                                 CODE OF VIRGINIA

INITIATING OF TREATMENT WITH AND DISPENSING AND ADMINISTERING OF CONTROLLED
SUBSTANCES BY PHARMACISTS (§ 54.1-3303.1)

A. Notwithstanding the provisions of § 54.1-3303, a pharmacist may initiate
treatment with, dispense, or administer the following drugs, devices, controlled
paraphernalia, and other supplies and equipment to persons 18 years of age or
older with whom the pharmacist has a bona fide pharmacist-patient relationship
and in accordance with a statewide protocol developed by the Board in
collaboration with the Board of Medicine and the Department of Health and set
forth in regulations of the Board:

   1. Naloxone or other opioid antagonist, including such controlled
   paraphernalia, as defined in &#xA7; 54.1-3466, as may be necessary to
   administer such naloxone or other opioid antagonist;

   2. Epinephrine;

   3. Injectable or self-administered hormonal contraceptives, provided the
   patient completes an assessment consistent with the United States Medical
   Eligibility Criteria for Contraceptive Use;

   4. Prenatal vitamins for which a prescription is required;

   5. Dietary fluoride supplements, in accordance with recommendations of the
   American Dental Association for prescribing of such supplements for persons
   whose drinking water has a fluoride content below the concentration
   recommended by the U.S. Department of Health and Human Services;

   6. Drugs as defined in &#xA7; 54.1-3401, devices as defined in &#xA7;
   54.1-3401, controlled paraphernalia as defined in &#xA7; 54.1-3466, and other
   supplies and equipment available over-the-counter, covered by the
   patient&#8217;s health carrier when the patient&#8217;s out-of-pocket cost is
   lower than the out-of-pocket cost to purchase an over-the-counter equivalent
   of the same drug, device, controlled paraphernalia, or other supplies or
   equipment;

   7. Vaccines included on the Immunization Schedule published by the Centers for
   Disease Control and Prevention and vaccines for COVID-19;

   8. Tuberculin purified protein derivative for tuberculosis testing;

   9. Controlled substances for the prevention of human immunodeficiency virus,
   including controlled substances prescribed for pre-exposure and post-exposure
   prophylaxis pursuant to guidelines and recommendations of the Centers for
   Disease Control and Prevention;

   10. Nicotine replacement and other tobacco cessation therapies, including
   controlled substances as defined in the Drug Control Act (&#xA7; 54.1-3400 et
   seq.), together with providing appropriate patient counseling;

   11. Controlled substances or devices for the initiation of treatment of the
   following diseases or conditions for which clinical decision making can be
   guided by a clinical test that is classified as waived under the federal
   Clinical Laboratory Improvement Amendments of 1988: group A Streptococcus
   bacteria infection, influenza virus infection, COVID-19 virus infection, and
   urinary tract infection; and

   12. Tests for COVID-19 and other coronaviruses.

B. Notwithstanding the provisions of § 54.1-3303, a pharmacist may initiate
treatment with, dispense, or administer the following drugs and devices to
persons three years of age or older in accordance with a statewide protocol as
set forth in regulations of the Board:

   1. (Contingent Effective Date) Vaccines included on the Immunization Schedule
   published by the Centers for Disease Control and Prevention and vaccines for
   COVID-19; and

   2. (Contingent Effective Date) Tests for COVID-19 and other coronaviruses.

C. A pharmacist who initiates treatment with or dispenses or administers a drug
or device pursuant to this section shall notify the patient&#8217;s primary
health care provider that the pharmacist has initiated treatment with such drug
or device or that such drug or device has been dispensed or administered to the
patient, provided that the patient consents to such notification. No pharmacist
shall limit the ability of notification to be sent to the patient&#8217;s
primary care provider by requiring use of electronic mail that is secure or
compliant with the federal Health Insurance Portability and Accountability Act
(42 U.S.C. &#xA7; 1320d et seq.). If the patient does not have a primary health
care provider, the pharmacist shall counsel the patient regarding the benefits
of establishing a relationship with a primary health care provider and provide
information regarding primary health care providers, including federally
qualified health centers, free clinics, or local health departments serving the
area in which the patient is located. If the pharmacist is initiating treatment
with, dispensing, or administering injectable or self-administered hormonal
contraceptives, the pharmacist shall counsel the patient regarding seeking
preventative care, including (i) routine well-woman visits, (ii) testing for
sexually transmitted infections, and (iii) pap smears.

D. A pharmacist who administers a vaccination pursuant to subdivisions A 7 and B
1 shall report such administration to the Virginia Immunization Information
System in accordance with the requirements of &#xA7; 32.1-46.01.

E. A pharmacist who initiates treatment with, dispenses, or administers drugs,
devices, controlled paraphernalia, and other supplies and equipment pursuant to
this section shall obtain a history from the patient, including questioning the
patient for any known allergies, adverse reactions, contraindications, or health
diagnoses or conditions that would be adverse to the initiation of treatment,
dispensing, or administration.

F. A pharmacist may initiate treatment with, dispense, or administer drugs,
devices, controlled paraphernalia, and other supplies and equipment pursuant to
this section through telemedicine services, as defined in &#xA7; 38.2-3418.16,
in compliance with all requirements of &#xA7; 54.1-3303 and consistent with the
applicable standard of care.

G. A pharmacist who administers a vaccination to a minor pursuant to subdivision
B 1 shall provide written notice to the minor&#8217;s parent or guardian that
the minor should visit a pediatrician annually.

HISTORY: 2020, c. 731; 2021, Sp. Sess. I, c. 214; 2022, cc. 790, 791; 2023, cc.
171, 172.