With a proven record, it cannot be said that codification of expanded pharmacist authority will produce any significant uncertainties.
Whether at the conference table, the committee hearing, or the chamber floor, the impact of proposed legislation is weighed and considered. Unintended consequences are contemplated, and unforeseen repercussions surmised. During such choke points in the process, a bill’s opponents will leverage any uncertainty about its impact to promise an adverse outcome of the bill’s passage.
It is rare for the legislature to consider a policy with no such uncertainty, when the question is not the impact of a new policy, but the continuation of one with a clear and unambiguous record. This occurred during the 88th Regular Session when the legislature considered codifying into state law a federal expansion of pharmacists’ ability to administer immunizations. HB 1105 (Price) was the legislative vehicle that would have accomplished this. Despite passing both the House and the Senate overwhelmingly, the chambers could not agree on a final version of the bill before the regular session came to an end.
HB 1105 would have locked in place the expanded ability for pharmacists to administer immunizations. This expansion was originally introduced by the U.S. Department of Health and Human Services (DHHS) declaration of a public health emergency (PHE) in response to the COVID-19 pandemic in 2020. In its third amendment to its COVID-19 PREP Act Declaration, DSHS preempted state law by instituting a policy that “authorizes, certain State-licensed pharmacists . . . to administer, any vaccine that the Advisory Committee on Immunization Practices recommends to persons ages three through 18 . . . .”[1] Since this declaration, pharmacists in Texas have been able to deliver the full array of federally recommended childhood vaccines to patients aged three years and older.[2] The figures below show the percentages of kindergarteners who were not vaccinated against the diseases shown in the 2016-2017 school year versus the 2021-2022 school year.
2016-2017 | 2021-2022 | |
Hepatitis B | 0.79% | 1.62% |
MMR | 0.48% | 3.14% |
Polio | 0.82% | 3.10% |
Tdap/TD | 0.87% | 3.09% |
Varicella | 0.89% | 3.27% |
Source: Department of State Health Services[3]
Childhood vaccination rates appear to be lagging in Texas (although still high in absolute terms), which is even more reason to support expanded immunization authority so that the parents who wish to obtain vaccines for their children have more options for doing so.
The impact of this policy has been nearly four years of increased access and convenience to immunizations that Texans have never before enjoyed. The DHHS expansion of pharmacy immunizations is temporary however. At the end of this year, the provision will expire, ushering back in the pre-PHE context, leaving certain medications farther out of reach from patients who need them.
Pharmacy immunizations in the pre-PHE context would be scaled back due to Texas Occupations Code § 554.004, which limits a pharmacist’s ability to administer drug therapies. The law stipulates that a pharmacist may administer medication when an authorized provider “is not reasonably available” to administer the medication and that failure to deliver its administration would constitute “a significant delay or interruption of a critical phase of drug therapy.”[4]
Since August of 2020, pharmacists, pharmacy interns and authorized technicians have been delivering immunizations with little to no evidence of adverse outcomes statewide. Such a long record leaves little uncertainty as to the potential effects that codifying into law the PHE expansion of pharmacist immunizations would have on the State. In HB 1105’s hearing in the House Public Health Committee during the 88th Regular Session, Representative Price epitomized the bill’s record quite succinctly when, in response to an opponent’s claim that the bill’s passage could harm patients, he stated “Because unlike other bills that we have heard today, this has actually been practiced now for three [four at the time of this writing] years, so we have outcomes to measure.”[5]
One of the questions before the next legislature will be whether or not to codify into law a policy that has been in force for nearly four years in the state. With a proven record, it cannot be said that its codification will produce any significant uncertainties. Instead, it will, as it has proven itself to be, an effective measure to expand access to patients seeking essential care. That is for certain.
The Texas Conservative Coalition Research Institute will be hosting a Health Care Policy Summit on Tuesday, May 21 that further discusses issues relating to access of care, such as immunization authority. If you wish to attend, please RSVP here.
[2] https://news.ashp.org/news/ashp-news/2023/04/14/hhs-extends-prep-act-for-certain-pharmacist-and-technician-services
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