An Act To Improve Access to HN Prevention Medications
Maine Legislature, Session 130, LD 1115
Committee Amendment CA_B_S240 (Senate)
Amends: 32 MRSA §13702-A

COMMITTEE AMENDMENT" J?" to S.P. 378, L.D. 1115, "An Act To Improve 
Access to HN Prevention Medications" 
Amend the bill in section 3 in paragraph Din the first 2 lines (page 1, lines 12 and 13 
in L.D.) by striking out the following: "as defined in Title 24-A, section 4 317-D, subsection 
1, paragraph B" 
Amend the bill by striking out all of section 4. 
Amend the bill by striking out all of section 5 and inserting the following: 
'Sec. 5. 32 MRSA §13702-A, sub-§28, as amended by PL 2017, c. 185, §1, is 
further amended to read: 
28. Practice of pharmacy. "Practice of pharmacy" means the interpretation and 
evaluation of prescription drug orders; the compounding, dispensing and labeling of drugs 
and devices, except labeling by a manufacturer, packer or distributor of nonprescription 
drugs and commercially packaged legend drugs and devices; the participation in drug 
selection and drug utilization reviews; the proper and safe storage of drugs and devices and 
the maintenance of proper records for these drugs and devices; the administration of 
vaccines licensed by the United States Food and Drug Administration that are 
recommended by the United States Centers for Disease Control and Prevention Advisory 
Committee on Immunization Practices, or successor organization, for administration to 
adults; the performance of collaborative drug therapy management; the responsibility for 
advising, when necessary or regulated, of therapeutic values, content, hazards and use of 
drugs and devices; the ordering and dispensing of over-the-counter nicotine replacement 
products approved by the United States Food and Drug Administration; the prescribing, 
dispensing and administering of an HN prevention drug, as defined in section 13786-E, 
subsection 1. paragraph B, pursuant to a standing order or collaborative practice agreement 
or to protocols developed by the board; and the offering or performing of those acts, 
services, operations or transactions necessary in the conduct, operation, management and 
control of a pharmacy.' 
Page I - 130LR1215(03) 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" \b" to S.P. 378, L.D. 1115 Cs- 2~) 
Amend the bill in section 6 in §13786-E in the first line (page 2, line 36 in L.D.) by 
striking out the following: "Dispensing" and inserting the following: 'Prescribing, 
dispensing and administering' 
Amend the bill in section 6 in §13786-E by striking out all of subsection 2 (page 3, 
lines 10 to 43 and page 4, lines 1 to 27 in L.D.) and inserting the following: 
'2. Authorization. Notwithstanding any provision of law to the contrary and as 
authorized by the board in accordance with rules adopted under subsection 3, a pharmacist 
may prescribe, dispense and administer HIV prevention drugs pursuant to a standing order 
or collaborative practice agreement or to protocols developed by the board for when there 
is no prescription drug order, standing order or collaborative practice agreement in 
accordance with the requirements in this subsection and may also order laboratory testing 
for HIV infection as necessary. 
A. Before furnishing an HIV prevention drug to a patient, a pharmacist shall complete 
a training program approved by the board on the use of protocols developed by the 
board for prescribing, dispensing and administering an HIV prevention drug, on the 
requirements for any laboratory testing for HIV infection and on guidelines for 
prescription adherence and best practices to counsel patients prescribed an HIV 
prevention drug. 
B. A pharmacist shall dispense or administer a preexposure prophylaxis drug in at least 
a 30-day supply, and up to a 60-day supply, as long as all of the following conditions 
are met: 
(1) The patient tests negative for HIV infection, as documented by a negative HIV 
test result obtained within the previous 7 days. If the patient does not provide 
evidence of a negative HIV test result in accordance with this subparagraph, 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 primary care providers and clinics within a reasonable travel distance of 
the patient's residence; 
(2) The patient does not report any signs or symptoms of acute HIV infection on 
a self-reporting checklist of acute HIV infection signs and symptoms; 
· 
3 
(3) The patient does not report taking any contraindicated medications; 
( 4) The pharmacist provides counseling to the patient, consistent with CDC 
5 
guidelines, on the ongoing use of a preexposure prophylaxis drug. The pharmacist 
shall notify the patient that the patient must be seen by a primary care provider to 
7 
receive subsequent prescriptions for a preexposure prophylaxis drug and that a 
8 
pharmacist may not dispense or administer more than a 60-day supply of a 
preexposure prophylaxis drug to a single patient once every 2 years without a 
prescription; 
(5) The pharmacist documents, to the extent possible, the services provided by the 
pharmacist in the patient's record in the patient profile record system maintained 
by the pharmacy. 
The pharmacist shall maintain records of preexposure 
prophylaxis drugs dispensed or administered to each patient; 
COMMITTEE AMENDMENT 
II 
COMMITTEEAMENDMENT".e, "to S.P. 378, L.D.1115 ls-249 
(6) The pharmacist does not dispense or administer more than a 60-day supply of 
a preexposure prophylaxis drug to a. single patient once every 2 years, unless 
otherwise directed by a practitioner; and 
(7) The pharmacist notifies the patient's primary care provider that the pharmacist 
completed the requirements specified in this paragraph. 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 a list of physicians, clinics or 
other health care providers to contact regarding follow-up care. 
C. A pharmacist shall dispense or administer a complete course of a post-exposure 
prophylaxis drug as long as all of the following conditions are met: 
(1) The pharmacist screens the patient and determines that the exposure occurred 
within the previous 72 hours and the patient otherwise meets the clinical criteria 
for a post-exposure prophylaxis drug under CDC guidelines; 
(2) The pharmacist provides HIV testing to the patient or determines that the 
patient is willing to undergo HIV testing consistent with CDC guidelines. If the 
patient refuses to undergo HIV testing but is otherwise eligible for a post-exposure 
prophylaxis drug under this subsection, the pharmacist may dispense or administer 
a post-exposure prophylaxis drug; 
(3) The pharmacist provides counseling to the patient, consistent with CDC 
guidelines, on the use of a post-exposure prophylaxis drug. The pharmacist shall 
also inform the patient of the availability of a preexposure prophylaxis drug for 
persons who are at substantial risk of acquiring HIV; and 
(4) The pharmacist notifies the patient's primary care provider of the dispensing 
or administering of the post-exposure prophylaxis drug. 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 a list of physicians, clinics or 
other health care providers to contact regarding follow-up care.' 
Amend the bill in section 6 in §13786-E by striking out all of subsection 3 (page 4, 
lines 28 to 32 in L.D.) and inserting the following: 
'3. Rules; protocols. The board by rule shall establish standards for authorizing 
pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with 
subsection 2, including adequate training requirements and protocols for when there is no 
prescription drug order, standing order or collaborative practice agreement. Rules adopted 
under this subsection are routine technical rules as defined in Title 5. chapter 375, 
subchapter 2-A.' 
Amend the bill by striking out all of sections 7 and 8 and inserting the following: 
'Sec. 7. Appropriations and allocations. The following appropriations and 
allocations are made. 
PROFESSIONAL AND FINANCIAL REGULATION, DEPARTMENT OF 
Administrative Services - Professional and Financial Regulation 0094 
Initiative: Allocates funds for technology-related costs associated with establishing one 
half-time Regulatory Health Compliance position to manage the anticipated increase in 
COMMITTEE AMENDMENT 
r,,j 
'U 
;~ 
COMMITTEE AMENDMENT" l:J" to S.P. 378, L.D. 1115 L.S • Z 4c) 
workload associated with the regulation of pharmacists' authority to dispense HIV 
prevention drugs. 
OTHER SPECIAL REVENUE FUNDS 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
Licensing and Enforcement 0352 
2021-22 
$2,729 
$2,729 
2022-23 
$3,347 
$3,347 
Initiative: Allocates funds for one half-time Regulatory Health Compliance position to 
manage the anticipated increase in workload associated with the regulation of phaffilacists' 
authority to dispense HIV prevention drugs. 
OTHER SPECIAL REVENUE FUNDS 
POSITIONS - LEGISLATIVE COUNT 
Personal Services 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
PROFESSIONAL AND FINANCIAL 
REGULATION, DEPARTMENT OF 
DEPARTMENT TOTALS 
OTHER SPECIAL REVENUE FUNDS 
DEPARTMENTTOTAL-ALLFUNDS 
2021-22 
0.500 
$35,328 
$5,782 
$41,110 
2021-22 
$43,839 
$43,839 
2022-23 
0.500 
$49,424 
$2,904 
$52,328 
2022-23 
$55,675 
$55,675 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section 
number to read consecutively. 
SUMMARY 
This amendment is the minority report of the committee. The amendment removes the 
provisions of the bill relating to requirements for health insurance coverage of HIV 
prevention drugs. The amendment makes changes to the bill's provisions authorizing a 
pharmacist to dispense HIV prevention drugs under certain conditions pursuant to a 
standing order or to protocols developed by the Maine Board of Pharmacy by authorizing 
a pharmacist to prescribe, dispense and administer HIV prevention drugs pursuant to a 
standing order or collaborative practice agreement or when there is no prescription drug 
order from a health care provider, subject to rules and protocols adopted by the board. The 
amendment also adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 05/04/21 :Wac. 
LD 1115 
LR 1215(03) 
An Act To Improve Access to HIV Prevention Medications 
Fiscal Note for Bill as Amended by Committee Amendment"~ [S-2.fD 
Committee: Health Coverage, Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2021-22 
FY 2022-23 
Projections 
FY2023-'24 
Appropriations/ Allocations 
Other Special Revenue Funds 
$43,839 
$55,675 
$58,640 
ansfers 
Other Special Revenue Funds 
$0 
$0 
$0 
Fiscal Detail and Notes 
Projections 
FY 2024-25 
$61,783 
$0 
The bill includes Other Special Revenue Funds allocations to the Department of Professional and Financial 
Regulation of $43,839 in fiscal year 2021-22 and $55,675 in fiscal year 2022-23 to implement the requirements of 
this legislation within the Office of Professional and Occupational Licensing, Maine Board of Pharmacy. 
Of this amount, the bill includes Other Special Revenue Funds allocations to the Licensing and Enforcement program 
of $41,110 in fiscal year 2021-22 and $52,328 in fiscal year 2022-23 to establish one half-time Regulatory Health 
Compliance position and related All Other costs to manage the anticipated increase in workload associated with the 
regulation of phannacists authority to dispense HIV prevention drugs. Additionally, the bill includes Other Special 
Revenue Funds allocations to the Administrative Services Division of $2,729 in fiscal year 2021-22 and $3,347 in 
fiscal year 2022-23 for technology-related costs associated with establishing the Regulatory Health Compliance 
position. The Office of Professional and Occupational Licensing will transfer funds from its Licensing and 
Enforcement program (which includes funds for the Maine Board of Pharmacy) to the Administrative Services 
Division to fund the allocations. 
The Maine Board of Phannacy within the Office of Professional and Occupational Licensing has sufficient resources 
available to support the cost of this legislation without raising fees through the 2022-2023 biennium. However, fees 
may need to be increased in future biennia if the current fee structure does not generate sufficient revenue to cover 
the cost of this lefri.slation.