1.1 	A bill for an act
1.2 	relating to health; allowing a licensed dietitian or licensed nutritionist to adhere 
1.3 	to a practice guideline or protocol for a legend drug prescribed by a physician;
1.4 	amending Minnesota Statutes 2012, section 151.37, subdivision 2; proposing 
1.5 	coding for new law in Minnesota Statutes, chapter 148.
1.6 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.7 	Section 1. [148.634] PRESCRIPTION PROTOCOL.
1.8 	A licensed dietitian or licensed nutritionist may implement a protocol that does 
1.9 	not reference a specific patient and results in a prescription of a legend drug that has 
1.10 	been predetermined and delegated by a licensed practitioner as defined in section 151.01, 
1.11 	subdivision 23, when caring for a patient whose condition falls within the protocol 
1.12 	specifies the circumstances under which the drug is to be prescribed or administered.

1.13 	Sec. 2. Minnesota Statutes 2012, section 151.37, subdivision 2, is amended to read:
1.14 		Subd. 2.Prescribing and filing. (a) A licensed practitioner in the course of 
1.15 	professional practice only, may prescribe, administer, and dispense a legend drug, and 
1.16 	may cause the same to be administered by a nurse, a physician assistant, or medical 
1.17 	student or resident under the practitioner's direction and supervision, and may cause a 
1.18 	person who is an appropriately certified, registered, or licensed health care professional 
1.19 	to prescribe, dispense, and administer the same within the expressed legal scope of the 
1.20 	person's practice as defined in Minnesota Statutes. A licensed practitioner may prescribe a 
1.21 	legend drug, without reference to a specific patient, by directing a licensed dietitian or 
1.22 	licensed nutritionist, pursuant to section 148.624; a nurse, pursuant to section 148.235, 
1.23 	subdivisions 8 and 9~~,~~; physician assistant~~,~~; medical student or resident~~,~~; or pharmacist 
1.24 	according to section 151.01, subdivision 27, to adhere to a particular practice guideline or 
2.1 	protocol when treating patients whose condition falls within such guideline or protocol, 
2.2 	and when such guideline or protocol specifies the circumstances under which the legend 
2.3 	drug is to be prescribed and administered. An individual who verbally, electronically, or 
2.4 	otherwise transmits a written, oral, or electronic order, as an agent of a prescriber, shall 
2.5 	not be deemed to have prescribed the legend drug. This paragraph applies to a physician 
2.6 	assistant only if the physician assistant meets the requirements of section 147A.18.
2.7 	(b) The commissioner of health, if a licensed practitioner, or a person designated 
2.8 	by the commissioner who is a licensed practitioner, may prescribe a legend drug to an 
2.9 	individual or by protocol for mass dispensing purposes where the commissioner finds that 
2.10 	the conditions triggering section 144.4197 or 144.4198, subdivision 2, paragraph (b), exist. 
2.11 	The commissioner, if a licensed practitioner, or a designated licensed practitioner, may 
2.12 	prescribe, dispense, or administer a legend drug or other substance listed in subdivision 10 
2.13 	to control tuberculosis and other communicable diseases. The commissioner may modify 
2.14 	state drug labeling requirements, and medical screening criteria and documentation, where 
2.15 	time is critical and limited labeling and screening are most likely to ensure legend drugs 
2.16 	reach the maximum number of persons in a timely fashion so as to reduce morbidity 
2.17 	and mortality.
2.18 	(c) A licensed practitioner that dispenses for profit a legend drug that is to be 
2.19 	administered orally, is ordinarily dispensed by a pharmacist, and is not a vaccine, must 
2.20 	file with the practitioner's licensing board a statement indicating that the practitioner 
2.21 	dispenses legend drugs for profit, the general circumstances under which the practitioner 
2.22 	dispenses for profit, and the types of legend drugs generally dispensed. It is unlawful to 
2.23 	dispense legend drugs for profit after July 31, 1990, unless the statement has been filed 
2.24 	with the appropriate licensing board. For purposes of this paragraph, "profit" means (1) 
2.25 	any amount received by the practitioner in excess of the acquisition cost of a legend drug 
2.26 	for legend drugs that are purchased in prepackaged form, or (2) any amount received 
2.27 	by the practitioner in excess of the acquisition cost of a legend drug plus the cost of 
2.28 	making the drug available if the legend drug requires compounding, packaging, or other 
2.29 	treatment. The statement filed under this paragraph is public data under section 13.03. 
2.30 	This paragraph does not apply to a licensed doctor of veterinary medicine or a registered 
2.31 	pharmacist. Any person other than a licensed practitioner with the authority to prescribe, 
2.32 	dispense, and administer a legend drug under paragraph (a) shall not dispense for profit. 
2.33 	To dispense for profit does not include dispensing by a community health clinic when the 
2.34 	profit from dispensing is used to meet operating expenses.
2.35 	(d) A prescription or drug order for the following drugs is not valid, unless it can be 
2.36 	established that the prescription or order was based on a documented patient evaluation, 
3.1 	including an examination, adequate to establish a diagnosis and identify underlying 
3.2 	conditions and contraindications to treatment:
3.3 	(1) controlled substance drugs listed in section 152.02, subdivisions 3 to 5;
3.4 	(2) drugs defined by the Board of Pharmacy as controlled substances under section 
3.5 	152.02, subdivisions 7, 8, and 12;
3.6 	(3) muscle relaxants;
3.7 	(4) centrally acting analgesics with opioid activity;
3.8 	(5) drugs containing butalbital; or
3.9 	(6) phoshodiesterase type 5 inhibitors when used to treat erectile dysfunction.
3.10 	(e) For the purposes of paragraph (d), the requirement for an examination shall be 
3.11 	met if an in-person examination has been completed in any of the following circumstances:
3.12 	(1) the prescribing practitioner examines the patient at the time the prescription 
3.13 	or drug order is issued;
3.14 	(2) the prescribing practitioner has performed a prior examination of the patient;
3.15 	(3) another prescribing practitioner practicing within the same group or clinic as the 
3.16 	prescribing practitioner has examined the patient;
3.17 	(4) a consulting practitioner to whom the prescribing practitioner has referred the 
3.18 	patient has examined the patient; or
3.19 	(5) the referring practitioner has performed an examination in the case of a 
3.20 	consultant practitioner issuing a prescription or drug order when providing services by 
3.21 	means of telemedicine.
3.22 	(f) Nothing in paragraph (d) or (e) prohibits a licensed practitioner from prescribing 
3.23 	a drug through the use of a guideline or protocol pursuant to paragraph (a).
3.24 	(g) Nothing in this chapter prohibits a licensed practitioner from issuing a 
3.25 	prescription or dispensing a legend drug in accordance with the Expedited Partner Therapy 
3.26 	in the Management of Sexually Transmitted Diseases guidance document issued by the 
3.27 	United States Centers for Disease Control.
3.28 	(h) Nothing in paragraph (d) or (e) limits prescription, administration, or dispensing 
3.29 	of legend drugs through a public health clinic or other distribution mechanism approved 
3.30 	by the commissioner of health or a board of health in order to prevent, mitigate, or treat 
3.31 	a pandemic illness, infectious disease outbreak, or intentional or accidental release of a 
3.32 	biological, chemical, or radiological agent.
3.33 	(i) No pharmacist employed by, under contract to, or working for a pharmacy 
3.34 	licensed under section 151.19, subdivision 1, may dispense a legend drug based on a 
3.35 	prescription that the pharmacist knows, or would reasonably be expected to know, is not 
3.36 	valid under paragraph (d).
4.1 	(j) No pharmacist employed by, under contract to, or working for a pharmacy 
4.2 	licensed under section 151.19, subdivision 2, may dispense a legend drug to a resident 
4.3 	of this state based on a prescription that the pharmacist knows, or would reasonably be 
4.4 	expected to know, is not valid under paragraph (d).