Commerce, Occupational and Professional Licensing

Section R156-71-202

Naturopathic Physician Formulary

Notice of Proposed Rule

(Amendment)

DAR File No.: 33552
Filed: 04/08/2010 08:31:48 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The Division, Naturopathic Formulary Advisory Peer Committee, and the Naturopathic Physicians Licensing Board reviewed the rule and determined that amendments need to be made. This rule filing includes several noncontrolled substances that need to be added or deleted from the formulary.

Summary of the rule or change:

In Subsection R156-71-202(1), the referenced 2008 edition of the American Hospital Formulary Service (AHFS) needs to have information included which is referenced on the AHFS Drug Information website. Several noncontrolled substance medications are being added to the formulary: Antidepressants, Miscellaneous; Gonadotropins, limited to Gonadotropin, Chorinoic; Skin and Mucous Membrane Agents, excluding Depigmenting and Pigmenting Agents; Skin and Mucous Membrane Agents, and Miscellaneous excluding Isotretinoin. In Subsection R156-71-202(2), updated the information to reflect that amino acids, minerals, oxygen, silver nitrate, DHEA (dihydroepiandrosterone), pregnenolene and allergy testing agents are approved for primary health care use.

State statutory or constitutional authorization for this rule:

• Section 58-71-101
• Subsection 58-1-202(1)(a)
• Subsection 58-1-106(1)(a)

Anticipated cost or savings to:

the state budget:

The Division will incur minimal costs of approximately $50 to print the rule and distribute it once the proposed amendments are made effective. Any costs incurred will be absorbed in the Division's current budget. The Division investigators should not require any additional training as a result of the proposed amendments. A possible increase in costs to the Division may occur if complaints regarding the prescribing practices of naturopathic physicians are reported to the Division. However, there are fewer than 30 licensed naturopathic physicians in Utah so any potential fiscal impact to the Division would be minimal.

local governments:

The proposed amendments only apply to licensed naturopathic physicians and applicants for licensure in that classification. As a result, no costs or savings are anticipated for local governments.

small businesses:

It should be noted that a licensed naturopathic physician's office may qualify as a small business if the naturopathic physician owns or works in a small clinic. The proposed amendments will create a possible savings for the public and insurance carriers resulting in possible loss to secondary prescribing practitioners. Patients currently must schedule additional visits with a secondary prescribing practitioner at a cost of approximately $100 per patient. The addition of several noncontrolled substance medications indicated above to the permitted medications also allows patients seen by a naturopathic physician to receive treatment from them instead of requiring the patient to schedule another office visit with another type of prescribing practitioner resulting in a similar cost savings. The Division is unable to determine the number of patients seen by naturopathic physicians. The proposed amendments may require pharmacists and other pharmacy employees to be educated and aware of the changes being made in the formulary which naturopathic physicians may utilize in their practice. There may be some unknown increase in costs to pharmacies in order to implement the updated formulary list. The Division is not able to determine an exact cost due to the variety of possible circumstances.

persons other than small businesses, businesses, or local governmental entities:

The proposed amendments apply primarily to licensed naturopathic physicians and applicants for licensure in that classification. It is anticipated the proposed amendments will create a possible savings for the public and insurance carriers resulting in possible loss to secondary prescribing practitioners. Patients currently must schedule additional visits with a secondary prescribing practitioner at a cost of approximately $100 per patient. The addition of several noncontrolled substance medications indicated above to the listing of permitted medications also allows patients seen by a naturopathic physician to receive treatment from them instead of requiring the patient to schedule another office visit with another type of prescribing practitioner resulting in a similar cost savings. The Division is unable to determine the number of patients seen by naturopathic physicians. The proposed amendments may require pharmacists and other pharmacy employees to be educated and aware of the changes being made in the formulary which naturopathic physicians may utilize in their practice. There may be some unknown increase in costs to pharmacies in order to implement the updated formulary list. The Division is not able to determine an exact cost due to the variety of possible circumstances.

Compliance costs for affected persons:

The proposed amendments apply primarily to licensed naturopathic physicians and applicants for licensure in that classification. It is anticipated the proposed amendments will create a possible savings for the public and insurance carriers resulting in possible loss to secondary prescribing practitioners. Patients currently must schedule additional visits with a secondary prescribing practitioner at a cost of approximately $100 per patient. The addition of several noncontrolled substance medications indicated above to the listing of permitted medications also allows patients seen by a naturopathic physician to receive treatment from them instead of requiring the patient to schedule another office visit with another type of prescribing practitioner resulting in a similar cost savings. The Division is unable to determine the number of patients seen by naturopathic physicians. The proposed amendments may require pharmacists and other pharmacy employees to be educated and aware of the changes being made in the formulary which naturopathic physicians may utilize in their practice. There may be some unknown increase in costs to pharmacies in order to implement the updated formulary list. The Division is not able to determine an exact cost due to the variety of possible circumstances.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule filing amends the naturopathic formulary to replace categories of legend drugs inadvertently left out of recent amendments and provides a website link to a reference formulary service. No fiscal impact to businesses is anticipated from the changes.

Francine A. Giani, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Commerce
Occupational and Professional Licensing
160 E 300 S
SALT LAKE CITY, UT 84111-2316

Direct questions regarding this rule to:

• Sally Stewart at the above address, by phone at 801-530-6179, by FAX at 801-530-6511, or by Internet E-mail at sstewart@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

05/31/2010

Interested persons may attend a public hearing regarding this rule:

• 05/17/2010 09:00 AM, Heber Wells Bldg, 160 E 300 S, Conference Room 474, Salt Lake City, UT

This rule may become effective on:

06/07/2010

Authorized by:

Mark Steinagel, Director

R156. Commerce, Occupational and Professional Licensing.

R156-71. Naturopathic Physician Practice Act Rule.

R156-71-202. Naturopathic Physician Formulary.

(1) In accordance with Subsections 58-71-102(8) and (12)(a) and Section 58-71-202, the naturopathic physician formulary which consists of noncontrolled substance legend medications deemed appropriate for the primary health care of patients within the scope of practice of naturopathic physicians, the prescription of which is approved by the Division in collaboration with the Naturopathic Formulary Advisory Peer Committee, consists of the following legend drugs, listed by category, with reference numbers identified in the American Hospital Formulary Service (AHFS), published by the American Society of Health System Pharmacists, 2008 edition ; including the monographs available on AHFS Drug Information website, which is http://www.ahfsdruginformation.com:

4:00 Antihistamines

8:08 Antihelminthics

8:12 Antibacterials, oral and topical forms only

8:14 Antifungals, oral and topical forms

8:18 Antivirals limited to oral and topical dosage forms, excluding:

8:18:08 Antiretrovirals

8:18:20 Interferons

8:18:24 Monoclonal Antibodies

8:18:32 Nucleosides and Nucleotides

8:30[:].04 Amebicides

8:30[:].92 Miscellaneous Antiprotozoals excluding those whose primary indication is the treatment of infection in immunosuppressed patients (i.e. Pentamidine and Trimetrexate)

8:36 Urinary anti-infectives

12:12[:].08[:].12 Selective Beta 2 Adrenergic Agonists

12:12[:].12 Alpha and Beta Adrenergic Agonists

12:16 Sympatholytic (Adrenergic Blocking) Agents, limited to ergot derivatives

12:20 Skeletal Muscle Relaxants, excluding scheduled medications

20:24 Hemorrheologic Agents

24:04[:].08 Cardiotonic Agents - limited to Digoxin

24:06 Antilipemic Agents

24:08 Hypotensive Agents - limited to oral dosage forms

24:20 Alpha Adrenergic Blocking Agents

24:24 Beta Adrenergic Blocking Agents - limited to oral dosage forms

24:28 Calcium Channel Blocking Agents - limited to oral dosage forms

24:32 Renin-Angiotensive-Aldosterone System Inhibitors - limited to oral dosage forms

28:08 Analgesics and Antipyretics, excluding scheduled medications

28:16[:].04[:].20 Selective-Serotonin Reuptake Inhibitors

28:16[:].04[:].24 Serotonin Modulators

28:16[:].04[:].28 Tricyclics and Other Norepinephrine-Reuptake Inhibitors

28:16.04.92 Antidepressants, Miscellaneous

40:00 Electrolytic, Caloric, and Water Balance

40:28 Diuretics

44:00 Enzymes, limited to digestive and proteolytic

48:10[:].24 Leukotriene Modifiers

52:08 Corticosteroids (oral, topical, and injectable), Anti-Inflammatory Agents except Ophthmologic Preparations, and DMARDS

56:22 Antiemetics

56:28 H2 Blockers, Anti-ulcer Agents and Acid Suppressants

68:12 Contraceptives, except implants and injections

68:16[:].04 Estrogen s

68:18 Gonadotropins; limited to Gonadotropin, Chorionic

68:20[:].02 Alpha-Glucosidase Inhibitors

68:20.04 Biguanides

68:20[:].08 Insulins[ and Biguanides]

68:20[:].20 Sulfonylureas

68:24 Parathyroid

68:32 Progestin s

68:36[:].04 Thyroid Agents, including Thyroid of glandular extract

72:00 Local Anesthetics

80:00 Serums, [limited to RhoGam]Toxoids, Vaccines

[ 80:08 Toxoids, limited to DTP and DTaP

80:12 Vaccines]

84:00 Skin and Mucous Membrane Agents, excluding Depigmenting and Pigmenting Agents (reference number 84:50)

84:92 Skin and Mucous Membrane Agents, Miscellaneous, excluding Isotretinoin

88:[28]00 [Multivitamin preparations]Vitamins

92:00 Miscellaneous Therapeutic Agents, limited to Antigout, and Bone-Resorption Inhibitors (limited to Raloxifene), and Botulinum Toxin type A (limited to superficial injections)

(2) In addition, [Amino Acids, Minerals, Oxygen and Silver Nitrate]the following items or substances, although not listed in Subsection (1), are approved for primary health care[.]:

(a) Amino Acids;

(b) Minerals;

(c) Oxygen;

(d) Silver Nitrate;

(e) DHEA (dihydroepiandrosterone);

(f) Pregnenolone; and

(g) Allergy Testing Agents.

(3) In accordance with Subsections 58-71-102(8) and (12)(a) and Section 58-71-202, the naturopathic physician formulary includes a single controlled substance with the reference number identified in the AHFS, published by the American Society of Health System Pharmacists, 2008 edition:

68:08 Testosterone.

(4) New categories or classes of drugs will need to be approved as part of the formulary prior to prescribing/administering.

(5) The licensed naturopathic physician has the responsibility to be knowledgeable about the medication being prescribed or administered.

 

KEY: licensing, naturopaths, naturopathic physician

Date of Enactment or Last Substantive Amendment: [July 23, 2009] 2010

Notice of Continuation: January 8, 2007

Authorizing, and Implemented or Interpreted Law: 58-71-101; 58-1-106(1)(a); 58-1-202(1)(a)