Assembly Bill No. 401
CHAPTER 548

An act to amend Sections 4059.5 and 4107 of, to add Sections 4044.3, 4044.6, 4044.7, and 4169.1 to, to add Article 8 (commencing with Section 4130) to Chapter 9 of Division 2 of, and to add and repeal Section 4180.5 of, the Business and Professions Code, and to add Section 1211 to the Health and Safety Code, relating to healing arts.

[ Approved by Governor  October 07, 2017. Filed with Secretary of State  October 07, 2017. ]

LEGISLATIVE COUNSEL'S DIGEST


AB 401, Aguiar-Curry. Pharmacy: remote dispensing site pharmacy: telepharmacy: shared clinic office space.
Existing law, the Pharmacy Law, requires the California State Board of Pharmacy, which is within the Department of Consumer Affairs, to license and regulate the practice of pharmacy, including pharmacists, pharmacy technicians, and pharmacies.
This bill would require the board to issue a remote dispensing site pharmacy license to a supervising pharmacy, as defined, of a remote dispensing site pharmacy, as defined, if all the requirements for licensure are met for the purpose of increasing access to dispensing or pharmaceutical care services in the geographic area in which the remote dispensing site pharmacy is located. The bill would require a remote dispensing site pharmacy to use a telepharmacy system, as specified, and would prohibit pharmacy services from being provided at a remote dispensing site pharmacy if the telepharmacy system is unavailable. The bill would require a remote dispensing site pharmacy to be located in a medically underserved area, as defined, unless otherwise approved by the board. The bill would authorize a pharmacy located in this state to serve as a supervising pharmacy to provide telepharmacy services for one remote dispensing site pharmacy. The bill would require a remote dispensing site pharmacy to utilize specified secure communications systems and security systems. The bill would prohibit a remote dispensing site pharmacy from being located in any state facility and would prohibit a remote dispensing site pharmacy from being located or operated for the purpose of displacing state employees. The bill would require a remote dispensing site pharmacy that dispenses more than 225 prescriptions per day, calculated each calendar year, to cease being a remote dispensing site pharmacy and authorizes the remote dispensing site pharmacy to become a full-service pharmacy if it meets all the requirements for licensure as a pharmacy.
Existing law prohibits the ordering of dangerous drugs and devices by an entity not licensed by the board, except as otherwise provided, and requires the order to be delivered to the licensed premises and signed for by a pharmacist.
This bill would authorize a licensed remote dispensing site pharmacy, as defined, to order dangerous drugs and devices and controlled substances and authorizes a registered pharmacy technician meeting specified requirements to receive and sign for the delivered order. The bill would require any controlled substances signed for by a pharmacy technician to be stored separately from existing inventory until they are reviewed and countersigned by a pharmacist.
Existing law requires every pharmacy to designate a pharmacist-in-charge, as specified, and requires the pharmacist-in-charge to be responsible for the pharmacy’s compliance with all state and federal laws pertaining to the practice of pharmacy.
This bill would authorize a pharmacist to serve as a pharmacist-in-charge of a pharmacy in addition to serving as a pharmacist-in-charge of a supervising pharmacy and would require the designated pharmacist-in-charge of the supervising pharmacy to also serve as the designated pharmacist-in-charge of the remote dispensing site pharmacy. The bill would require the pharmacist-in-charge and the pharmacist-on-duty at the supervising pharmacy to be responsible for ensuring sufficient staffing, as specified.
Existing law authorizes a pharmacy technician to perform packaging, manipulative, repetitive, or other nondiscretionary tasks only while assisting, and while under the direct supervision and control of, a pharmacist and prohibits the ratio of pharmacy technicians performing these tasks to any additional pharmacists from exceeding 2 to 1, except as specified.
This bill would instead authorize a registered pharmacy technician, who meets certain requirements, to work at a remote dispensing site pharmacy and to perform order entry, packaging, manipulative, repetitive, and other nondiscretionary tasks under the supervision of a pharmacist at a supervising pharmacy using a telepharmacy system. The bill would prohibit a pharmacy technician working at a remote dispensing site pharmacy from performing certain tasks, including receiving a new prescription order orally. The bill would authorize a pharmacist at a supervising pharmacy to supervise up to 2 pharmacy technicians at each remote dispensing site pharmacy in addition to any pharmacy technicians being supervised at the supervising pharmacy.
Existing law prohibits a person from acting as a wholesaler of any dangerous drug or dangerous device unless the wholesaler has obtained a license from the board. Subject to certain exceptions, existing federal law requires a person, who manufactures, distributes, dispenses, imports, or exports any controlled substance to obtain a registration and requires a registrant to inform the United States Drug Enforcement Administration of any suspicious orders.
This bill would require a wholesaler to notify the board in writing of any suspicious orders of controlled substances placed by a California-licensed pharmacy or wholesaler by providing the board a copy of the information that the wholesaler provides to the United States Drug Enforcement Administration.
Existing law prohibits the board from issuing more than one site license to a single premises, except as specified.
This bill, until January 1, 2021, would authorize the board to issue specified licenses to 2 independently owned clinics that share a clinic office space, as specified. The bill would make each clinic jointly and severally responsible for drug losses. The bill would require the applicants to provide the board with a copy of the co-location agreement and a one-time application fee of $750 for the licenses. The bill would require a new application and specified fees for any change in ownership in either clinic. The bill would prohibit the board from issuing these licenses to clinics that share a clinic office space until the board is provided with documentation from the Director of the Department of Health Care Services that any Medi-Cal financing issues have been sufficiently addressed, as specified. The bill would authorize the Department of Health Care Services to seek any federal approvals it deems necessary to implement this provision. The bill also would prohibit the board from issuing these licenses to clinics that share a clinic office space until the board is provided with documentation from the Director of the Department of Public Health that any licensing and regulatory issues have been sufficiently addressed, as specified.
Under existing law, the State Department of Public Health is responsible for the licensing and regulation of clinics, as defined. Existing law exempts from the licensing and regulation provisions any clinic directly conducted, maintained, or operated by the United States or by any of its departments, offices, or agencies, and specified primary care clinics directly conducted, maintained, or operated by this state or by any of its political subdivisions or districts, or by any city.
This bill, until January 1, 2021, would authorize primary care clinics and specialty clinics to operate, as specified, in shared clinic space with the government clinics specified above. The bill would authorize the department to enter and inspect the shared space at any time, as specified. The bill would make the licensed primacy care clinic or specialty clinic responsible for any statutory or regulatory violations occurring on the premises. The bill would authorize the department to implement, interpret, or make specific these provisions by means of all-facility letters, or similar instructions, without taking regulatory action.
Existing law makes a violation of any provision of the Pharmacy Law punishable as a crime.
By expanding the scope of an existing crime, this bill would result in a state-mandated local program.
This bill would incorporate additional changes to Section 4059.5 of the Business and Professions Code proposed by SB 752 to be operative only if this bill and SB 752 are enacted and this bill is enacted last.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 (a) The Legislature hereby finds and declares all of the following:
(1) Greater access to health care professionals improves patient outcomes. Patients see their pharmacist more often than any other health care professional. Making pharmacists readily available should be a top priority of the state.
(2) Health care delivery and technology are evolving. Utilizing technology to connect patients to pharmacists in areas where there is no access will improve medication adherence and outcomes.
(3) Over 30 percent of patients never fill their prescriptions. According to a study by Kaiser, this number drops to 5 percent when patients have more convenient access to a pharmacy. Lack of convenient access to a pharmacy leads to lower rates of medication adherence and, according to the New England Healthcare Institute, nonadherence leads to over $290 billion in avoidable medial spending each year.
(4) Seventy-seven percent of rural counties are designated as health professional shortage areas. In California there are 115 identified areas located in 47 counties where the closest pharmacy is more than 10 miles away.
(5) In rural communities, the geographic and economic realities make it difficult to maintain a pharmacy. Between 2003 and 2013, there was a 12.1-percent decrease in rural pharmacies. Remote dispensing site pharmacies create an economically feasible way to bring pharmacy access to these underserved areas through the use of technology.
(b) The Legislature further finds and declares both of the following:
(1) Section 4001.1 of the Business and Professions Code establishes public protection as the highest priority of the California State Board of Pharmacy in exercising its licensing, regulatory, and disciplinary functions. That section further provides that whenever the protection of the public is inconsistent with other interests sought to be promoted, the protection of the public shall be paramount.
(2) Public protection requires the California State Board of Pharmacy to enforce the laws related to a supervising pharmacy, as defined by Section 4044.6 of the Business and Professions Code, and a remote dispensing site pharmacy, as defined in Section 4044.3 of the Business and Professions Code, through licensure.
(c) It is the intent of the Legislature to enact legislation that will promote policies to allow all California patients, regardless of location, to have access to a pharmacist, thereby increasing medication adherence.

SEC. 2.

 Section 4044.3 is added to the Business and Professions Code, to read:

4044.3.
 (a) “Remote dispensing site pharmacy” means a licensed pharmacy located in this state that is exclusively overseen and operated by a supervising pharmacy and staffed by one or more qualified registered pharmacy technicians, as defined in Section 4132, where pharmaceutical care services, including, but not limited to, the storage and dispensing of prescription drugs and controlled substances, drug regimen review, and patient counseling, are remotely monitored or provided, or both, by a licensed pharmacist through the use of telepharmacy technology.
(b) Unless otherwise specified in this chapter, a remote dispensing site pharmacy shall comply with all state and federal laws regulating the practice of pharmacy.

SEC. 3.

 Section 4044.6 is added to the Business and Professions Code, to read:

4044.6.
 (a) “Supervising pharmacy” means a licensed pharmacy located in this state that is owned and operated by a person or persons where the majority of the beneficial interest in, as well as the management and control, resides with at least one board-licensed pharmacist, as defined in Section 4036, that exclusively oversees the operations of a remote dispensing site pharmacy.
(b) A supervising pharmacy shall be exclusively responsible for the operation of the remote dispensing site pharmacy and its employees pursuant to Section 4131.

SEC. 4.

 Section 4044.7 is added to the Business and Professions Code, to read:

4044.7.
 “Telepharmacy” means a system that is used by a supervising pharmacy for the purpose of monitoring the dispensing of prescription drugs by a remote dispensing site pharmacy and provides for related drug regimen review and patient counseling by an electronic method, including, but not limited to, the use of audio, visual, still image capture, and store and forward technology.

SEC. 5.

 Section 4059.5 of the Business and Professions Code is amended to read:

4059.5.
 (a) Except as otherwise provided in this chapter, dangerous drugs or dangerous devices may only be ordered by an entity licensed by the board and shall be delivered to the licensed premises and signed for and received by a pharmacist. Where a licensee is permitted to operate through a designated representative, the designated representative shall sign for and receive the delivery.
(b) A dangerous drug or dangerous device transferred, sold, or delivered to a person within this state shall be transferred, sold, or delivered only to an entity licensed by the board, to a manufacturer, or to an ultimate user or the ultimate user’s agent.
(c) Notwithstanding subdivisions (a) and (b), deliveries to a hospital pharmacy may be made to a central receiving location within the hospital. However, the dangerous drugs or dangerous devices shall be delivered to the licensed pharmacy premises within one working day following receipt by the hospital, and the pharmacist on duty at that time shall immediately inventory the dangerous drugs or dangerous devices.
(d) Notwithstanding any other law, a dangerous drug or dangerous device may be ordered by and provided to a manufacturer, physician, dentist, podiatrist, optometrist, veterinarian, naturopathic doctor pursuant to Section 3640.7, or laboratory, or a physical therapist acting within the scope of his or her license. A person or entity receiving delivery of a dangerous drug or dangerous device, or a duly authorized representative of the person or entity, shall sign for the receipt of the dangerous drug or dangerous device.
(e) A dangerous drug or dangerous device shall not be transferred, sold, or delivered to a person outside this state, whether foreign or domestic, unless the transferor, seller, or deliverer does so in compliance with the laws of this state and of the United States and of the state or country to which the dangerous drugs or dangerous devices are to be transferred, sold, or delivered. Compliance with the laws of this state and the United States and of the state or country to which the dangerous drugs or dangerous devices are to be delivered shall include, but not be limited to, determining that the recipient of the dangerous drugs or dangerous devices is authorized by law to receive the dangerous drugs or dangerous devices.
(f) Notwithstanding subdivision (a), a pharmacy may take delivery of dangerous drugs and dangerous devices when the pharmacy is closed and no pharmacist is on duty if all of the following requirements are met:
(1) The drugs are placed in a secure storage facility in the same building as the pharmacy.
(2) Only the pharmacist-in-charge or a pharmacist designated by the pharmacist-in-charge has access to the secure storage facility after dangerous drugs or dangerous devices have been delivered.
(3) The secure storage facility has a means of indicating whether it has been entered after dangerous drugs or dangerous devices have been delivered.
(4) The pharmacy maintains written policies and procedures for the delivery of dangerous drugs and dangerous devices to a secure storage facility.
(5) The agent delivering dangerous drugs and dangerous devices pursuant to this subdivision leaves documents indicating the name and amount of each dangerous drug or dangerous device delivered in the secure storage facility.
The pharmacy shall be responsible for the dangerous drugs and dangerous devices delivered to the secure storage facility. The pharmacy shall also be responsible for obtaining and maintaining records relating to the delivery of dangerous drugs and dangerous devices to a secure storage facility.
(g) Notwithstanding subdivision (a), dangerous drugs and devices and controlled substances may be ordered by a remote dispensing site pharmacy licensed by the board and may be signed for and received by a registered pharmacy technician, who meets the qualifications of Section 4132, at the remote site. A controlled substance signed for by a pharmacy technician under this section shall be stored separately from existing inventory until the time the controlled substance is reviewed and countersigned by a pharmacist. Any receipt and storage of a controlled substance by a pharmacy technician pursuant to this section shall be captured on video, and that video shall be made accessible to the supervising pharmacy and maintained by the remote dispensing site pharmacy for 120 days.

SEC. 5.5.

 Section 4059.5 of the Business and Professions Code is amended to read:

4059.5.
 (a) Except as otherwise provided in this chapter, dangerous drugs or dangerous devices may only be ordered by an entity licensed by the board and shall be delivered to the licensed premises and signed for and received by a pharmacist. Where a licensee is permitted to operate through a designated representative, or in the case of a reverse distributor a designated representative-reverse distributor, that individual shall sign for and receive the delivery.
(b) A dangerous drug or dangerous device transferred, sold, or delivered to a person within this state shall be transferred, sold, or delivered only to an entity licensed by the board, to a manufacturer, or to an ultimate user or the ultimate user’s agent.
(c) Notwithstanding subdivisions (a) and (b), deliveries to a hospital pharmacy may be made to a central receiving location within the hospital. However, the dangerous drugs or dangerous devices shall be delivered to the licensed pharmacy premises within one working day following receipt by the hospital, and the pharmacist on duty at that time shall immediately inventory the dangerous drugs or dangerous devices.
(d) Notwithstanding any other law, a dangerous drug or dangerous device may be ordered by and provided to a manufacturer, physician, dentist, podiatrist, optometrist, veterinarian, naturopathic doctor pursuant to Section 3640.7, or laboratory, or a physical therapist acting within the scope of his or her license. A person or entity receiving delivery of a dangerous drug or dangerous device, or a duly authorized representative of the person or entity, shall sign for the receipt of the dangerous drug or dangerous device.
(e) A dangerous drug or dangerous device shall not be transferred, sold, or delivered to a person outside this state, whether foreign or domestic, unless the transferor, seller, or deliverer does so in compliance with the laws of this state and of the United States and of the state or country to which the dangerous drugs or dangerous devices are to be transferred, sold, or delivered. Compliance with the laws of this state and the United States and of the state or country to which the dangerous drugs or dangerous devices are to be delivered shall include, but not be limited to, determining that the recipient of the dangerous drugs or dangerous devices is authorized by law to receive the dangerous drugs or dangerous devices.
(f) Notwithstanding subdivision (a), a pharmacy may take delivery of dangerous drugs and dangerous devices when the pharmacy is closed and no pharmacist is on duty if all of the following requirements are met:
(1) The drugs are placed in a secure storage facility in the same building as the pharmacy.
(2) Only the pharmacist-in-charge or a pharmacist designated by the pharmacist-in-charge has access to the secure storage facility after dangerous drugs or dangerous devices have been delivered.
(3) The secure storage facility has a means of indicating whether it has been entered after dangerous drugs or dangerous devices have been delivered.
(4) The pharmacy maintains written policies and procedures for the delivery of dangerous drugs and dangerous devices to a secure storage facility.
(5) The agent delivering dangerous drugs and dangerous devices pursuant to this subdivision leaves documents indicating the name and amount of each dangerous drug or dangerous device delivered in the secure storage facility.
The pharmacy shall be responsible for the dangerous drugs and dangerous devices delivered to the secure storage facility. The pharmacy shall also be responsible for obtaining and maintaining records relating to the delivery of dangerous drugs and dangerous devices to a secure storage facility.
(g) Notwithstanding subdivision (a), dangerous drugs and devices and controlled substances may be ordered by a remote dispensing site pharmacy licensed by the board and may be signed for and received by a registered pharmacy technician, who meets the qualifications of Section 4132, at the remote site. A controlled substance signed for by a pharmacy technician under this section shall be stored separately from existing inventory until the time the controlled substance is reviewed and countersigned by a pharmacist. Any receipt and storage of a controlled substance by a pharmacy technician pursuant to this section shall be captured on video, and that video shall be made accessible to the supervising pharmacy and maintained by the remote dispensing site pharmacy for 120 days.

SEC. 6.

 Section 4107 of the Business and Professions Code is amended to read:

4107.
 (a) The board shall not issue more than one site license to a single premises except as follows:
(1) To issue a veterinary food-animal drug retailer license to a wholesaler pursuant to Section 4196.
(2) To issue a license to compound sterile drugs to a pharmacy pursuant to Section 4127.1 or 4127.2.
(3) To issue a centralized hospital packaging license pursuant to Section 4128.
(4) To issue licenses to two independently owned clinics that share a clinic office space pursuant to Section 4180.5.
(b) For the purposes of this subdivision, “premises” means a location with its own address and an independent means of ingress and egress.

SEC. 7.

 Article 8 (commencing with Section 4130) is added to Chapter 9 of Division 2 of the Business and Professions Code, to read:
Article  8. Telepharmacy Systems and Remote Dispensing Site Pharmacies

4130.
 (a) A telepharmacy system shall be used for the dispensing of prescription drugs and providing related drug regimen review and patient counseling services at a remote dispensing site pharmacy.
(b) If all of the requirements of this article and other relevant provisions of this chapter are met, the board shall issue a remote dispensing site pharmacy license for the purpose of increasing access to dispensing or pharmaceutical care services in the geographic area in which the remote dispensing site pharmacy is to be located.
(c) (1) A remote dispensing site pharmacy shall only be located in a medically underserved area unless otherwise approved by the board. For purposes of this section, a “medically underserved area” means a location that does not have a pharmacy that serves the general public within 10 road miles of the remote dispensing site.
(2) Notwithstanding paragraph (1), if a pharmacy serving the general public is later established within 10 road miles of a remote dispensing site pharmacy, the remote dispensing site pharmacy may continue to operate.
(d) A remote dispensing site pharmacy shall only be staffed by pharmacists or pharmacy technicians, or both, and shall not employ any unlicensed personnel.
(e) A remote dispensing site pharmacy license shall be issued only to the supervising pharmacy. A supervising pharmacy shall not obtain more than one remote dispensing site pharmacy license.
(f) A remote dispensing site pharmacy shall not be operated by the state and shall not be located in any state facility, including, but not limited to, correctional facilities, state hospitals, or developmental centers. This section shall not be construed to preclude a pharmacist who is otherwise eligible to operate a remote dispensing site pharmacy pursuant to this section from leasing space in property owned by the state, provided it is not for the purpose of serving individuals otherwise served by pharmacists and pharmacy technicians employed by the state.
(g) A remote dispensing site pharmacy shall not be located or operated for the purpose of displacing state employees.
(h) If a remote dispensing site pharmacy dispenses more than 225 prescriptions per day, calculated each calendar year, it shall cease to be a remote dispensing site pharmacy and may become a full-service pharmacy licensed under Section 4110 with a pharmacist onsite if it meets all the requirements for licensure for a pharmacy.

4131.
 (a) A supervising pharmacy shall provide telepharmacy services for only one remote dispensing site pharmacy.
(b) A supervising pharmacy shall not be located greater than 150 road miles from a remote dispensing site pharmacy, unless otherwise approved by the board.
(c) A supervising pharmacy and remote dispensing site pharmacy shall be under common ownership.
(d) Unless staffed by a pharmacist, a remote dispensing site pharmacy shall be staffed by at least one registered pharmacy technician meeting the qualifications of Section 4132. A technician shall remain under the direct supervision and control of a pharmacist at the supervising pharmacy at all times that the remote dispensing site pharmacy is operational. For the purposes of this article, direct supervision and control does not require the pharmacist to be physically present at the remote dispensing site pharmacy, but the pharmacist shall use a telepharmacy system to supervise operations through audio and visual technology from the supervising pharmacy.
(e) Notwithstanding any other law, a pharmacist may serve as the pharmacist-in-charge for a pharmacy in addition to serving as pharmacist-in-charge of a supervising pharmacy. The designated pharmacist-in-charge of the supervising pharmacy shall also serve as the designated pharmacist-in-charge at the remote dispensing site pharmacy.
(f) Notwithstanding any other law, the pharmacist-in-charge of the remote dispensing site pharmacy and the pharmacist-on-duty at the supervising pharmacy shall be responsible for ensuring that both the supervising pharmacy and remote dispensing site pharmacy are sufficiently staffed to allow for appropriate supervision, which is supervision that would not be reasonably expected to result in an unreasonable risk of harm to public health, safety, or welfare.

4132.
 (a) In addition to the requirements of Section 4202, a pharmacy technician working at a remote dispensing site pharmacy shall meet the qualifications promulgated by the board. The regulations developed by the board shall only apply to pharmacy technicians working at remote dispensing sites.
(b) Notwithstanding Section 4115, a registered pharmacy technician may perform order entry, packaging, manipulative, repetitive, and other nondiscretionary tasks at a remote dispensing site pharmacy under the supervision of a pharmacist at a supervising pharmacy using a telepharmacy system.
(c) A pharmacy technician at a remote dispensing site pharmacy shall not do any of the following:
(1) Receive a new prescription order orally from a prescriber or other person authorized to prescribe by law.
(2) Consult with a patient or his or her agent regarding a prescription, either prior to or after dispensing, or regarding any medical information contained in a patient medication record system or patient chart.
(3) Identify, evaluate, or interpret a prescription.
(4) Interpret the clinical data in a patient medication record system or patient chart.
(5) Consult with any prescriber, nurse, or other health care professional or authorized agent thereof.
(6) Supervise the packaging of drugs and check the packaging procedure and product upon completion.
(7) Perform any function that requires the professional judgment of a licensed pharmacist.
(8) Compound drug preparations.
(d) Notwithstanding Section 4115, a pharmacist at a supervising pharmacy may supervise up to two pharmacy technicians at each remote dispensing site pharmacy. This subdivision shall not be construed to alter a pharmacist’s ability to also supervise pharmacy technicians at the supervising pharmacy.

4133.
 (a) A telepharmacy system shall maintain a video and audio communication system that provides for effective communication between the supervising pharmacy and the remote dispensing site pharmacy’s personnel and patients.
(b) A telepharmacy system shall facilitate adequate pharmacist supervision and allow the appropriate exchange of visual, verbal, and written communications for patient counseling and other matters involved in the lawful dispensing of drugs.
(c) Patient counseling shall be provided using audio-visual communication prior to all prescriptions being dispensed from a remote dispensing site pharmacy.
(d) A telepharmacy system shall be able to do all of the following:
(1) Identify and record the pharmacy technician preparing each prescription and the supervising pharmacist who reviewed and authorized the dispensing of the prescription.
(2) Require a pharmacist to review and compare the electronic image of any new prescription presented at the remote dispensing site pharmacy with the data entry record of the prescription.
(3) Require the pharmacy technician to use barcode technology to verify the accuracy of the drug to be dispensed.
(4) Require remote visual confirmation by a pharmacist at the supervising pharmacy of the drug stock bottle and the drug to be dispensed prior to dispensing.
(5) Ensure that a prescription is not sold or delivered to a patient prior to a pharmacist performing final verification of the accuracy of the prescription and releasing the prescription for sale and delivery.
(e) The video and audio communication system used to counsel and interact with each patient or patient’s caregiver shall be secure and compliant with the federal Health Insurance Portability and Accountability Act (Public Law 104-191).
(f) All records of prescriptions dispensed including the records of the actions performed through the telepharmacy system shall be maintained at the remote dispensing site pharmacy and shall be maintained for three years after the filling of the prescription.

4134.
 (a) A pharmacist from the supervising pharmacy shall complete a monthly in-person, self-inspection of each remote dispensing site pharmacy using a form designated by the board and shall retain all inspection reports.
(b) A perpetual inventory shall be kept for all controlled substances stored at a remote dispensing site pharmacy.
(c) All controlled substances at a remote dispensing site pharmacy shall be stored in a secure cabinet or safe that is locked.
(d) A pharmacist from the supervising pharmacy shall perform inventory and inventory reconciliation functions at a remote dispensing site pharmacy to detect and prevent the loss of any controlled substance.
(e) The pharmacist-in-charge of a remote dispensing site pharmacy shall review all inventory and inventory reconciliation reports taken and shall establish and maintain secure methods to prevent losses of any controlled substance. The board shall develop written policies and procedures for performing the inventory reconciliation reports required by this section.
(f) A pharmacist from the supervising pharmacy shall compile an inventory reconciliation report of all Schedule II controlled substances at a remote dispensing site pharmacy at least once every three months. This compilation shall require all of the following:
(1) A physical count, not an estimate, of all quantities of Schedule II controlled substances at the remote dispensing site pharmacy. The biennial inventory of controlled substances as required under federal law may serve as one of the mandated inventories under this section in the year that the federal biennial inventory is performed, provided that the biennial inventory was taken no more than three months from the last inventory required by this section.
(2) A review of all acquisitions and dispositions of Schedule II controlled substances since the last inventory reconciliation report.
(3) A comparison of paragraphs (1) and (2) in order to determine if there are any variances.
(4) All records used to compile each inventory reconciliation report shall be maintained in the remote dispensing site pharmacy for at least three years in a readily retrievable form.
(g) A remote dispensing site pharmacy shall report to the board, in writing, any identified losses of controlled substances and possible causes of the loss within 30 days of discovering the loss unless the cause of loss is theft, diversion, or self-use in which case the report shall be made within 14 days of discovering the loss. If the remote dispensing site pharmacy is unable to identify the cause of the loss, the remote dispensing site pharmacy shall undertake further investigation to identify the cause of the loss and security improvements necessary to prevent any additional losses of controlled substances. The pharmacist-in-charge shall be responsible for submitting the report to the board.
(h) Possible causes of overages shall be identified in writing and incorporated into the inventory reconciliation report.
(i) The inventory reconciliation report shall be dated and signed by the individual or individuals performing the inventory and countersigned by the pharmacist-in-charge of the remote dispensing site pharmacy. A countersignature shall not be required if the pharmacist-in-charge personally completed the inventory reconciliation report. The inventory reconciliation report shall be maintained in the remote dispensing site pharmacy for at least three years in a readily retrievable form.

4135.
 (a) While closed, a remote dispensing site pharmacy shall utilize an alarm or other comparable monitoring system to protect its equipment, records, and supply of drugs, devices, and other restricted sale items from unauthorized access, acquisition, or use.
(b) Unless a pharmacist is present at the remote dispensing site pharmacy, a remote dispensing site pharmacy shall not be open or its employees allowed access to it during times the supervising pharmacy is closed. The security system shall allow for tracking of entries into the remote dispensing site pharmacy and the pharmacist-in-charge shall periodically review the record of entries. Pharmacy services shall not be provided at a remote dispensing site pharmacy if the telepharmacy system is unavailable.
(c) The remote dispensing site pharmacy shall retain a recording of facility surveillance, excluding patient communications, for a minimum of 120 days.

SEC. 8.

 Section 4169.1 is added to the Business and Professions Code, immediately following Section 4169, to read:

4169.1.
 A wholesaler, upon discovery, shall notify the board in writing of any suspicious orders of controlled substances placed by a California-licensed pharmacy or wholesaler by providing the board a copy of the information that the wholesaler provides to the United States Drug Enforcement Administration. Suspicious orders include, but are not limited to, orders of unusual size, orders deviating substantially from a normal pattern, and orders of unusual frequency.

SEC. 9.

 Section 4180.5 is added to the Business and Professions Code, to read:

4180.5.
 (a) The board may issue licenses authorized under Section 4180 to two independently owned clinics that share a clinic office space, provided that the clinics comply with the following:
(1) Each clinic maintains a separate clinic license with the board with its own professional directors, administrators, owners, and officers.
(2) Each clinic maintains physically separate and locked drug stocks.
(3) Each clinic separately maintains all records required by this article, including acquisition and disposition records.
(4) Dangerous drugs and dangerous devices shall not be loaned between the two licensed clinics.
(b) Dangerous drugs and dangerous device losses at the shared clinic office shall be reported to the board as required by law. Each clinic may be jointly and severally responsible for the drug losses.
(c) The applicants shall also provide the board with a copy of the co-location agreement and a one-time application fee of seven hundred fifty dollars ($750) for the licenses.
(d) Any change in ownership in either clinic shall require a new application under this section and fees as required by subdivision (q) of Section 4400 and subdivision (c) of this section.
(e) The board shall not issue licenses authorized under Section 4180 to two independently owned clinics that share a clinic office space pursuant to this section until the board is provided with documentation from the Director of the Department of Health Care Services that any Medi-Cal financing issues, including the ability to claim associated federal financial participation or 340(b) program participation, have been sufficiently addressed to the director’s satisfaction. The Department of Health Care Services may seek any federal approvals it deems necessary to implement this section.
(f) The board shall not issue licenses authorized under Section 4180 to two independently owned clinics that share a clinic office space pursuant to the section until the board is provided with documentation from the Director of the Department of Public Health that any licensing and regulatory issues have been sufficiently addressed to the director’s satisfaction.
(g) This section shall become inoperative on January 1, 2021, and as of that date is repealed.

SEC. 10.

 Section 1211 is added to the Health and Safety Code, to read:

1211.
 (a) Notwithstanding any other law, a clinic licensed pursuant to Section 1204 may operate in shared clinic space with a clinic exempt from licensure pursuant to subdivision (b) of Section 1206 under the following conditions:
(1) Each clinic uses signage that clearly identifies which clinic is operating during the hours of operation.
(2) The licensed clinic reports the operating hours of both clinics.
(3) Each clinic maintains separate medical records.
(4) Each clinic maintains separate drug storage.
(5) Both clinics are licensed by the California State Board of Pharmacy pursuant to Section 4180.5 of the Business and Professions Code.
(b) The department may enter and inspect the shared space at any time pursuant to Section 1227 of the Health and Safety Code, including accessing records. The exempt clinic shall allow the department to access and inspect its records.
(c) The licensed clinic shall be responsible for any statutory or regulatory violations occurring on the premises.
(d) Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the department may implement, interpret, or make specific this section by means of all-facility letters, or similar instructions, without taking regulatory action.
(e) This section shall become inoperative on January 1, 2021, and as of that date is repealed.

SEC. 11.

 Section 5.5 of this bill incorporates amendments to Section 4059.5 of the Business and Professions Code proposed by both this bill and Senate Bill 752. That section shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2018, (2) each bill amends Section 4059.5 of the Business and Professions Code, and (3) this bill is enacted after Senate Bill 752, in which case Section 5 of this bill shall not become operative.

SEC. 12.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.