SB342 (2006) Detail

(New Title) relative to the treatment of glaucoma by optometrists.


CHAPTER 182

SB 342 – FINAL VERSION

03/22/06 1393s

05/11/06 2095eba

2006 SESSION

06-2717

10/09

SENATE BILL 342

AN ACT relative to the treatment of glaucoma by optometrists.

SPONSORS: Sen. Martel, Dist 18; Sen. Clegg, Dist 14; Sen. Letourneau, Dist 19; Sen. Gallus, Dist 1; Sen. Johnson, Dist 2; Rep. G. Katsakiores, Rock 5; Rep. P. Katsakiores, Rock 5; Rep. DeJoie, Merr 11; Rep. Dalrymple, Rock 4; Rep. R. Wheeler, Hills 7

COMMITTEE: Executive Departments and Administration

AMENDED ANALYSIS

This bill revises the requirements for optometrists treating glaucoma patients.

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03/22/06 1393s

05/11/06 2095eba

06-2717

10/09

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Six

AN ACT relative to the treatment of glaucoma by optometrists.

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

182:1 Definition of Pharmaceutical Agent. Amend RSA 327:1, III 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 and credentialing committee and included in the formulary] pursuant to RSA 327:6-a, VI.

(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 the lacrimal gland, or structures posterior to the iris, approved [by the joint pharmaceutical formulary and credentialing committee and included in the formulary] pursuant to RSA 327:6-a, VI.

(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 the lacrimal gland, or structures posterior to the iris. This may include class III and IV controlled substances approved [by the joint pharmaceutical formulary and credentialing committee] pursuant to RSA 327:6-a, VI 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 and credentialing committee] pursuant to RSA 327:6-a, VI.

(j) Non-steroidal anti-inflammatory agents approved [by the joint pharmaceutical formulary and credentialing committee] pursuant to RSA 327:6-a, VI 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] board.

(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] approved pursuant to RSA 327:6-a, VI.

(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.

182:2 New Paragraphs; Pharmaceutical Agents. Amend RSA 327:6-a by inserting after paragraph V the following new paragraphs:

VI. To the extent approval of pharmaceuticals is referenced in RSA 327:1, III, the board shall have the authority to review and approve topically applied pharmaceuticals and the joint pharmaceutical formulary and credentialing committee shall have the authority to review and approve orally administered pharmaceuticals.

VII. The board shall provide the pharmacy board with a current list of pharmaceutical

agents approved pursuant to paragraph VI. The current optometric formulary shall be available from the board and posted on the board’s website.

VIII. Upon certification to treat glaucoma patients pursuant to RSA 327:6-c, the board shall issue a license to the optometrist with a “tpa/g” certification. A current list of “tpa/g” certified optometrists with date of certification shall be available from the board and posted on the board’s website.

182:3 Joint Pharmaceutical Formulary and Credentialing Committee. Amend RSA 327:6-b, II to read as follows:

II. The committee shall meet quarterly to:

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

(b) Develop a glaucoma [reporting] credentialing 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)] Review suggestions, complaints, and concerns regarding the glaucoma certification process described in RSA 327:6-c, II, and report the results of its review to the board. This subparagraph shall not grant the committee additional authority or powers not stated in this subparagraph;

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

[(f)] (e) 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].

182:4 Treatment of Glaucoma. Amend RSA 327:6-c to read as follows:

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] shall waive the requirements of [subparagraphs (a) and (b)] this paragraph and of paragraph II for optometrists who have either graduated after 2002 or who have proof of 12 months of credentialed privileges to treat glaucoma by the United States Department of Defense or Department of Veteran Affairs or the national Indian Health Service, verified by the board.

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; and “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 subparagraph I(c) or paragraph III, therapeutic pharmaceutical agent certified optometrists are required to provide evidence of successful collaborative treatment and co-management of [40] 25 glaucoma patients, up to [20] 5 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)] (1) A new or existing glaucoma patient is examined and diagnosed by the optometrist;

[(ii)] (2) The optometrist develops a proposed treatment plan and forwards the plan with examination documentation to an ophthalmologist for consultation;

[(iii)] (3) The ophthalmologist[,] examines the patient and reviews the optometrist’s examination documentation and proposed treatment plan;

[(iv)] (4) The ophthalmologist, optometrist, and patient mutually agree to and document a treatment plan;

[(v)] (5) The optometrist shall [refer the patient within 30 days to] consult with 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 documented progression of optic nerve damage [or]; the patient develops documented and repeated progression of visual field loss; or the patient develops angle-closure or other secondary glaucoma; and

[(vi)] (6) For each successfully co-managed glaucoma patient the optometrist and co-managing ophthalmologist 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] may 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)] requirements of RSA 327:6-c, I and II for the following categories of optometrists:

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

[(d)] (b) Optometrists who have [completed] proof of successful completion of a 12-month accredited optometric residency program or its equivalent.

IV. [(a)] Upon certification to treat glaucoma patients[,]:

(a) For a period of 24 months, optometrists shall [refer] consult with an ophthalmologist within 30 days for 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.]

(b) An optometrist shall [refer a glaucoma patient] consult with an ophthalmologist 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)] (1) The patient is experiencing documented progression of optic nerve damage or the patient develops documented and repeated progression of visual field loss on maximum tolerated medical therapy; or

[(iv)] (2) 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.]

182:5 Disciplinary Proceedings; Misconduct. Amend RSA 327:20, II(g) and (h) to read as follows:

(g) Willful or repeated violation of the provisions of this chapter; [or]

(h) Suspension or revocation of a license, similar to one issued under this chapter, in another jurisdiction and not reinstated; or

(i) The use of any pharmaceutical agent by an optometrist not authorized under RSA 327:6-a or the use of any pharmaceutical agent other than those agents described in RSA 327:1 or those previously approved by the joint pharmaceutical formulary and credentialing committee.

182:6 Repeal. RSA 327:6-b, III, relative to violations relating to the use of pharmaceutical agents, is repealed.

182:7 Effective Date. This act shall take effect 60 days after its passage.

Approved: May 25, 2006

Effective: July 24, 2006