6mar02...2822h

2may02...3769eba

2002 SESSION

01-2212

10/01

HOUSE BILL 1318

COMMITTEE: Executive Departments and Administration

AMENDED ANALYSIS

This bill allows licensed optometrists to use certain pharmaceutical agents in the treatment of glaucoma and conditions and diseases of the eye.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

6mar02...2822h

2may02...3769eba

01-2212

10/01

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Two

Be it Enacted by the Senate and House of Representatives in General Court convened:

274:1 Definitions Amended; Pharmaceutical Agent; Practice of Optometry. Amend RSA 327:1, III and IV to read as follows:

III. "Pharmaceutical agent" means the following pharmaceutical products:

(a) Non-legend, over the counter, agents.

(b) Mydriatic and cycloplegic agents which are topically applied.

(c) Miotic agents approved by the joint pharmaceutical formulary [board] and credentialing committee and included in the formulary.

(d) Antibiotics, sulfonomides, and combinations thereof, which are topically applied or orally administered to treat or alleviate the effects of disease or abnormal conditions of the human eye, adnexa, and eyelids, excluding [treatment of the lacrimal drainage system,] the lacrimal gland, or structures posterior to the iris, approved by the joint pharmaceutical formulary [board] and credentialing committee and included in the formulary.

(e) Anti-allergy medications, including but not limited to antihistamines, decongestants, and mast-cell stabilizers which are topically applied.

(f) Anesthetics and dyes which are topically applied.

(g) Ocular lubricants and hypertonic agents which are topically applied.

(h) Orally administered analgesic agents used for the purpose of alleviating pain caused by a disease or abnormal condition of the human eye or eyelid, excluding [treatment of the lacrimal drainage system,] the lacrimal gland, or structures posterior to the iris. This may include class III and IV controlled substances approved by the joint pharmaceutical formulary [board] and credentialing committee and included in the formulary.

(i) Other pharmaceutical agents, any solely diagnostic agents, and diagnostic agents combined with pharmaceutical agents as defined in this paragraph and as approved by the joint pharmaceutical formulary [board] and credentialing committee.

(j) Non-steroidal anti-inflammatory agents approved by the joint pharmaceutical formulary [board] and credentialing committee and included in the formulary

(k) Anti-glaucoma agents which are topically applied provided that an optometrist may dispense or prescribe such agents if the optometrist has met the requirements of RSA 327:6-c.

(l) Corticosteroids which are topically applied, as approved by the joint pharmaceutical formulary and credentialing committee.

(m) Antivirals which are topically applied, provided that prior to dispensing or prescribing, the therapeutic pharmaceutical agent certified optometrist shall consult with an ophthalmologist with whom he or she has a collaborative relationship. The consultation shall be in a manner to be determined by the ophthalmologist.

(n) Corticosteroids or antivirals, provided that optometrists with patients on corticosteroids or antivirals who demonstrate no improvement in 10 days shall be referred to an ophthalmologist.

IV. "Practice of optometry" means the employment of any methods or means, other than surgery, for the:

(a) Diagnosis and treatment of any optical defect, deficiency, deformity, or disease of the human eye, adnexa and eyelids.

(b) Diagnosis and treatment of any visual or muscular anomaly of the visual system.

(c) Adaptation or prescribing of spectacle lenses, contact lenses, prisms or ocular exercises for the correction, relief or aid of the visual functions.

(d) Prescribing, administering or dispensing of pharmaceutical agents.

(e) The application or removal of Food and Drug Administration approved medical devices as approved by the board and consistent with the practice of optometry as set forth in this chapter including, but not limited to, contact lenses and punctal plugs.

["Practice of optometry" shall not include and nothing in this chapter shall authorize or allow the treatment of glaucoma or other intraocular pressure elevation, or the prescribing, administering, or dispensing of cortico-steroids in any form.]

(f) Diagnosis of acute angle closure glaucoma. Upon such diagnosis, an optometrist may administer emergency care and shall immediately refer the patient to an ophthalmologist. Oral pharmaceutical agents may be used for the emergency treatment of acute angle closure glaucoma.

274:2 Joint Pharmaceutical Formulary and Credentialing Committee. RSA 327:6-b is repealed and reenacted to read as follows:

327:6-b Joint Pharmaceutical Formulary and Credentialing Committee.

I. The joint pharmaceutical formulary and credentialing committee shall be comprised of 3 optometrists licensed under RSA 327 appointed by the New Hampshire Optometric Association, 3 ophthalmologists licensed under RSA 329 appointed by the New Hampshire Society of Eye Physicians and Surgeons, and 3 pharmacists licensed under RSA 318 appointed by the pharmacy board. Members shall serve terms of 5 years and shall not be eligible for a second consecutive term. The initial members shall be appointed for staggered terms as follows: one optometrist, one ophthalmologist, and one pharmacist for a term of 5 years; one optometrist, one ophthalmologist, and one pharmacist for a term of 4 years; and one optometrist, one ophthalmologist, and one pharmacist for a term of 3 years. All members shall be residents of the state of New Hampshire. Neither they nor their spouses shall have any material financial interest in the provision of eye care services other than that which is directly related to the practice of their professions. Matters to be brought before the committee shall be filed in writing with the chairperson at least 30 days prior to the scheduled meeting. Any member of the committee may submit items to be assigned to the agenda for consideration. Agendas shall be posted on the board of optometry's public access Internet site at least 10 days prior to committee meetings.

II. The committee shall meet quarterly to:

(a) Review glaucoma reporting forms and develop prescription drug protocols;

(b) Develop a glaucoma reporting form and patient consent form;

(c) Approve corticosteroids for optometric use;

(d) Determine which combination medications shall be considered one medication for the purposes of treating glaucoma patients.

(e) Provide minutes of their meetings to the board, the board of medicine, and the pharmacy board;

(f) Determine which optometrists have successfully completed the requirements of RSA 327:6-c and maintain a list of such optometrists; and

(g) Maintain a current list of approved prescription drugs which shall be available from the board.

III. Violations of this section shall be reported in writing to the board of pharmacy and to the board of registration in optometry, which shall investigate alleged violations and take disciplinary actions as appropriate under RSA 327:20. The joint pharmaceutical formulary and credentialing committee shall be apprised of all reported violations of this section and shall receive copies of all reports, findings, and disciplinary action taken. The use of any pharmaceutical agents by an optometrist not authorized under RSA 327:6-a or, other than those agents described in RSA 327:1 or those approved by the joint pharmaceutical formulary and credentialing committee, shall be considered a violation of RSA 327:20.

274:3 New Section; Treatment of Glaucoma. Amend RSA 327 by inserting after section 6-b the following new section:

327:6-c Treatment of Glaucoma.

I.(a) Optometrists seeking authorization to treat glaucoma shall complete at least 40 hours of classroom education, approved by the board, incorporating: epidemiology of the glaucomas; genetics of the glaucomas; anatomy, physiology, and mechanics of aqueous inflow and aqueous outflow; optic nerve anatomy and pathophysiology; neurotoxicity and neuroprotectants; receptor biology; pharmacology, clinical use and toxic effects of alpha and beta adrenergic agents, carbonic anhydrase inhibitors, prostanoids and cholinergic agents.

(b) Optometrists shall pass an examination approved by the board that covers the educational components listed in subparagraph (a). Upon passage of such exam, an optometrist shall have prescriptive authority during the clinical management period pursuant to RSA 327:6-a.

(c) The board may waive the requirements of subparagraphs (a) and (b) for optometrists who have graduated after 2002.

II.(a) To be authorized to initiate treatment of glaucoma for patients 18 years of age or older, a therapeutic pharmaceutical agent certified optometrist shall complete the educational requirements in paragraph I and provide evidence of written referrals and consultations with an ophthalmologist. For purposes of this section, "glaucoma" means primary open-angle glaucoma; "ophthalmologist" means a physician licensed under RSA 329 with a specialty in ophthalmology; and "treatment" means the use of no more than 2 concurrent topical prescription glaucoma medications. The joint pharmaceutical formulary and credentialing committee shall review evidence of glaucoma co-management submitted pursuant to subparagraph (b).

(b) Except as provided in paragraph III, therapeutic pharmaceutical agent certified optometrists are required to provide evidence of successful collaborative treatment and co-management of 40 glaucoma patients, up to 20 of which may be established patients, during a period of not less than 18 months for each patient, to ophthalmologists according to the following criteria:

(i) A new or existing glaucoma patient is examined and diagnosed by the optometrist;

(ii) The optometrist develops a proposed treatment plan and forwards the plan with examination documentation to an ophthalmologist for consultation;

(iii) The ophthalmologist, examines the patient and reviews the optometrist's examination documentation and proposed treatment plan;

(iv) The ophthalmologist, optometrist, and patient mutually agree to and document a treatment plan;

(v) The optometrist shall refer the patient within 30 days to the co-managing ophthalmologist when any of the following occurs: the patient's target pressure is not reached within 90 days; the patient requires more than 2 prescription glaucoma medications; the patient is experiencing progression of optic nerve damage or visual field loss; or the patient develops angle-closure or other secondary glaucoma; and

(vi) For each glaucoma patient the optometrist shall complete a glaucoma credentialing reporting form and submit the form to the joint pharmaceutical formulary and credentialing committee upon completion of the 18 months of treatment.

III. The following categories of optometrists may petition the joint pharmaceutical formulary and credentialing committee to waive or reduce the consultation requirement from 40 to 20 patients:

(a) Optometrists who have graduated after 2002;

(b) Optometrists with proof of 12 months of credentialed privileges to treat glaucoma by the U.S. Department of Defense, U.S. Department of Veteran Affairs, or the National Indian Health Service;

(c) Optometrists with a license and proof of practice for 12 months in another state that currently authorizes the treatment of glaucoma by optometrists; or

(d) Optometrists who have completed a 12-month accredited optometric residency program or its equivalent.

IV.(a) Upon certification to treat glaucoma patients, for a period of 24 months, optometrists shall refer each new glaucoma patient within 30 days to an ophthalmologist for confirmation of diagnosis and review of treatment plan. After the 24-month period, optometrists shall consult with an ophthalmologist upon diagnosis of a new glaucoma patient. An optometrist shall refer a glaucoma patient within 30 days when any of the following occurs:

(i) The patient's target pressure is not reached within 90 days;

(ii) The patient requires more than 2 prescription glaucoma medications;

(iii) The patient is experiencing progression of optic nerve damage or visual field loss; or

(iv) The patient develops angle-closure or other secondary glaucoma.

(b) Upon certification to treat glaucoma patients, the board shall issue a license awarding the optometrist with a "tpa/g" certification.

274:4 Continuing Education; Pharmaceutical and Glaucoma Certification. RSA 327:33-a is repealed and reenacted to read as follows:

327:33-a Continuing Education Courses Required for Pharmaceutical and Glaucoma Certification.

I. An optometrist certified to use pharmaceutical agents in the practice of optometry shall complete a minimum of 50 hours of continuing education every year in order to maintain pharmaceutical certification. A minimum of 20 hours shall be by participation in formal courses and the remainder by independent study. Each optometrist shall report continuing education hours to the board annually in accordance with rules adopted by the board for the implementation of this section. Such continuing education courses and activities shall satisfy the requirements of RSA 327:33.

II. An optometrist certified to treat glaucoma shall complete a minimum of 10 of the required hours in glaucoma specific education. A minimum of 7 hours shall be by participation in formal courses and 3 hours may be by independent study.

274:5 Continuation of Formulary. The formulary adopted by the joint pharmaceutical formulary board and in effect immediately prior to the effective date of this act shall continue in effect under the joint pharmaceutical formulary and credentialing committee as inserted by this act.

274:6 Effective Date. This act shall take effect 60 days after its passage.

(Approved: May 18, 2002)

(Effective Date: July 17, 2002)