Adoption of this amendment will MAINTAIN a 2/3s majority vote requirement for final passage of SB425 (§ 20).
ASSEMBLY ACTION Initial and Date |SENATE ACTION Initial and Date
Adopted Lost | Adopted Lost
Concurred In Not |Concurred In Not
Receded Not | Receded Not
Amend section 1, page 1, line 2, by deleting;
“2 and 3” and inserting:
“2, 3 and 3.5”.
Amend the bill as a whole by adding a new section designated sec. 3.5, following sec. 3, to read as follows:
“Sec. 3.5. 1. A wholesaler may sell a prescription drug only to:
(a) A pharmacy or practitioner; or
(b) Another wholesaler if:
(1) The wholesaler who purchases the drug is licensed by the Board; and
(2) The sale is a bona fide transaction.
2. A wholesaler may purchase a prescription drug only from:
(a) A manufacturer; or
(b) Another wholesaler if:
(1) The wholesaler who sells the drug is licensed by the Board; and
(2) The sale is a bona fide transaction.
3. The Board shall not limit the quantity of prescription drugs a wholesaler may purchase, sell, distribute or otherwise provide to another wholesaler, distributor or manufacturer.
4. For the purposes of this section:
(a) A purchase shall be deemed a bona fide transaction if:
(1) The wholesaler purchased the drug:
(I) Directly from the manufacturer of the drug; or
(II) With a reasonable belief that the drug was originally purchased directly from the manufacturer of the drug;
(2) The circumstances of the purchase reasonably indicate that the drug was not purchased from a source prohibited by law;
(3) Unless the drug is purchased by the wholesaler from the manufacturer, before the wholesaler sells the drug to another wholesaler, the wholesaler who sells the drug conducts a reasonable visual examination of the drug to ensure that the drug is not:
(I) Counterfeit;
(II) Deemed to be adulterated or misbranded in accordance with the provisions of chapter 585 of NRS;
(III) Mislabeled;
(IV) Damaged or compromised by improper handling, storage or temperature control;
(V) From a foreign or unlawful source; or
(VI) Manufactured, packaged, labeled or shipped in violation of any state or federal law relating to prescription drugs;
(4) The drug is shipped directly from the wholesaler who sells the drug to the wholesaler who purchases the drug; and
(5) The documents of the shipping company concerning the shipping of the drug are attached to the invoice for the drug and are maintained in the records of the wholesaler.
(b) A sale shall be deemed a bona fide transaction if there is a reasonable assurance by the wholesaler that purchases the drug that the wholesaler will sell the drug directly and only to a pharmacy or practitioner.
(c) The purchase or sale of a prescription drug includes, without limitation, the distribution, transfer, trading, bartering or any other provision of a prescription drug to another person by a wholesaler. A transfer of a prescription drug from a wholesale facility of a wholesaler to another wholesale facility of the wholesaler shall not be deemed a purchase or sale of a prescription drug pursuant to this section if the wholesaler is a corporation whose securities are publicly traded and regulated by the Securities Exchange Act of 1934.”.
Amend sec. 16, page 8, by deleting lines 7 through 11 and inserting:
“pharmaceutical technicians and supportive personnel; and
(b) [Services] The services which may be performed by pharmaceutical”.
Amend sec. 20, page 10, line 21, by deleting “50” and inserting “[50] 20”.
Amend sec. 20, page 10, line 23, by deleting “50” and inserting “[50] 20”.
Amend the bill as a whole by adding a new section designated sec. 24.5, following sec. 24, to read as follows:
“Sec. 24.5. NRS 639.233 is hereby amended to read as follows:
639.233 1. Any person, including a wholesaler or manufacturer, who engages in the business of wholesale distribution or furnishing controlled substances, poisons, drugs, devices or appliances that are restricted by federal law to sale by or on the order of a physician to any person located within this state shall obtain a license pursuant to the provisions of this chapter.
2. [The provisions of subsection 1 do not apply to a wholesaler or manufacturer whose principal place of business is located in another state and who ships controlled substances, drugs, poisons or restricted devices or appliances to a wholesaler or manufacturer located within this state and licensed by the Board.
3.] For the purpose of this section, a person is “engaged in the business of furnishing” if he:
(a) Solicits or accepts orders for drugs or devices whose sale in this state is restricted by this chapter or chapter 453 or 454 of NRS; or
(b) Receives, stores or ships such drugs or devices.”.
Amend sec. 25, page 13, line 24, by deleting “inspection” and inserting:
“inspection , copying and removal for copying”.
Amend sec. 25, page 13, line 27, after “licensee” by inserting:
“is not a resident of this state and”.
Amend sec. 25, page 13, by deleting lines 36 through 38 and inserting:
“4. [Failure] The intentional failure to furnish a true copy of the required records or the intentional refusal to permit their inspection is a ground for [the revocation or] summary suspension of and disciplinary action relating to any license issued pursuant to NRS 639.233.”.
Amend the bill as a whole by adding a new section designated sec. 40.5, following sec. 40, to read as follows:
“Sec. 40.5. NRS 453.375 is hereby amended to read as follows:
453.375 A controlled substance may be possessed and administered by the following persons:
1. A practitioner.
2. A registered nurse licensed to practice professional nursing or licensed practical nurse, at the direction of a physician, physician assistant, dentist, podiatric physician or advanced practitioner of nursing, or pursuant to a chart order, for administration to a patient at another location.
3. An advanced emergency medical technician:
(a) As authorized by regulation of:
(1) The State Board of Health in a county whose population is less than 100,000; or
(2) A county or district board of health in a county whose population is 100,000 or more; and
(b) In accordance with any applicable regulations of:
(1) The State Board of Health in a county whose population is less than 100,000;
(2) A county board of health in a county whose population is 100,000 or more; or
(3) A district board of health created pursuant to NRS 439.370 in any county.
4. A respiratory therapist,at the direction of a physician or physician assistant.
5. A medical student, student in training to become a physician assistant or student nurse in the course of his studies at an approved college of medicine or school of professional or practical nursing, at the direction of a physician or physician assistant and:
(a) In the presence of a physician, physician assistant or a registered nurse; or
(b) Under the supervision of a physician, physician assistant or a registered nurse if the student is authorized by the college or school to administer the substance outside the presence of a physician, physician assistant or nurse.
FLUSH
A medical student or student nurse may administer a controlled
substance in the presence or under the supervision of a registered nurse alone
only if the circumstances are such that the registered nurse would be
authorized to administer it personally.
6. An ultimate user or any person whom the ultimate user designates pursuant to a written agreement.
7. Any person designated by the head of a correctional institution.
8. A veterinary technician at the direction of his supervising veterinarian.
9. In accordance with applicable regulations of the State Board of Health, an employee of a residential facility for groups, as defined in NRS 449.017, pursuant to a written agreement entered into by the ultimate user.
10. In accordance with applicable regulations of the State Board of Pharmacy, an animal control officer, a wildlife biologist or an employee designated by a federal, state or local governmental agency whose duties include the control of domestic, wild and predatory animals.
11. A person who is enrolled in a training program to become an advanced emergency medical technician, respiratory therapist or veterinary technician if the person possesses and administers the controlled substance in the same manner and under the same conditions that apply, respectively, to an advanced emergency medical technician, respiratory therapist or veterinary technician who may possess and administer the controlled substance, and under the direct supervision of a person licensed or registered to perform the respective medical art or a supervisor of such a person.”.
Amend the bill as a whole by adding a new section designated sec. 41.5, following sec. 41, to read as follows:
“Sec. 41.5. NRS 454.213 is hereby amended to read as follows:
454.213 A drug or medicine referred to in NRS 454.181 to 454.371, inclusive, may be possessed and administered by:
1. A practitioner.
2. A physician assistant at the direction of his supervising physician or a licensed dental hygienist acting in the office of and under the supervision of a dentist.
3. Except as otherwise provided in subsection 4, a registered nurse licensed to practice professional nursing or licensed practical nurse, at the direction of a prescribing physician, physician assistant, dentist, podiatric physician or advanced practitioner of nursing, or pursuant to a chart order, for administration to a patient at another location.
4. In accordance with applicable regulations of the Board, a registered nurse licensed to practice professional nursing or licensed practical nurse who is:
(a) Employed by a health care agency or health care facility that is authorized to provide emergency care, or to respond to the immediate needs of a patient, in the residence of the patient; and
(b) Acting under the direction of the medical director of that agency or facility who works in this state.
5. An intermediate emergency medical technician or an advanced emergency medical technician, as authorized by regulation of the State Board of Pharmacy and in accordance with any applicable regulations of:
(a) The State Board of Health in a county whose population is less than 100,000;
(b) A county board of health in a county whose population is 100,000 or more; or
(c) A district board of health created pursuant to NRS 439.370 in any county.
6. A respiratory therapist employed in a health care facility. The therapist may possess and administer respiratory products only at the direction of a physician.
7. A dialysis technician, under the direction or supervision of a physician or registered nurse only if the drug or medicine is used for the process of renal dialysis.
8. A medical student or student nurse in the course of his studies at an approved college of medicine or school of professional or practical nursing, at the direction of a physician and:
(a) In the presence of a physician or a registered nurse; or
(b) Under the supervision of a physician or a registered nurse if the student is authorized by the college or school to administer the drug or medicine outside the presence of a physician or nurse.
FLUSH
A medical student or student nurse may administer a dangerous
drug in the presence or under the supervision of a registered nurse alone only
if the circumstances are such that the registered nurse would be authorized to
administer it personally.
9. Any person designated by the head of a correctional institution.
10. An ultimate user or any person designated by the ultimate user pursuant to a written agreement.
11. A nuclear medicine technologist, at the direction of a physician and in accordance with any conditions established by regulation of the Board.
12. A radiologic technologist, at the direction of a physician and in accordance with any conditions established by regulation of the Board.
13. A chiropractic physician, but only if the drug or medicine is a topical drug used for cooling and stretching external tissue during therapeutic treatments.
14. A physical therapist, but only if the drug or medicine is a topical drug which is:
(a) Used for cooling and stretching external tissue during therapeutic treatments; and
(b) Prescribed by a licensed physician for:
(1) Iontophoresis; or
(2) The transmission of drugs through the skin using ultrasound.
15. In accordance with applicable regulations of the State Board of Health, an employee of a residential facility for groups, as defined in NRS 449.017, pursuant to a written agreement entered into by the ultimate user.
16. A veterinary technician at the direction of his supervising veterinarian.
17. In accordance with applicable regulations of the Board, a registered pharmacist who:
(a) Is trained in and certified to carry out standards and practices for immunization programs;
(b) Is authorized to administer immunizations pursuant to written protocols from a physician; and
(c) Administers immunizations in compliance with the “Standards of Immunization Practices” recommended and approved by the United States Public Health Service Advisory Committee on Immunization Practices.
18. A person who is enrolled in a training program to become a physician assistant, dental hygienist, intermediate emergency medical technician, advanced emergency medical technician, respiratory therapist, dialysis technician, nuclear medicine technologist, radiologic technologist, physical therapist or veterinary technician if the person possesses and administers the drug or medicine in the same manner and under the same conditions that apply, respectively, to a physician assistant, dental hygienist, intermediate emergency medical technician, advanced emergency medical technician, respiratory therapist, dialysis technician, nuclear medicine technologist, radiologic technologist, physical therapist or veterinary technician who may possess and administer the drug or medicine, and under the direct supervision of a person licensed or registered to perform the respective medical art or a supervisor of such a person.”.
Amend the title of the bill to read as follows:
“AN ACT relating to pharmacy; increasing the fee for the biennial renewal of a license for a manufacturer or wholesaler; abolishing inactive licenses; revising provisions governing prescriptions purchased with cash; revising provisions governing the sale and purchase of prescription drugs by a wholesaler; revising provisions governing a rehearing of the State Board of Pharmacy concerning a contest or appeal of a decision of the Board; repealing the requirement that a notice concerning the substitution of certain drugs be displayed in a pharmacy; reducing the fees for the initial registration and renewal of a registration of supportive personnel; authorizing persons enrolled in certain training programs to administer controlled substances and certain drugs and medicines; and providing other matters properly relating thereto.”.