A.R.S. § 32-1979.04: Pharmacists; statewide written protocol; independent testing; treatment; health conditions; notification and insurance requirements

A. Pursuant to a statewide written protocol approved by the board, a pharmacist may independently order, perform and interpret tests that are authorized by the United States food and drug administration and waived under the clinical laboratory improvement amendments of 1988 (P.L. 100-578; 102 Stat. 2903; 42 United States Code section 201). A pharmacist may independently initiate treatment to eligible persons who are at least twelve years of age or the age authorized by the treatment, whichever age is older, and who have test results that indicate the need for treatment, by a test that is authorized by the United States food and drug administration and waived under the clinical laboratory improvement amendments of 1988, for any of the following:

1. Influenza.

2. Group A streptococcus pharyngitis.

3. SARS-COV-2 or any other coronavirus respiratory illness.

4. A condition related to an emerging or existing public health threat identified by the department of health services for which a statewide standing order, rule or executive order is issued.

B. When developing the statewide written protocol, the board shall address at a minimum the following:

1. Documentation.

2. Records retention.

3. Referrals.

4. Patient screening requirements and obtaining relevant medical history.

5. Exclusion criteria.

6. Treatment instructions based on the patient's age and medical history.

7. Follow-up maintenance and care plans.

8. Pharmacist training and certification requirements.

C. A pharmacist who orders or conducts testing or treats health conditions pursuant to subsection A of this section shall use any test that may guide clinical decision-making for which a waiver has been obtained under the clinical laboratory improvement amendments of 1988, or the federal rules adopted thereunder, or any screening procedure that is established by the statewide written protocol.

D. A pharmacist shall use evidence-based clinical guidelines published by the United States centers for disease control and prevention or the infectious diseases society of America, the American academy of pediatrics committee on infectious disease or another clinically recognized recommendation that aligns with standards of care in providing patient treatment pursuant to subsection A of this section.

E. An eligible person must meet criteria for treatment based on the statewide written protocol that specifies the following:

1. Patient inclusion and exclusion criteria.

2. Explicit medical referral criteria.

F. A pharmacist shall refer a patient to the patient's primary care provider, if one is identified, or recommend follow-up with a primary care provider, if the patient either:

1. Is not eligible for treatment pursuant to this section and presents with symptoms.

2. Does not respond to the initial treatment provided pursuant to this section.

G. A pharmacist who initiates a treatment under this section shall:

1. Notify the patient's primary care provider, if one is identified, within seventy-two hours after initiating treatment pursuant to this section. The notice shall include the patient's name, the treatment initiated and the date of treatment and may be submitted by entry into an electronic health record or by telephone, fax, mail or email. The pharmacist shall make a reasonable effort to identify the patient's primary care provider by at least one of the following methods:

(a) Checking pharmacy records.

(b) Requesting the information from the patient or, for a patient under eighteen years of age, the patient's parent or guardian.

2. Maintain for at least seven years a record of the results of any testing or screening for which a treatment is initiated pursuant to this section, including a summary of the visit, patient assessment information, history of illness, examination findings, vitals and plan of care.

3. Notify the patient's primary care provider, if one is identified, within forty-eight hours after the occurrence of any adverse reaction that is reported to or witnessed by the pharmacist as a result of the treatment provided pursuant to this section.

4. Provide informational materials to the patient requesting treatment or, for a patient under eighteen years of age, to the patient's parent or guardian about the importance of pediatric preventive health care visits as recommended by the American academy of pediatrics.

H. A pharmacist may delegate the task of performing a test waived by the clinical laboratory improvement amendments of 1988 to a licensed member of the pharmacy staff who is under the supervision of the pharmacist. A pharmacist may not delegate any tasks that include clinical judgment or treatment and may delegate only ancillary duties as allowed by board rules.

I. This section does not require a pharmacist to provide the services authorized by this section. Pursuant to section 32-1901.01, subsection A, paragraph 21, an employer may not overrule a pharmacist's decision to not provide services that are authorized by this section.

J. This section does not establish a cause of action against a patient's primary care provider for any adverse reaction, complication or negative outcome arising from any treatment initiated by a pharmacist pursuant to this section.

K. A pharmacist may not independently initiate a treatment using opioids for a patient.

L. A pharmacist may not independently order a test or screening or treat a minor without the written consent of the minor's parent or guardian.

M. A pharmacy shall display a notice and include in a patient's consent paperwork that the testing and treatment being performed pursuant to this section are being performed by a pharmacist without consultation with or oversight by a physician and that the patient should consult with a primary care provider if symptoms continue.

N. Each pharmacy where testing and treatment services are provided pursuant to this section shall ensure that there is an area that provides privacy to patients for the testing and treatment services.

O. A pharmacist shall maintain professional liability insurance if performing services that are authorized under this section.