Revision: Dec. 2, 2019, 4:01 p.m.
HB 1404 - AS INTRODUCED
2020 SESSION
20-2159
01/05
HOUSE BILL 1404
SPONSORS: Rep. Muscatel, Graf. 12; Rep. Marsh, Carr. 8; Rep. Knirk, Carr. 3; Rep. Merchant, Sull. 4; Rep. P. Schmidt, Straf. 19; Rep. Weston, Graf. 8; Rep. Kenney, Straf. 6; Rep. Query, Hills. 16
COMMITTEE: Health, Human Services and Elderly Affairs
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ANALYSIS
This bill authorizes physicians and advanced practice registered nurses to examine and provide prophylaxis or treatment for human immunodeficiency virus or acquired immune deficiency syndrome for a minor without parental consent under certain circumstances. This bill also authorizes pharmacists to administer up to a 60-day supply of pre-exposure prophylaxis for human immunodeficiency virus if certain conditions are met.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
20-2159
01/05
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Paragraph; Communicable Disease; Sexually Transmitted Disease. Amend RSA 141-C:18 by inserting after paragraph II the following new paragraph:
III.(a) Any licensed physician or advanced practice registered nurse (APRN) may examine and provide prophylaxis or treatment for human immunodeficiency virus infection or acquired immune deficiency syndrome for a minor without knowledge or consent of the parents or guardian of the minor if the minor requests that his or her parents or guardian not be notified and the physician or APRN determines that notification of the parents or guardian of the minor will result in prophylaxis or treatment being denied or the physician or APRN determines that the minor will not seek, pursue, or continue prophylaxis or treatment if the parents or guardian are notified. The physician or APRN shall document that the reasons for the determination to provide prophylaxis or treatment without the consent or notification of the parents or guardian of the minor and shall include such documentation, signed by the minor, in the minor's clinical record. The fact of consultation, examination, and prophylaxis or treatment of a minor under the provisions of this paragraph shall be confidential and shall not be divulged without the minor's consent, including a bill sent for the services to any person other than the minor until the physician or APRN consults with the minor regarding the procedures for sending a bill. In this paragraph:
(1) "Prophylaxis" means the use of medication to prevent human immunodeficiency virus, but does not include the administration of any vaccine.
(2) "Minor" means any person under the age of 18.
(b) A minor shall be personally liable for all costs and expenses for services afforded the minor at their request under this paragraph.
2 New Section; Pharmacist Administration of Pre-exposure Prophylaxis. Amend RSA 318 by inserting after section 16-d the following new section:
318:16-e Pharmacist Administration of Pre-exposure Prophylaxis.
I. A pharmacist may initiate and furnish HIV pre-exposure prophylaxis in accordance with this section. A pharmacist shall furnish at least a 30-day supply, and up to a 60-day supply, of pre-exposure prophylaxis if all of the following conditions are met:
(a) The patient is HIV negative, as documented by a negative HIV test result obtained within the previous 7 days from an HIV antigen/antibody test or antibody-only test or from a rapid, point-of-care fingerstick blood test approved by the federal Food and Drug Administration. If the patient does not provide evidence of a negative HIV test in accordance with this paragraph, the pharmacist shall order an HIV test. If the test results are not transmitted directly to the pharmacist, the pharmacist shall verify the test results to the pharmacist’s satisfaction. If the patient tests positive for HIV infection, the pharmacist or person administering the test shall direct the patient to a primary care provider and provide a list of providers and clinics in the region.
(b) The patient does not report any signs or symptoms of acute HIV infection on a self-reported checklist of acute HIV infection signs and symptoms.
(c) The patient does not report taking any contraindicated medications.
(d) The pharmacist provides counseling to the patient on the ongoing use of pre-exposure prophylaxis, which may include education about side effects, safety during pregnancy and breastfeeding, adherence to recommended dosing, and the importance of timely testing and treatment, as applicable, for HIV, renal function, hepatitis B, hepatitis C, sexually transmitted diseases, and pregnancy for individuals of child-bearing capacity. The pharmacist shall notify the patient that the patient must be seen by a primary care provider to receive subsequent prescriptions for pre-exposure prophylaxis and that a pharmacist shall not furnish a 60-day supply of pre-exposure prophylaxis to a single patient more than once every 2 years.
(e) The pharmacist documents, to the extent possible, the services provided by the pharmacist in the patient’s record in the record system maintained by the pharmacy. The pharmacist shall maintain records of pre-exposure prophylaxis furnished to each patient.
(f) The pharmacist does not furnish more than a 60-day supply of pre-exposure prophylaxis to a single patient more than once every 2 years, unless directed otherwise by a prescriber.
(g) The pharmacist notifies the patient’s primary care provider that the pharmacist completed the requirements specified in this section. If the patient does not have a primary care provider, or refuses consent to notify the patient’s primary care provider, the pharmacist shall provide the patient with a list of physicians and surgeons, clinics, or other health care service providers to contact regarding ongoing care for pre-exposure prophylaxis.
II. In this section:
(a) “Pre-exposure prophylaxis” means a fixed-dose combination of tenofovir disoproxil fumarate (TDF) (300 mg) with emtricitabine (FTC) (200 mg), or another drug or drug combination determined by the board to meet the same clinical eligibility recommendations provided in CDC guidelines.
(b) “CDC guidelines” means the “2017 Pre-exposure Prophylaxis for the Prevention of HIV Infection in the United States–2017 Update: A Clinical Practice Guideline,” or any subsequent guidelines, published by the federal Centers for Disease Control and Prevention.
3 New Paragraph; Pharmacy Board; Rulemaking. Amend RSA 318:5-a by inserting after paragraph XX the following new paragraph:
XXI. Procedures and protocols for the administration of pre-exposure prophylaxis for the human immunodeficiency virus, pursuant to RSA 318:16-e.
4 Effective Date. This act shall take effect 60 days after its passage.