texas.gov/members.php
  5. Legislative update summaries. Texas Board of Pharmacy website. Accessed June 26, 2022. https://www.pharmacy.texas.gov/newsletter/legislative_update_summaries.asp
  6. Recent adopted rule changes. Texas Board of Pharmacy website. Accessed June 26, 2022. https://www.pharmacy.texas.gov/Rules_Recent_Adopted_Changes.asp
  7. Rule update summaries. Texas Board of Pharmacy website. Accessed June 26, 2022. https://www.pharmacy.texas.gov/newsletter/Rule_Update_Summaries.asp
  8. State rules and open meetings. Texas Secretary of State website. Accessed June 26, 2022. https://www.sos.state.tx.us/texreg/index.shtml
  9. Texas Administrative Code. Section 281.66. Application for reissuance or removal of restrictions of a license or registration. June 6, 2022. Accessed June 26, 2022. https://casetext.com/regulation/texas-administrative-code/title-22-examining-boards/part-15-texas-state-board-of-pharmacy/chapter-281-administrative-practice-and-procedures/subchapter-c-disciplinary-guidelines/section-28166-application-for-reissuance-or-r
  10. Texas Administrative Code: Section 297.8. Continuing education requirements. December 9, 2019. Accessed July 18, 2022. https://casetext.com/regulation/texas-administrative-code/title-22-examining-boards/part-10-texas-funeral-service-commission/chapter-203-licensing-and-enforcement-specific-substantive-rules/subchapter-a-licensing/section-2038-continuing-education
  11. Texas Administrative Code: Section 295.8. Continuing education requirements. June 18, 2020. Accessed June 26, 2022. http://txrules.elaws.us/rule/title22_chapter295_sec.295.8
  12. Advancing team-based care through collaborative practice agreements: a resource and implementation guide for adding pharmacists to the care team. Centers for Disease Control and Prevention. Accessed June 27, 2022. cdc.gov/dhdsp/pubs/docs/CPA-Team-Based-Care.pdf
  13. Sachdev, G, Kliethermes, MA, Vernon, V, Leal, S, Crabtree, G. Current status of prescriptive authority by pharmacists in the United States. J Am Coll Clin Pharm. 2020;3:807–817. https://doi.org/10.1002/jac5.1245
  14. Texas Administrative Code: Section 295.13. Drug therapy management by a pharmacist under written protocol of a physician. Updated March 14, 2021. Accessed July 5, 2022. https://www.pharmacy.texas.gov/files_pdf/BN/Feb21/D.1.2.pdf
  15. 2019 Texas legislative wrap-up. 86th Texas Legislative Session. Texas Pharmacists Association. Accessed July 5, 2022. https://www.texaspharmacy.org/page/2019Wrapup
  16. Billing and payment. American Pharmacists Association. Accessed July 5, 2022. https://pharmacist.com/Practice/Practice-Resources/Billing-Payment-Center
  17. Kliethermes MA. What is needed for pharmacists to bill directly and get paid for patient care services under the fee for service model. American Society of Health-System Pharmacists website. January 30, 2020. Accessed July 5, 2022. https://connect.ashp.org/blogs/mary-kliethermes/2020/01/30/what-is-needed-for-pharmacists-to-bill-directly-an?ssopc=1
  18. Bluml BM. Definition of medication therapy management: development of professionwide consensus. J Am Pharm Assoc (2003). 2005;45(5):566-572. doi:10.1331/1544345055001274
  19. Medication therapy management (MTM) services. American Pharmacists Association. Accessed July 5, 2022. https://pharmacist.com/Practice/Patient-Care-Services/Medication-Management
  20. Centers for Disease Control and Prevention. Pharmacist-provided medication therapy management in Medicaid. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2021. Accessed July 5, 2022. https://www.cdc.gov/dhdsp/docs/MTM_in_Medicaid-508.pdf
  21. 2021 Texas legislative wrap-up: 87th Texas legislative session. Texas Pharmacists Association. Accessed July 5, 2022. https://www.texaspharmacy.org/page/2021Wrapup
  22. Beran D, Lazo-Porras M, Mba CM, Mbanya JC. A global perspective on the issue of access to insulin. Diabetologia. 2021;64(5):954-962. doi:10.1007/s00125-020-05375-2
  23. Cubanski J, Neuman T, True S, et.al. Insulin costs and coverage in Medicare Part D. Kaiser Family Foundation. June 4, 2020. Accessed July 6, 2022. https://www.kff.org/report-section/insulin-costs-and-coverage-in-medicare-part-d-issue-brief/
  24. Bakkila BF, Basu S, Lipska KJ. Catastrophic spending on insulin in the United States, 2017–18. Health Affairs. 2021;41(7). https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2021.01788
  25. Locklear M. Insulin is an extreme financial burden for over 14% of Americans who use it. MedicalXpress. July 5, 2022. Accessed July 6, 2022. https://medicalxpress.com/news/2022-07-insulin-extreme-financial-burden-americans.html
  26. Texas Administrative Code: Section 291.34. Pharmacies. Community pharmacies (class a). Records. Updated March 15, 2022. Accessed July 6, 2022. https://casetext.com/regulation/texas-administrative-code/title-22-examining-boards/part-15-texas-state-board-of-pharmacy/chapter-291-pharmacies/subchapter-b-community-pharmacy-class-a/section-29134-records
  27. Becker C. Prescription drug trends: pharmacy benefit manager reform, affordability boards and more. National Conference of State Legislators. January 28, 2022. Accessed July 6, 2022. https://www.ncsl.org/research/health/prescription-drug-trends-benefit-manager-reform-affordability-boards-and-more-magazine2022.aspx
  28. Concerns regarding the pharmacy benefit management industry. Applied Policy. National Association of Community Pharmacists. November 2015. Accessed July 6, 2022. http://www.ncpa.co/pdf/advocacy/concerns-pbm-issue-brief.pdf
  29. PBM reform has not raised costs for patients and payers. National Community Pharmacists Association. Accessed July 17, 2022. https://ncpa.org/sites/default/files/2022-03/pbm-regulations-one-pager.pdf
  30. Texas State Board of Pharmacy. Texas Prescription Monitoring Program. Accessed July 18, 2022. https://www.pharmacy.texas.gov/PMP/
  31. Texas Prescription Monitoring Program. Texas State Board of Pharmacy. Accessed July 7, 2022. https://www.pharmacy.texas.gov/PMP/
  32. Texas Administrative Code. Section 281.65: Schedule of administrative penalties. Updated September 9, 2020. Accessed July 7, 2022. https://casetext.com/regulation/texas-administrative-code/title-26-health-and-human-services/part-1-health-and-human-services-commission/chapter-554-nursing-facility-requirements-for-licensure-and-medicaid-certification/subchapter-v-enforcement/division-2-licensing-remedies/section-5542112-administrative-penalties
  33. Rule update summaries. Texas State Board of Pharmacy. Accessed July 7, 2022. https://www.pharmacy.texas.gov/files_pdf/rule-memo/feb-2021.pdf
  34. Texas Administrative Code. Section 3: Prescriptions. Updated June 9, 2021. Accessed July 7, 2022. https://casetext.com/regulation/texas-administrative-code/title-22-examining-boards/part-15-texas-state-board-of-pharmacy/chapter-315-controlled-substances/section-3153-prescriptions
  35. 2019 Texas legislative session summary (86th Texas legislature). Texas Board of Pharmacy website. Accessed July 7, 2022. https://www.pharmacy.texas.gov/files_pdf/newsletter_pdfs/86th%20Texas%20Legislature%20-%20Highlights%20_06_28_2019.pdf
  36. Texas Administrative Code. Section 281.69: Automatic denial or revocation. Updated March 5, 2020. Accessed https://casetext.com/regulation/texas-administrative-code/title-19-education/part-7-state-board-for-educator-certification/chapter-249-disciplinary-proceedings-sanctions-and-contested-cases/subchapter-b-enforcement-actions-and-guidelines/section-24912-administrative-denial-appeal
  37. Rule update summaries. Texas State Board of Pharmacy. Accessed July 7, 2022. https://www.pharmacy.texas.gov/files_pdf/rule-memo/nov-2021.pdf
  38. Texas Administrative Code. Section 283.5: Pharmacist-intern duties. Updated December 10, 2020. Accessed July 7, 2022. https://casetext.com/regulation/texas-administrative-code/title-22-examining-boards/part-15-texas-state-board-of-pharmacy/chapter-283-licensing-requirements-for-pharmacists/section-2835-pharmacist-intern-duties
  39. Texas Administrative Code. Section 291.32: Personnel. Updated December 10, 2020. Accessed July 7, 2022. https://casetext.com/regulation/texas-administrative-code/title-22-examining-boards/part-15-texas-state-board-of-pharmacy/chapter-291-pharmacies/subchapter-b-community-pharmacy-class-a/section-29132-personnel
  40. Texas Administrative Code. Section 291.53: Personnel. Updated December 10, 2020. Accessed July 7, 2022. https://casetext.com/regulation/texas-administrative-code/title-22-examining-boards/part-15-texas-state-board-of-pharmacy/chapter-291-pharmacies/subchapter-c-nuclear-pharmacy-class-b/section-29153-personnel
  41. Texas Administrative Code. Section 291.153: Central prescription drug or medication order processing pharmacy (Class G). Updated December 10, 2020. Accessed July 7, 2022. https://casetext.com/regulation/texas-administrative-code/title-22-examining-boards/part-15-texas-state-board-of-pharmacy/chapter-291-pharmacies/subchapter-h-other-classes-of-pharmacy/section-291153-central-prescription-drug-or-medication-order-processing-pharmacy-class-g
  42. Texas Administrative Code. Section 291.129: Satellite pharmacy. Updated December 10, 2020. Accessed July 7, 2022. https://casetext.com/regulation/texas-administrative-code/title-22-examining-boards/part-15-texas-state-board-of-pharmacy/chapter-291-pharmacies/subchapter-g-services-provided-by-pharmacies/section-291129-satellite-pharmacy
  43. Texas Administrative Code. Section 291.33: Operational standards. Updated December 10, 2020. Accessed July 7, 2022. https://casetext.com/regulation/texas-administrative-code/title-22-examining-boards/part-15-texas-state-board-of-pharmacy/chapter-291-pharmacies/subchapter-b-community-pharmacy-class-a/section-29133-operational-standards
  44. Rule update summaries. Texas State Board of Pharmacy. Accessed July 7, 2022. https://www.pharmacy.texas.gov/files_pdf/rule-memo-august-2020.pdf
  45. 2021 Texas legislative session summary (87th Texas legislature). Texas Board of Pharmacy website. Accessed July 7, 2022. https://www.pharmacy.texas.gov/files_pdf/newsletter/2021-87th-tx-leg-summaries.pdf
  46. Texas Administrative Code. Section 291.29: Professional responsibility of pharmacists. Updated March 15, 2022. Accessed July 7, 2022. https://casetext.com/regulation/texas-administrative-code/title-22-examining-boards/part-15-texas-state-board-of-pharmacy/chapter-291-pharmacies/subchapter-a-all-classes-of-pharmacies/section-29129-professional-responsibility-of-pharmacists

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