An article posted on May 26, 2000 noted that Texas law effectively prohibited the use of automated pharmaceutical dispensing machines to dispense prescription drugs at nursing homes. See Should States License Automated Pharmaceutical Dispensing Machines?. Now the Texas legislature has corrected the situation. Senate Bill 98 from the 77th session adds §562.109 to the Occupations Code. The new law provides that a pharmacy may provide pharmacy services through an automated pharmacy system in a different location. Automated pharmacy system ("APS") is defined as a mechanical system that dispenses prescription drugs and maintains related transaction information. The pharmacist in charge of the "bricks and mortar" licensed pharmacy is responsible for loading the medication into the APS. Although an APS is required to be under the "continuous supervision" of a pharmacist (to be defined by board rule), the pharmacist is not required to be physically present at the site of the APS but may instead supervise the system electronically.
The law does not allow an APS to be located in a convenience store. An APS may be located only at a health care facility regulated by the state. The law instructs the Texas State Board of Pharmacy to adopt rules regarding the use of an APS. The board rules will regulate the types of health care facilities in which an APS may be located together with recordkeeping and security requirements. Although the law authorizes the pharmacy board to regulate the types of health care facilities where an APS may be located, it specifies that nursing homes (governed by Chapter 142 of the Health & Safety Code) shall be included. It also singles out for inclusion intermediate care facilities for the mentally retarded.
Following a recent Texas trend in healthcare legislation, Senate Bill 98 also directs the Texas Department of Health (TDH) to study the costs and savings associated with the use of APSs. TDH will study reimbursement methodologies, usage rates, costs and benefits of drugs when using the systems and participation in the use of the systems by providers. TDH will report it findings by January 1, 2003. Although the act is effective immediately, the pharmacy board has until February 28, 2002 to adopt the required regulations.
The Texas law differs in some respects from the National Association of Boards of Pharmacy (NABP) Model State Pharmacy Act and Model Rules. For example, the model act provides that nonpharmacist personnel may fill/stock an APS under a pharmacist’s supervision. The commentary to the model act notes that states may decide to allow only a pharmacist to perform this function—the approach adopted by Texas. See White Paper on Automation in Pharmacy, Appendix 1, NABP Model Act & Rules available at http://www.ascp.com/public/pubs/tcp/1998/mar/appendix1.shtml.
Such systems have the potential to reduce medical error, save time and money, and allow physicians to easily vary dosage and duration of prescriptions based on patient response. The APSs are already used in some hospitals that hold a valid pharmacy license. However, nursing homes and some other health care facilities typically do not hold pharmacy licenses, nor do they have a licensed pharmacist on staff.