A1503

An Act concerning the issuance of prescriptions by veterinarians, supplementing Chapter 16 of Title 45 of the Revised Statutes, and amending P.L.2007, c.244.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. (New section) a. Whenever a veterinarian prescribes a medication for use by an animal, the veterinarian shall issue the prescription in the name of the animal’s owner. The veterinarian shall also indicate, on the prescription blank, the name of the animal that is to be administered the prescribed medication. The person named on the prescription blank shall be the only person who is authorized to possess the prescribed drug for the purposes of administering it to the identified animal.

b. If an animal is jointly possessed by multiple owners, and more than one of the owners wishes to engage in administration of the prescribed drug to the animal, the prescribing veterinarian shall, upon request, list the name of each owner on the prescription blank that is issued pursuant to subsection a. of this section. In such a case, the prescribed drug, in the amount and dosage listed on the prescription blank, may be dispensed to any of the owners listed on the prescription blank, and any of those identified owners may possess the prescribed medication for the purposes of administering it to the identified animal. Except in the case of authorized prescription refills, nothing in this subsection shall be deemed to authorize an animal owner to fill a prescription issued under this section, if the prescription has already been filled by a co-owner on a previous occasion.

c. Before issuing a prescription under this section for a controlled dangerous substance, a veterinarian shall review relevant prescription monitoring information obtained under the Prescription Monitoring Program, as provided by section 26 of P.L.2007, c.244 (C.45:1-46).

d. As used in this section, “owner” means an individual who has a right of property in an animal, or who has an animal in their keeping, at the time when veterinary care is sought for the animal. “Owner” includes any private citizen, such as a pet owner, animal foster care parent, or private animal rescuer, who is providing a temporary or permanent home for the animal at the time when veterinary care is sought; or the owner, operator, or designated employee of a pet shop, pound, kennel, animal shelter, animal boarding facility, or animal rescue facility where an animal is being temporarily housed at the time when veterinary care is sought.

e. The State Board of Veterinary Medical Examiners shall adopt rules and regulations, pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), as may be necessary to effectuate the purposes of this section.

2. Section 24 of P.L.2007, c.244 (C.45:1-44) is amended to read as follows:

24. Definitions. As used in sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50):

"CDS registration" means registration with the Division of Consumer Affairs to manufacture, distribute, dispense, or conduct research with controlled dangerous substances issued pursuant to section 11 of P.L.1970, c.226 (C.24:21-11).

"Certified medical assistant" means a person who is a graduate of a post-secondary medical assisting educational program accredited by the American Medical Association's Committee on Allied Health Education and Accreditation (CAHEA), or its successor, the Accrediting Bureau of Health Education Schools (ABHES), or its successor, or any accrediting agency recognized by the U.S. Department of Education, which educational program includes, at a minimum, 600 clock hours of instruction, and encompasses training in the administration of intramuscular and subcutaneous injections, as well as instruction and demonstration in: pertinent anatomy and physiology appropriate to injection procedures; choice of equipment; proper technique, including sterile technique; hazards and complications; and emergency procedures; and who maintains current certification or registration, as appropriate, from the Certifying Board of the American Association of Medical Assistants (AAMA), the National Center for Competency Testing (NCCT), the American Medical Technologists (AMT), or any other recognized certifying body approved by the Board of Medical Examiners.

“Certified veterinary aide” means a person who has passed the Veterinary Technician National Examination and is certified by the New Jersey Veterinary Technicians and Assistants Association (NJVTA), or its successor organization, to provide services in this State as a veterinary technician; and any person who has passed the Approved Veterinary Assistant Examination, developed by the Approved Veterinary Assistant Committee of the National Association of Veterinary Technicians of America (NAVTA), and who is certified to provide services in this State as an Approved Veterinary Assistant.

"Controlled dangerous substance" means any substance that is listed in Schedules II, III, and IV of the schedules provided under the "New Jersey Controlled Dangerous Substances Act," P.L.1970, c.226 (C.24:21-1 et seq.). Controlled dangerous substance also means any substance that is listed in Schedule V under the "New Jersey Controlled Dangerous Substances Act" when the director has determined that reporting Schedule V substances is required by federal law, regulation, or funding eligibility.

"Dental resident" means a person who practices dentistry as a resident pursuant to R.S.45:6-20 and, pursuant to N.J.A.C.13:30-1.3, is a graduate of a dental school approved by the Commission on Dental Accreditation and has passed Part I and Part II of the National Board Dental examination and obtained a resident permit from the New Jersey Board of Dentistry.

"Director" means the Director of the Division of Consumer Affairs in the Department of Law and Public Safety.

"Division" means the Division of Consumer Affairs in the Department of Law and Public Safety.

"Licensed health care professional" means a registered nurse, licensed practical nurse, advanced practice nurse, physician assistant, or dental hygienist licensed pursuant to Title 45 of the Revised Statutes.

"Licensed pharmacist" means a pharmacist licensed pursuant to P.L.2003, c.280 (C.45:14-40 et seq.).

"Medical resident" means a graduate physician who is authorized to practice medicine and surgery by means of a valid permit issued by the State Board of Medical Examiners to a person authorized to engage in the practice of medicine and surgery while in the second year or beyond of a graduate medical education program pursuant to N.J.A.C.13:35-1.5.

"Mental health practitioner" means a clinical social worker, marriage and family therapist, alcohol and drug counselor, professional counselor, psychologist, or psychoanalyst licensed or otherwise authorized to practice pursuant to Title 45 of the Revised Statutes.

"Pharmacy permit holder" means an individual or business entity that holds a permit to operate a pharmacy practice site pursuant to P.L.2003, c.280 (C.45:14-40 et seq.).

"Practitioner" means [an] a physician, veterinarian, or other individual who is currently licensed, registered, or otherwise authorized by this State or another state to prescribe drugs in the course of professional practice.

"Registered dental assistant" is a person who has fulfilled the requirements for registration established by "The Dental Auxiliaries Act," P.L.1979, c.46 (C.45:6-48 et al.) and works under the direct supervision of a licensed dentist.

"Ultimate user" means a person who has obtained from a dispenser and possesses for the person's own use, or for the use of a member of the person's household or an animal owned by the person or by a member of the person's household, a controlled dangerous substance.

“Veterinary client” or “client” means an animal owner who receives a prescription from a veterinarian, pursuant to section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill), for a drug that is intended for use by an animal; and who is identified on the prescription blank as being authorized to fill the prescription and possess the drug for the purposes of administering it to the animal.

(cf: P.L.2015, c.74, s.2)

3. Section 25 of P.L.2007, c.244 (C.45:1-45) is amended to read as follows:

25. Prescription Monitoring Program; requirements.

a. There is established the Prescription Monitoring Program in the Division of Consumer Affairs in the Department of Law and Public Safety. The program shall consist of an electronic system for monitoring controlled dangerous substances that are dispensed in or into the State by a pharmacist in an outpatient setting.

b. Each pharmacy permit holder shall submit, or cause to be submitted, to the division, by electronic means in a format and at such intervals as are specified by the director, information about each prescription for a controlled dangerous substance dispensed by the pharmacy that includes:

(1) The surname, first name, and date of birth of the patient for whom the medication is intended , or, if the medication has been prescribed by a veterinarian for use by an animal, the surname, first name, and date of birth of the veterinary client or clients identified on the prescription blank, and the name and approximate age of the animal for whom the controlled dangerous substance was prescribed;

(2) The street address and telephone number of the patient or veterinary client;

(3) The date that the medication is dispensed;

(4) The number or designation identifying the prescription and the National Drug Code of the drug dispensed;

(5) The pharmacy permit number of the dispensing pharmacy;

(6) The prescribing practitioner's name and Drug Enforcement Administration registration number;

(7) The name, strength, and quantity of the drug dispensed, the number of refills ordered, and whether the drug was dispensed as a refill or a new prescription;

(8) The date that the prescription was issued by the practitioner;

(9) The source of payment for the drug dispensed;

(10) Identifying information for any individual, other than the patient or veterinary client for whom the prescription was written, who picks up , or attempts to pick up, a prescription, if the pharmacist has a reasonable belief that the person [picking up the prescription] may be seeking [a] the controlled dangerous substance, in whole or in part, for any reason other than delivering the substance to the patient or animal, as appropriate, for the treatment of an existing medical condition; and

(11) Such other information, not inconsistent with federal law, regulation, or funding eligibility requirements, as the director determines necessary.

The pharmacy permit holder shall submit the information to the division with respect to the prescriptions dispensed during the reporting period not less frequently than every seven days.

c. The division may grant a waiver of electronic submission to any pharmacy permit holder for good cause, including financial hardship, as determined by the director. The waiver shall state the format in which the pharmacy permit holder shall submit the required information.

d. The requirements of this act shall not apply to: the direct administration of a controlled dangerous substance to the body of an ultimate user; or the administration or dispensing of a controlled dangerous substance that is otherwise exempted as determined by the Secretary of Health and Human Services pursuant to the "National All Schedules Prescription Electronic Reporting Act of 2005," Pub.L.109-60.

e. The provisions of paragraph (10) of subsection b. of this section shall not take effect until the director determines that the Prescription Monitoring Program has the technical capacity to accept the information required by that paragraph.

(cf: P.L.2015, c.74, s.3)

4. Section 26 of P.L.2007, c.244 (C.45:1-46) is amended to read as follows:

26. Access to prescription information.

a. The division shall maintain procedures to ensure the privacy and confidentiality of [patients] patient and veterinary client information. To that end, the division shall ensure that any patient or client information that is collected, recorded, transmitted, and maintained is not disclosed, except as permitted in this section, including, but not limited to, through the use of a password-protected system [for maintaining] that maintains this information and [permitting] permits access thereto as authorized under sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50), and through the imposition of a requirement that a person [as listed] identified in subsection h. or i. of this section provide affirmation of the person's intent to comply with the provisions of sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50) as a condition of accessing the information.

b. The prescription monitoring information submitted to the division shall be confidential , and shall not be subject to public disclosure under P.L.1963, c.73 (C.47:1A-1 et seq.)[,] or P.L.2001, c.404 (C.47:1A-5 et al.).

c. The division shall review the prescription monitoring information provided by a pharmacy permit holder pursuant to sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50). The review shall include, but not be limited to:

(1) a review to identify whether any person is obtaining a prescription in a manner that may be indicative of misuse, abuse, or diversion of a controlled dangerous substance. The director shall establish guidelines regarding the terms "misuse," "abuse," and "diversion" for the purposes of this review. When an evaluation of the information indicates that a person may be obtaining a prescription for the same or a similar controlled dangerous substance from multiple practitioners or pharmacists during the same time period, the division may provide prescription monitoring information about the person to practitioners and pharmacists; and

(2) a review to identify whether a violation of law or regulation or a breach of the applicable standards of practice by any person may have occurred, including, but not limited to, diversion of a controlled dangerous substance. If the division determines that such a violation or breach may have occurred, the division shall notify the appropriate law enforcement agency or professional licensing board, and provide the prescription monitoring information required for an investigation.

d. (Deleted by amendment, P.L.2015, c.74)

e. (Deleted by amendment, P.L.2015, c.74)

f. (Deleted by amendment, P.L.2015, c.74)

g. (Deleted by amendment, P.L.2015, c.74)

h. (1) The division shall register a practitioner to access prescription monitoring information upon issuance or renewal of the practitioner's CDS registration.

(2) The division shall provide to a pharmacist who is employed by a current pharmacy permit holder online access to prescription monitoring information for the purpose of providing health care to a current patient , providing veterinary care or treatment to an animal, or verifying information with respect to a patient , veterinary client, or [a] prescriber.

(3) The division shall provide to a practitioner who has a current CDS registration online access to prescription monitoring information for the purpose of providing health care to a current patient, providing veterinary care or treatment to an animal, or verifying information with respect to a patient , veterinary client, or [a] prescriber. The division shall also grant online access to prescription monitoring information to as many licensed health care professionals or certified veterinary aides, as appropriate, as are authorized by a practitioner to access that information and for whom the practitioner is responsible for the use or misuse of that information, subject to a limit on the number of such [health care] professionals or aides as may be deemed appropriate by the division for that particular type and size of professional practice, in order to minimize the burden to practitioners , to the extent practicable, while protecting the confidentiality of the prescription monitoring information obtained. The director shall establish, by regulation, the terms and conditions under which a practitioner may delegate that authorization, including procedures for authorization and termination of authorization, provisions for maintaining confidentiality, and such other matters as the division may deem appropriate.

(4) The division shall provide online access to prescription monitoring information to as many medical or dental residents as are authorized by a faculty member of a medical or dental teaching facility to access that information and for whom the practitioner is responsible for the use or misuse of that information. The director shall establish, by regulation, the terms and conditions under which a faculty member of a medical or dental teaching facility may delegate that authorization, including procedures for authorization and termination of authorization, provisions for maintaining confidentiality, provisions regarding the duration of a medical or dental resident's authorization to access prescription monitoring information, and such other matters as the division may deem appropriate.

(5) The division shall provide online access to prescription monitoring information to as many certified medical assistants as are authorized by a practitioner to access that information and for whom the practitioner is responsible for the use or misuse of that information. The director shall establish, by regulation, the terms and conditions under which a practitioner may delegate that authorization, including procedures for authorization and termination of authorization, provisions for maintaining confidentiality, provisions regarding the duration of a certified medical assistant's authorization to access prescription monitoring information, and such other matters as the division may deem appropriate.

(6) The division shall provide online access to prescription monitoring information to as many registered dental assistants as are authorized by a licensed dentist to access that information and for whom the licensed dentist is responsible for the use or misuse of that information. The director shall establish, by regulation, the terms and conditions under which a licensed dentist may delegate that authorization, including procedures for authorization and termination of authorization, provisions for maintaining confidentiality, provisions regarding the duration of a registered dental assistant's authorization to access prescription monitoring information, and such other matters as the division may deem appropriate.

(7) A person listed in this subsection, as a condition of accessing prescription monitoring information pursuant thereto, shall certify that the request is for the purpose of providing health care to a current patient, providing veterinary care or treatment to an animal, or verifying information with respect to a patient, veterinary client, or practitioner. Such certification shall be furnished through means of an online statement or alternate means authorized by the director, in a form and manner prescribed by rule or regulation adopted by the director.

i. The division may provide online access to prescription monitoring information, or may provide access to prescription monitoring information through any other means deemed appropriate by the director, to the following persons:

(1) authorized personnel of the division or a vendor or contractor responsible for maintaining the Prescription Monitoring Program;

(2) authorized personnel of the division responsible for administration of the provisions of P.L.1970, c.226 (C.24:21-1 et seq.);

(3) the State Medical Examiner, a county medical examiner, a deputy or assistant county medical examiner, or a qualified designated assistant thereof, who certifies that the request is for the purpose of investigating a death pursuant to P.L.1967, c.234 (C.52:17B-78 et seq.);

(4) a controlled dangerous substance monitoring program in another state with which the division has established an interoperability agreement, or which participates with the division in a system that facilitates the secure sharing of information between states;

(5) a designated representative of the State Board of Medical Examiners, New Jersey State Board of Dentistry, State Board of Nursing, New Jersey State Board of Optometrists, State Board of Pharmacy, State Board of Veterinary Medical Examiners, or any other board in this State or another state that regulates the practice of persons who are authorized to prescribe or dispense controlled dangerous substances, as applicable, who certifies that the representative is engaged in a bona fide specific investigation of a designated practitioner or pharmacist whose professional practice was or is regulated by that board;

(6) a State, federal, or municipal law enforcement officer who is acting pursuant to a court order and certifies that the officer is engaged in a bona fide specific investigation of a designated practitioner, pharmacist, [or] patient, or veterinary client. A law enforcement agency that obtains prescription monitoring information shall comply with security protocols established by the director by regulation;

(7) a designated representative of a state Medicaid or other program who certifies that the representative is engaged in a bona fide investigation of a designated practitioner, pharmacist, [or] patient, or veterinary client;

(8) a properly convened grand jury pursuant to a subpoena properly issued for the records; and

(9) a licensed mental health practitioner providing treatment for substance abuse to patients at a residential or outpatient substance abuse treatment center licensed by the Division of Mental Health and Addiction Services in the Department of Human Services, who certifies that the request is for the purpose of providing health care to a current patient or verifying information with respect to a patient or practitioner, and who furnishes the division with the written consent of the patient for the mental health practitioner to obtain prescription monitoring information about the patient. The director shall establish, by regulation, the terms and conditions under which a mental health practitioner may request and receive prescription monitoring information. Nothing in sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50) shall be construed to require or obligate a mental health practitioner to access or check the prescription monitoring information in the course of treatment beyond that which may be required as part of the mental health practitioner's professional practice.

j. A person listed in subsection i. of this section, as a condition of obtaining prescription monitoring information pursuant thereto, shall certify the reasons for seeking to obtain that information. Such certification shall be furnished through means of an online statement or alternate means authorized by the director, in a form and manner prescribed by rule or regulation adopted by the director.

k. The division shall offer an online tutorial for those persons listed in subsections h. and i. of this section, which shall, at a minimum, include: how to access prescription monitoring information; the rights of persons who are the subject of this information; the responsibilities of persons who access this information; a summary of the other provisions of sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50) and the regulations adopted pursuant thereto, regarding the permitted uses of that information and penalties for violations thereof; and a summary of the requirements of the federal health privacy rule set forth at 45 CFR Parts 160 and 164 and a hypertext link to the federal Department of Health and Human Services website for further information about the specific provisions of the privacy rule.

l. The division may request and receive prescription monitoring information from prescription monitoring programs in other states and may use that information for the purposes of sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50). When sharing data with programs in another state, the division shall not be required to obtain a memorandum of understanding unless required by the other state.

m. The director may provide nonidentifying prescription drug monitoring information to public or private entities for statistical, research, or educational purposes, in accordance with the provisions of sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50).

n. Nothing shall be construed to prohibit the division from obtaining unsolicited automated reports from the program or disseminating such reports to pharmacists, practitioners, mental health care practitioners, and other licensed health care professionals or certified veterinary aides.

o. (1) A current patient or veterinary client of a practitioner may request from that practitioner that patient's or client’s own prescription monitoring information that has been submitted to the division pursuant to sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50). A parent or legal guardian of a child who is a current patient of a practitioner may request from that practitioner the child's prescription monitoring information that has been submitted to the division pursuant to sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50).

(2) Upon receipt of a request pursuant to paragraph (1) of this subsection, [a] the practitioner, or a health care professional or certified veterinary aide authorized by that practitioner , may provide the current patient, veterinary client, or parent or legal guardian, as the case may be, with access to or a copy of the prescription monitoring information pertaining to that patient, veterinary client, or child.

(3) The division shall establish a process by which a patient or veterinary client, or the parent or legal guardian of a child who is a patient, may request a pharmacy permit holder that submitted prescription monitoring information concerning a prescription for controlled dangerous substances for that patient, client, or child [to the division], pursuant to sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50), to correct information that the person believes [to have been] was inaccurately entered into that patient's, client’s, or child's prescription profile. Upon confirmation of the inaccuracy of any such entry into a patient's, veterinary client’s, or child's prescription profile, the pharmacy permit holder shall be authorized to correct any such inaccuracies by submitting corrected information to the division pursuant to sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50). The process developed under this subsection shall provide for the review, by the Board of Pharmacy, of any disputed request for correction [, which]. Any determination, which is made by the board following such review, shall be appealable to the director.

p. The division shall take steps to ensure that appropriate channels of communication exist to enable any licensed health care professional, licensed pharmacist, mental health practitioner, pharmacy permit holder, certified veterinary aide, or other practitioner who has online access to the Prescription Monitoring Program pursuant to this section to seek or provide information to the division related to the provisions of this section.

(cf: P.L2015, c.74, s.4)

5. This act shall take effect on the 90th day next following the date of enactment, except that the State Board of Veterinary Medical Examiners shall take anticipatory administrative action in advance thereof as may be necessary for the implementation of section 1 of this act, and the Director of the Division of Consumer Affairs shall take anticipatory administrative action in advance thereof as may be necessary for the implementation of sections 2 through 4 of this act.

STATEMENT

This bill would impose certain requirements to better ensure that prescription drugs issued by a veterinarian, for the treatment of an animal, are not misused, abused, or subject to diversion by the humans who have control over those drugs.

The bill would amend the State’s veterinarian practice laws to specify that, whenever a veterinarian prescribes a medication for use by an animal: (1) the prescription is to be issued in the name of the animal owner; and (2) the prescription blank must identify both the name of the animal owner and the name of the animal that is to be administered the prescribed medication. Only the person who is named on the prescription blank will be authorized to possess the drug for the purposes of administering it to the identified animal.

In the event that an animal is jointly owned by multiple owners, and more than one of the owners wishes to engage in administration of the drug to the animal, the bill would require the prescribing veterinarian, upon request, to list the names of each such owner on the prescription blank. In such a case, the bill would authorize the dispensation of the drug to any of the owners listed on the prescription blank, and it would further authorize any of those identified owners to possess the drugs for the purposes of administering it to the animal. Except in the case of authorized prescription refills, nothing in the bill’s provisions would authorize an animal owner to fill a prescription, if the prescription has already been filled by a co-owner on a previous occasion.

“Owner” is defined by the bill, in a manner consistent with the State’s animal laws, to mean an individual who has a right of property in an animal, or who has an animal in their keeping, at the time when veterinary care is sought for the animal. The term includes any private citizen, such as a pet owner, animal foster care parent, or private animal rescuer, who is providing a temporary or permanent home for the animal at the time when veterinary care is sought; or the owner, operator, or designated employee of a pet shop, pound, kennel, animal shelter, animal boarding facility, or animal rescue facility where the animal is being temporarily housed at the time when veterinary care is sought.

The bill would require a veterinarian to review relevant prescription monitoring information under the State’s Prescription Monitoring Program (PMP) before prescribing any controlled dangerous substance for use in the treatment of an animal. The bill would amend the State’s PMP law to expressly clarify that veterinarians are authorized to access PMP information for the purposes of providing care or treatment to an animal, and for the purposes of verifying information related to a veterinary client. The bill would also expressly authorize a veterinarian to provide any certified veterinary aides employed thereby with delegated authority to access PMP information for these purposes. “Certified veterinary aide” is defined to include certified veterinary technicians and Approved Veterinary Assistants.

Whenever a veterinarian prescribes a controlled dangerous substance for use by an animal, the pharmacy permit holder dispensing the prescription drug will be required under the bill to submit certain information about the veterinary client (i.e., the animal owner) to the Prescription Monitoring Program. In particular, the pharmacy permit holder is required to submit the surname, first name, date of birth, street address, and telephone number of the veterinary client/animal owner identified on the prescription blank, as well as the name and approximate age of the animal for whom the controlled dangerous substance was prescribed. The pharmacy permit holder is also required to submit identifying information about any other individual who attempts to pick up an animal’s prescription, if the pharmacist has a reasonable belief that that person may be seeking the drug for any reason other than delivering the substance to the animal for the treatment of an existing medical condition.

The bill further amends the PMP law to authorize: (1) a veterinary client to request the client’s own prescription monitoring information from a veterinarian; (2) a veterinarian, or a certified veterinary aide employed thereby, to provide such requested information to the client; and (3) a veterinary client to ask a pharmacy permit holder to correct any information that was inaccurately entered into the system.

The bill would also amend the PMP law to authorize the division to allow a law enforcement officer or an authorized representative of a state program to access PMP information when engaged in a bona fide investigation of a veterinary client.

Finally, the bill would make minor technical corrections to the PMP law.