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UPDATE: 5/1/2024 - SB 869 was enacted and signed by Governor Bill Lee and became effective immediately on 5/1/2024. Public Chapter 824.
The ENACTED version of SB 869 adds a new section of Tennessee Code Annotated, numbered Section 63-10-204(39) that expands the definition of the "practice of pharmacy" to authorize pharmacists to prescribe, order, and administer a vaccine for a communicable disease to susceptible adults eighteen (18) years of age and older and any COVID-19 or influenza vaccine to children three (3) to seventeen (17) years of age, with certain recordkeeping and reporting requirements. One of the requirements requires a pharmacist to submit the required immunization information to the Tennessee State vaccine registry TennIIS.
The final version of this bill does not authorize a pharmacy intern or pharmacy technician to administer vaccines. This authorization was removed from the introduced version of the bill through a series of substitute amendments.
NVIC OPPOSES the enacted version of this bill because pharmacists are not medically trained professionals and should not be authorized to administer a vaccine that carries potentially life-altering or deadly risks for some individuals. See NVIC's position on the introduced version of the bill for more reasons to OPPOSE the bill.
UPDATE: 4/17/2024 - SB 869 was enrolled on 4/17/2024.
UPDATE: 4/17/2024 - SB 869, as amended (HA0958), was concurred in the Senate by a vote of 28 Ayes, 0 Nays, on 4/17/2024.
UPDATE: 4/16/2024 - SB 869, as amended (HA0958), passed the full House by a vote of 93 Ayes and 3 Nays on 4/16/2024.
UPDATE: 4/16/2024 - House Amendment HA0958 was adopted into SB 869 on the House floor on 4/16/2024. This amendment deletes all introduced language and substitutes language amending Section 63-10-204(39) to expand the "practice of pharmacy" definition to include vaccinating children as young as 3 years old for COVID-19 and influenza. (See the detailed description of House Amendment HA0958 under the 4/3/2024 update below.)
UPDATE: 4/16/2024 - SB 869 was substituted on the House floor for HB 282 on 4/16/2024. This substitution replaces the language of HB 282 with the amended language of SB 869. View Senate Amendment SA0842 HERE.
UPDATE: 4/16/2024 - HB 282 was substituted on the House floor with the amended version (SA0842) of SB 869 on 4/16/2024. This substitution replaces the language of HB 282 with the amended language of SB 869. View Senate Amendment SA0842 HERE.
UPDATE: 4/11/2024 - HB 282 is eligible for a House floor vote as of 4/11/2024.
UPDATE: 4/3/2024 - HB 282 was reported with the recommendation "for passage if amended" in the House Health Committee on 4/3/2024.
This amendment (HA0958) deletes all introduced language and substitutes language amending Section 63-10-204(39) to expand the practice of pharmacy to include vaccinating children as young as three (3) years old with a COVID-19 or influenza vaccine, and all other vaccines for susceptible persons aged eighteen (18) years and older. Additionally, this amendment removes the changes to definitions (37) "Pharmacy intern" and (38) "Pharmacy technician" that (37) authorizes a pharmacy intern to perform tasks delegated by the pharmacist; and (38) authorizes a pharmacy technician to perform tasks delegated by the pharmacist, including drug administration, including vaccines. These are expanded definitions that authorize the pharmacy intern and pharmacy technician to administer vaccines that is not authorized in existing code and is removed by this substitute amendment. Amendment HA0958 is summarized as follows:
SECTION 1. (C) of HB 282 is amended, summarized as follows:
(ii) Agents for active immunization when prescribed for susceptible persons for a communicable disease for individuals who are eighteen (18) years of age and older, and agents for active immunization for influenza and COVID-19 for individuals who are three (3) to seventeen (17) years of age; provided, that pharmacists shall comply with recordkeeping and reporting requirements, including, but not limited to:
(a) Informing the patient's primary care provider, if the patient identifies a primary care provider;
(b) Submitting the required immunization information to this state's vaccine registry;
(c) Complying with requirements related to reporting adverse events; and
(d) Reviewing the patient's vaccine history, if any, through this state's vaccine registry or other vaccination records prior to administering a vaccine.
The language regarding vaccines in the House Amendment HA0958 to HB 282 is identical to the language regarding vaccines in Senate Amendment SA0842 to SB 869. NVIC opposes these amendments. Pharmacists do not have the medical training or knowledge of family and personal medical history to screen for contraindications. Pharmacies are not equipped to deal with vaccine adverse reactions and pharmacists do not have the necessary medical training to be able to tell the difference between cardiac arrest, anaphylaxis, or fainting and act accordingly to save the lives of individuals who react at the time of vaccination. These amendments expand the number of immunizations that pharmacists can administer, undermine the doctor patient relationship, remove critical health history screenings prior to vaccination, and risks the lives of individuals who experience vaccine adverse reactions. Earlier versions of this bill authorized a pharmacist to administer a COVID-19 or influenza vaccine to a child as young as six (6) years old. This amendment substitutes that language and lowers the age of the child vaccine recipient from six (6) to three (3). Additionally, the Tennessee Immunization Registry (TennIIS) is currently an Opt-Out system. When an individual requests their information to be removed, that individual's basic identifying information such as name and date of birth remains in TennIIS. NVIC opposes all vaccine tracking and registries, but if one must exist, it should be an OPT-IN system where an individual provides written informed consent prior to their information being entered into the system.
This amendment necessitates a title change to HB 282 in the NVIC Advocacy Portal from "Expands the practice of pharmacy, including authorizing pharmacists, interns, and technicians to vaccinate children 6 years old and older" to "Authorizes pharmacists to prescribe, order, & administer all vaccines to adults & COVID & flu vaccines to children 3 & up; requires registry reporting."
UPDATE: 3/28/2024 - SB 869, as amended (SA0842), passed the full Senate by a vote of 29 Ayes and 0 Nays on 3/28/2024.
UPDATE: 3/28/2024 - Senate Amendment SA0842 was adopted into SB 869 on the Senate floor on 3/28/2024.
UPDATE: 3/27/2024 - HB 282 is scheduled for a hearing in the House Health Committee on Wednesday, 4/3/2024 at 3:00 PM in the House Hearing Room I. View the Hearing Agenda HERE and the video details HERE.
UPDATE: 3/26/2024 - HB 282 was reported with the recommendation "for passage if amended" by the House Health Subcommittee and was referred to the House Health Committee on 3/26/2024.
UPDATE: 3/25/2024 - SB 869 is eligible for a Senate floor vote as of 3/25/2024.
UPDATE: 3/20/2024 - HB 282 is scheduled for a hearing in the House Health Subcommittee on Tuesday, 3/26/2024 at 1:30PM in House Hearing Room IV. View the Hearing Agenda HERE and the video details HERE.
UPDATE: 3/19/2024 - SB 869 was reported with the recommendation for passage with an amendment in the Senate Health and Welfare Committee by a vote of 8 Ayes, 0 Noes, 1 Not Voting, on 3/19/2024. This amendment (SA0842) deletes all introduced language and substitutes language amending Section 63-10-204(39) to expand the practice of pharmacy to include vaccinating children as young as three (3) years old with a COVID-19 or influenza vaccine, and all other vaccines for communicable diseases to susceptible persons eighteen (18) years of age and older. Additionally, this amendment removes the changes to definitions (37) "Pharmacy intern" and (38) "Pharmacy technician" that (37) authorizes a pharmacy intern to perform tasks delegated by the pharmacist; and (38) authorizes a pharmacy technician to perform tasks delegated by the pharmacist, including drug administration, including vaccines. These are expanded definitions that authorize the pharmacy intern and pharmacy technician to administer vaccines that is not authorized in existing code and is removed by this substitute amendment. Amendment SA0842 is summarized as follows:
SECTION 1. (C) of SB 869 is amended, summarized as follows:
(ii) Agents for active immunization when prescribed for susceptible persons for a communicable disease for individuals who are eighteen (18) years of age and older, and agents for active immunization for influenza and COVID-19 for individuals who are three (3) to seventeen (17) years of age; provided, that pharmacists shall comply with recordkeeping and reporting requirements, including, but not limited to:
(a) Informing the patient's primary care provider, if the patient identifies a primary care provider;
(b) Submitting the required immunization information to this state's vaccine registry;
(c) Complying with requirements related to reporting adverse events; and
(d) Reviewing the patient's vaccine history, if any, through this state's vaccine registry or other vaccination records prior to administering a vaccine.
NVIC opposes this amendment. Pharmacists do not have the medical training or knowledge of family and personal medical history to screen for contraindications. Pharmacies are not equipped to deal with vaccine adverse reactions and pharmacists do not have the necessary medical training to be able to tell the difference between cardiac arrest, anaphylaxis, or fainting and act accordingly to save the lives of individuals who react at the time of vaccination. This amendment expands the number of immunizations that pharmacists can administer, undermines the doctor patient relationship, removes critical health history screenings prior to vaccination, and risks the lives of individuals who experience vaccine adverse reactions. Earlier versions of this bill authorized a pharmacist to administer a COVID-19 or influenza vaccine to a child as young as six (6) years old. This amendment substitutes that language and lowers the age of the child vaccine recipient from six (6) to three (3). Additionally, the Tennessee Immunization Registry (TennIIS) is currently an Opt-Out system. When an individual requests their information to be removed, that individual's basic identifying information such as name and date of birth remains in TennIIS. NVIC opposes all vaccine tracking and registries, but if one must exist, it should be an OPT-IN system where an individual provides written informed consent prior to their information being entered into the system.
This amendment necessitates a title change to SB 869 in the NVIC Advocacy Portal from "Expands the practice of pharmacy, including authorizing pharmacists, interns, and technicians to vaccinate children 6 years old and older" to "Authorizes pharmacists to prescribe, order, & administer all vaccines to adults & COVID & flu vaccines to children 3 & up; requires registry reporting." The title for HB 282 remains "Expands the practice of pharmacy, including authorizing pharmacists, interns, and technicians to vaccinate children 6 years old and older."
UPDATE: 3/13/2024 - HB 282 is scheduled for a hearing in the House Health Subcommittee on Tuesday, 3/19/2024 at 1:30PM in House Hearing Room IV. View the Hearing Agenda HERE and the video details HERE.
UPDATE: 3/13/2024 - SB 869 is scheduled for a hearing in the Senate Health and Welfare Committee on Tuesday, 3/19/2024 at 3:00PM in Senate Hearing Room I. View the Hearing Agenda HERE and the video details HERE.
UPDATE: 3/6/2024 - SB 869 is scheduled for a hearing in the Senate Health and Welfare Committee on Wednesday, 3/13/2024 at 12:30PM in Senate Hearing Room I. View the Hearing Agenda HERE and the video details HERE.
UPDATE: 4/21/2023 - HB 282 failed to be scheduled for a hearing in the House Health Subcommittee before the session adjourned on 4/21/2023. Bills can carryover from odd to even years in Tennessee.
UPDATE: 4/21/2023 - SB 869 failed to be scheduled for a hearing in the Senate Health and Welfare Committee before the session adjourned on 4/21/2023. Bills can carryover from odd to even years in Tennessee.
UPDATE: 2/6/2024 - SB 869 was referred to the Senate Health and Welfare Committee on 2/6/2023.
UPDATE: 1/21/2023 - HB 282 was assigned to the House Health Subcommittee on 1/24/2023.
UPDATE: 1/21/2023 - HB 282 was referred to the House Health Committee on 1/21/2023.
HB 282 was introduced in the House on 1/19/2023. This bill is sponsored by Representative Charlie Baum.
SB 869 was introduced in the Senate on 1/31/2023. This bill is sponsored by Senator Shane Reeves.
HB 282 and SB 869 expand the practice of pharmacy to include administration of vaccination for children 6 years old and older. These bills also authorize pharmacy interns and pharmacy technicians to administer vaccinations, summarized as follows:
SECTION 1. amends the Tennessee Code Annotated, Section 63-10-204, related to pharmacy practice definitions, to remove definitions (37) "Pharmacy intern" and (38) "Pharmacy technician" and substitute with new expanded language, summarized as follows:
(37) authorizes a pharmacy intern to perform tasks delegated by the pharmacist; and
(38) authorizes a pharmacy technician to perform tasks delegated by the pharmacist, including drug administration, including vaccines. These are expanded definitions that authorize the pharmacy intern and pharmacy technician to administer vaccines that is not authorized in existing code.
SECTION 2. amends Tennessee Code Annotated, Section 63-10-204 (39), related to the definition of the practice of pharmacy, to add a new subdivision C. (i) that authorizes a pharmacist to prescribe (b) "Agents for active immunization when prescribed for susceptible individuals who are six (6) years of age or older for the from communicable disease." This is a change from existing code that does not authorize a pharmacist to prescribe or administer a vaccine to a person of any age.
NVIC is opposed to this bill as trivializes very real vaccine risks and serious reactions by allowing the administration of potentially life-threatening vaccines for children by pharmacists, pharmacy interns, and pharmacy technicians. This bill undermines the doctor patient relationship and removes critical health history screenings that typically take place in a physician's office prior to vaccination. A pharmacist is not a medically trained professional and does not have the training required to identify and treat a life-threatening vaccine reaction that can occur following vaccination, including anaphylaxis or cardiac arrest. These bills not only allow a non-medically trained individual to prescribe and administer a medical intervention, but they also authorize lesser-qualified pharmacy technicians and pharmacy interns to administer vaccinations.
According to the Pharmacy Technician Certification Board Test Prep website, Pharmacy Technicians are not regulated by the Tennessee State Board of Pharmacy. The listed state requirements state that a candidate must be 18-years or older, must have earned a high school diploma or GED, and must be proficient in the English language. View the Application for Pharmacy Technician Registration HERE.
Before a vaccine is administer, a physician or nurse will screen the individual for contraindications to vaccination. This process involves a thorough evaluation of the patient's medical history and family medical history, a process that a pharmacist will not have sufficient medical records or time to perform. The following reasons not to vaccinate are recorded in federally required vaccine information statements. It is unlikely that a pharmacist, pharmacy intern, or pharmacy technician would catch the following problems:
- Allergic reactions to ingredients in the vaccine, including anaphylaxis. The HPV vaccine lists a contraindication of an individual having a yeast allergy.
- immunocompromised due to disease (such as cancer or HIV/AIDS), medical treatments (such as radiation, immunotherapy, steroids, or chemotherapy), if they have a history of seizures, if they have a parent, brother, or sister with a history of seizures, or if they have a parent, brother, or sister with a history of immune system problems?
- bleeding conditions, if they might be pregnant (some vaccines cannot be given in pregnancy), or if they are taking aspirin
- recently had a blood transfusion or if they have ever had Guillain-Barre syndrome post vaccination
- a previous serious or a life-threatening reaction to any vaccine
Additionally, most pharmacies and grocery stores don’t have lifesaving defibrillators like they do in doctors’ offices when life-threatening reactions to vaccines occur. Will pharmacy interns and pharmacy technicians have the equipment and training to be able to tell the difference between cardiac arrest, anaphylaxis, fainting, and act accordingly to save the lives of children who react at the time of vaccination?
Vaccines, just like all pharmaceutical products, can cause injury and death in some people. As of September 1, 2023, the United States Government has paid out more than $5 billion dollars to vaccine victims through the National Vaccine Injury Compensation Program (VICP). As of August 8, 2023, there were 46,093 deaths and 2,518,732 adverse events reported to the US government's Vaccine Adverse Events Reporting System.
America’s biopharmaceutical research companies are developing 258 vaccines. The U.S. Vaccine Market alone was $36.45 billion in 2018 and is expected to reach $58.4 billion by 2024 and pharmacies stand to increase their profits substantially by allowing pharmacy technicians to put those shots into customers. There is no doubt the pharmacy groups will support this bill, but it presents a serious conflict of interest because of the financial benefits they will receive if this bill passes.
This conflict is compounded by the fact that pharmacy employees will have no liability for the injuries and deaths caused by the vaccines they administer. Vaccines administrators are shielded from liability for vaccine injuries and deaths through the combination of the law passed by Congress in 1986 establishing the National Vaccine Injury Compensation Program and the 2011 Supreme Court Decision BRUESEWITZ ET AL. v. WYETH LLC, FKA WYETH, INC., ET AL.
If passed, the provisions of the bill would go into effect immediately.
https://wapp.capitol.tn.gov/apps/BillInfo/default.aspx?BillNumber=HB0282&GA=113 - text, status, and history of HB 282
https://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=SB0869&GA=113 - text, status, and history of SB 869
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