BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Deborah V. Ortiz, Chair
BILL NO: AB 2583
A
AUTHOR: Nation
B
AMENDED: April 27, 2006
HEARING DATE: June 21, 2006
2
FISCAL: Business, Professions and Economic
Development / 5
Appropriations
8
CONSULTANT:
3
Vazquez / ak
SUBJECT
Dispensing prescription drugs and devices: refusal to
dispense
SUMMARY
This bill requires the California Board of Pharmacy (Board)
to include, within an existing consumer notice, a statement
that describes a patient's right to timely access to
prescribed drugs and devices, even if a pharmacist refuses
to dispense based on ethical, moral, or religious grounds.
ABSTRACT
Existing law:
1.Prohibits a health care licensee (licensee) [e.g.
pharmacist] from obstructing a patient from obtaining
prescribed drugs or devices, except when:
a. The licensee determines that the prescription is
contrary to law, causes a harmful drug interaction, or
would adversely affect the patient's medical
condition; or
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b. The prescription drug or device is not in stock, in
which case the licensee shall take one of the
following actions:
i. Notify the patient and arrange to have the
prescription delivered to its site or directly to
the patient in a timely manner;
ii. Transfer the prescription to another pharmacy
known to stock the prescription drug or device that
is near enough to the site to ensure the patient has
timely access to the drug or device; or
iii. Return the prescription to the patient and
make a reasonable effort to refer the patient to a
pharmacy that stocks the drug or device and that is
near enough to the site to ensure the patient has
timely access to the drug or device.
2.Permits a licensee to decline to dispense a drug or
device based on ethical, moral, or religious grounds only
if the licensee has previously provided a written
notification to his or her employer of the drug or class
of drugs to which he or she objects and the licensee's
employer can provide a reasonable accommodation to the
licensee's objection and establishes protocols that
ensure that the patient has timely access to the drug or
device.
3.Requires every pharmacy to conspicuously post a sign that
is readable by drug consumers that provides information
on the availability of prescription price information,
the possibility of generic drug product selection, the
types of drug services provided by pharmacies, and other
related information.
This bill:
1.Requires that the notice to the consumer currently
required by law include a statement that describes
patients' rights relative to the requirements under
current law when a drug or device is not dispensed due to
the professional judgment of the licensee, the drug or
device not being in stock, or the licensee refuses to
dispense based on ethical, moral, or religious grounds.
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FISCAL IMPACT
According to the Assembly Appropriations Committee, the
bill will result in minor one-time special fund costs to
the Board (Pharmacy Board Contingent Fund) of $25,000 to
change the existing notice through regulation and to print
and mail signs to pharmacies, and on-going costs of $2,400.
BACKGROUND AND DISCUSSION
Purpose of the bill
According to the author, as pharmacists last year were
informed of their right to refuse to dispense, patients
also deserve to be informed of their rights regarding
access to their prescriptions. Additionally, in order to
ensure California can officially and easily report
prescribing complaints, the bill would create a mechanism
to file a complaint. This legislation will ensure patients
receive their prescription drugs in a timely manner when a
pharmacist chooses not to fill the prescription based on
ethical reasons. A sign notifying a patient will allow a
patient to, among other options, choose a pharmacy that
will fulfill the patient's needs. Waiting in line just to
be rejected will only delay access to a prescribed drug or
device, and potentially lead to infliction of emotional
distress. With over thirty bills introduced this year
across the United Stated relating to pharmacists' refusal
to dispense, patients rights need to be clarified to ensure
timely access to their prescriptions.
Reports of refusals to fill prescriptions
There have been a number of news stories in the United
States describing incidents where pharmacists have refused
to dispense oral contraceptives and other types of birth
control based on moral grounds or religious beliefs. A
March 28, 2005 Washington Post article reported that it is
not known how often refusals are occurring, but there have
been cases in California, Washington, Georgia, Illinois,
Louisiana, Massachusetts, Texas, New Hampshire, Ohio, and
North Carolina. The article stated that Wisconsin was one
of at least 11 states considering "conscience clause" laws
that would protect pharmacists' ability to decline to fill
a prescription and that four states already had laws that
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permit pharmacists to refuse to fill prescriptions that
violate their beliefs. At least four other states were
considering laws that would explicitly require pharmacists
to fill all prescriptions. Some large pharmacy chains,
including Walgreen's, Wal-Mart, and CVS, have instituted
policies to balance pharmacists' and customers' rights by
ensuring that another pharmacist is on duty to fill the
prescription or contacting another pharmacy willing to fill
the prescription in the case that a pharmacist objects to
filling it.
Arguments in support
The American College of Obstetricians and Gynecologists,
District IX (ACOG) writes that this measure will help
ensure timely access to emergency contraception (EC) and
all medications by alerting consumers about their right to
timely access to medications under state law through the
use of a sign in a pharmacy. ACOG is particularly
concerned about access to EC given that timely use of the
drug after unprotected sex, most often due to failed birth
control or rape, could reduce the abortion rate by half.
EC is essentially high dose birth control medication and
the effectively is very time sensitive. If taken within 12
hours, it is 95 percent effective. ACOG emphasizes that
every hour of delay in accessing and using the medication
affects its effectiveness, therefore the ability to go to a
pharmacy and understand the right of access to medication
can save valuable time for a patient.
Arguments in opposition
The California Family Council writes in a letter dated
April 12 that it views this bill as an unnecessary attempt
to harass the pharmacist by placing his or her employer in
the position of drawing undue attention to that
pharmacist's personally held beliefs. The Council states
that there is no practical reason for such a sign other
than to try to bring pressure on the employer to persuade
the declining pharmacist into reneging on his or her moral
stand. At the writing of this analysis, the Committee has
not received an updated letter from the Council responding
to the simplifying amendments adopted April 27, 2006 and
how these might alter the Council's position.
Prior legislation
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SB 644 (Ortiz, Chapter 417, Statutes of 2005) requires a
licentiate responsible for dispensing drugs and devices
to dispense a lawful prescription or order except under
specified circumstances, including on ethical, moral, or
religious grounds, and establishes conditions and
circumstances under which the drug or device should be
provided if unavailable, or protocols to be followed if
there is a refusal to dispense the prescription or order
based on ethical, moral, or religious grounds.
SB 490 (Alpert, Chapter 651, Statutes of 2003) permits a
licensed pharmacist to initiate EC drug therapy in
accordance with a standardized procedure approved by the
Board and the Medical Board of California. It also
requires a pharmacist, prior to furnishing EC, to
complete a training program of at least one hour of
approved continuing education on EC drug therapy.
AB 21 (Levine, 2005) sought to require pharmacists to
dispense a lawful prescription unless certain specified
circumstances exist, including allowing a pharmacist to
decline on ethical, moral, or religious grounds to
dispense a drug if the pharmacist satisfies certain
conditions. The bill deems a violation of these
provisions unprofessional conduct and harassment, as
specified. This bill failed passage in this Committee.
PRIOR ACTIONS
Assembly Floor: 47 - 31 Pass
Assembly Appropriations: 13 - 5 Do Pass
Assembly Health: 9 - 3 Do Pass
Assembly B. & P.: 6 - 2 Do Pass
POSITIONS
Support: American College of Obstetricians and
Gynecologists, District IX
California Medical Association
California Primary Care Association
Oppose:California Family Council
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