S T A T E O F N E W Y O R K
________________________________________________________________________
6751--A
2017-2018 Regular Sessions
I N A S S E M B L Y
March 16, 2017
___________
Introduced by M. of A. PAULIN, COOK, CYMBROWITZ, ABINANTI, GUNTHER,
WEPRIN, HEVESI, RYAN, TITUS, STIRPE, SKOUFIS, BUCHWALD, DiPIETRO,
BRABENEC, BLAKE, FAHY, ORTIZ, COLTON, WALTER, NORRIS, McDONALD,
BARRETT, PHEFFER AMATO, DINOWITZ, OAKS, LALOR, ZEBROWSKI, STECK,
JENNE, HUNTER, BRONSON, SOLAGES, PEOPLES-STOKES, DE LA ROSA, B. MILL-
ER, RAIA, GARBARINO, MORINELLO, FITZPATRICK, DICKENS, MAGNARELLI,
PICHARDO, SANTABARBARA, GIGLIO, PELLEGRINO, D. ROSENTHAL, KIM, RODRI-
GUEZ, ABBATE, JONES -- Multi-Sponsored by -- M. of A. BARCLAY, BLANK-
ENBUSH, BUTLER, CAHILL, CROUCH, CUSICK, ERRIGO, FRIEND, GALEF,
GOODELL, GOTTFRIED, HAWLEY, HIKIND, LENTOL, LUPARDO, MAGEE, PALMESANO,
RIVERA, SKARTADOS, STEC, THIELE, WALSH, WOERNER, WRIGHT -- read once
and referred to the Committee on Higher Education -- recommitted to
the Committee on Higher Education in accordance with Assembly Rule 3,
sec. 2 -- committee discharged, bill amended, ordered reprinted as
amended and recommitted to said committee
AN ACT to amend the education law, in relation to the use of oral medi-
cations by optometrists; and providing for the repeal of certain
provisions upon expiration thereof
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph (e) of subdivision 1 of section 7101-a of the
education law, as added by chapter 517 of the laws of 1995, is amended
to read as follows:
(e) [Phase one] TOPICAL therapeutic pharmaceutical agents. [Phase one]
TOPICAL THERAPEUTIC pharmaceutical agents shall mean those drugs which
shall be limited to topical application to the surface of the eye for
therapeutic purposes and shall be limited to:
(i) antibiotic/antimicrobials;
(ii) decongestants/anti-allergenics;
(iii) non-steroidal anti-inflammatory agents;
(iv) steroidal anti-inflammatory agents;
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04288-12-7
A. 6751--A 2
(v) antiviral agents;
(vi) hyperosmotic/hypertonic agents;
(vii) cycloplegics;
(viii) artificial tears and lubricants; AND
(IX) IMMUNOSUPPRESSIVE AGENTS.
§ 2. Paragraph (f) of subdivision 1 of section 7101-a of the education
law, as added by chapter 517 of the laws of 1995, is amended to read as
follows:
(f) [Phase two therapeutic] THERAPEUTIC pharmaceutical agents FOR
TREATMENT OF GLAUCOMA AND OCULAR HYPERTENSION. [Phase two] THERAPEUTIC
pharmaceutical agents FOR TREATMENT OF GLAUCOMA AND OCULAR HYPERTENSION
shall mean those drugs which shall be limited to topical application to
the surface of the eye and shall be limited to:
(i) beta blockers;
(ii) alpha agonists;
(iii) direct acting cholinergic agents;
(IV) PROSTAGLANDIN ANALOGS; AND
(V) CARBONIC ANHYDRASE INHIBITORS.
§ 3. Subdivision 1 of section 7101-a of the education law is amended
by adding a new paragraph (g) to read as follows:
(G) ORAL THERAPEUTIC PHARMACEUTICAL AGENTS. ORAL THERAPEUTIC PHARMA-
CEUTICAL AGENTS SHALL MEAN THOSE ORALLY ADMINISTERED DRUGS USED FOR
THERAPEUTIC PURPOSES SOLELY FOR THE TREATMENT OF DISEASES OF THE EYE AND
ADNEXA AND SHALL BE LIMITED TO:
(I) THE FOLLOWING ANTIBIOTICS, INCLUDING, WHERE APPLICABLE, THE GENER-
IC EQUIVALENT OF ANY OF THE LISTED DRUGS:
(1) AUGMENTIN;
(2) KEFLEX;
(3) AZITHROMYCIN;
(4) BACTRIM;
(5) DOXYCYCLINE; AND
(6) TETRACYCLINE;
(II) THE FOLLOWING DECONGESTANTS/ANTI-ALLERGENIC/ANTIHISTAMINES,
INCLUDING THE GENERIC EQUIVALENTS OF THE LISTED DRUGS:
(1) CLARINEX;
(2) XYZAL; AND
(3) SINGULAIR;
(III) THE FOLLOWING ANTIGLAUCOMA AGENTS, INCLUDING THE GENERIC EQUIV-
ALENTS OF SUCH AGENTS, USED FOR THE MANAGEMENT OF ACUTE INCREASES IN
INTRAOCULAR PRESSURE; PROVIDED, HOWEVER, AN OPTOMETRIST MAY USE OR
PRESCRIBE A MAXIMUM OF ONE TWENTY-FOUR HOUR PRESCRIPTION AND SHALL IMME-
DIATELY REFER THE PATIENT TO A LICENSED PHYSICIAN SPECIALIZING IN
DISEASES OF THE EYE:
(1) DIAMOX; AND
(2) NEPTAZANE;
(IV) THE FOLLOWING ANTIVIRAL AGENTS, INCLUDING THE GENERIC EQUIVALENTS
OF SUCH AGENTS, USED FOR HERPES ZOSTER OPHTHALMICUS; PROVIDED AN OPTOME-
TRIST SHALL USE OR PRESCRIBE IN MAXIMUM, SEVEN-DAY PRESCRIPTIONS;
PROVIDED, HOWEVER, IF A PATIENT IS DIAGNOSED WITH HERPES ZOSTER OPHTHAL-
MICUS AND HAS NOT ALREADY BEEN EXAMINED BY A PRIMARY CARE PHYSICIAN OR
OTHER APPROPRIATE PHYSICIAN FOR SUCH VIRAL CONDITION, AN OPTOMETRIST
SHALL REFER THE PATIENT TO A LICENSED PRIMARY CARE PHYSICIAN, LICENSED
PHYSICIAN SPECIALIZING IN DISEASES OF THE EYE, OR OTHER APPROPRIATE
PHYSICIAN WITHIN THREE DAYS OF SUCH DIAGNOSIS:
(1) VALACYCLOVIR; AND
(2) ACYCLOVIR; AND
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(V) THE FOLLOWING NON-STEROIDAL ANTI-INFLAMMATORY AGENTS:
(1) COX-2 INHIBITORS;
(2) IBUPROFEN; AND
(3) NAPROXEN.
§ 4. The subdivision heading and paragraph (a) of subdivision 4 of
section 7101-a of the education law, as added by chapter 517 of the laws
of 1995, are amended to read as follows:
[Phase one] TOPICAL therapeutic pharmaceutical agents. (a) Before
using or prescribing [phase one] TOPICAL therapeutic pharmaceutical
agents, each optometrist shall have completed at least three hundred
hours of clinical training in the diagnosis, treatment and management of
patients with ocular disease other than glaucoma and ocular hyperten-
sion, not fewer than twenty-five hours of such training shall have been
completed subsequent to June thirtieth, nineteen hundred ninety-three
and additionally shall either have taken and successfully passed the
treatment and management of ocular diseases portion of the National
Board of Examiners in Optometry test or have taken and successfully
passed an examination acceptable to the board.
§ 5. Paragraph (b) of subdivision 4 of section 7101-a of the education
law, as added by chapter 517 of the laws of 1995, is amended to read as
follows:
(b) Before using or prescribing [phase two] therapeutic pharmaceutical
agents FOR TREATMENT OF GLAUCOMA AND OCULAR HYPERTENSION, an optometrist
must be certified for diagnostic and [phase one] TOPICAL therapeutic
agents and have completed an additional one hundred hours of clinical
training in the diagnosis, treatment and management of patients with
glaucoma and ocular hypertension, not fewer than twenty-five hours of
such training shall have been completed subsequent to July first, nine-
teen hundred ninety-four, and shall have taken and successfully passed
an oral or written examination acceptable by the board.
§ 6. Paragraphs (c) and (d) of subdivision 4 of section 7101-a of the
education law are relettered paragraphs (d) and (e) and a new paragraph
(c) is added to read as follows:
(C) BEFORE USING OR PRESCRIBING ORAL THERAPEUTIC PHARMACEUTICAL
AGENTS, AN OPTOMETRIST MUST BE CERTIFIED TO PRESCRIBE DIAGNOSTIC PHARMA-
CEUTICAL AGENTS AND TOPICAL THERAPEUTIC AND THERAPEUTIC PHARMACEUTICAL
AGENTS FOR TREATMENT OF GLAUCOMA AND OCULAR HYPERTENSION, HAVE COMPLETED
AN ORAL THERAPEUTIC PHARMACEUTICAL AGENT CERTIFICATION COURSE AND HAVE
PASSED AN EXAMINATION WITHIN FIVE YEARS OF THE DEPARTMENT'S APPROVAL OF
THE INITIAL CERTIFICATION COURSE OR THE INITIAL EXAMINATION, WHICHEVER
IS LATER.
(I) THE CURRICULUM FOR THE COURSE SHALL INCLUDE, BUT NOT BE LIMITED
TO, INSTRUCTION IN PHARMACOLOGY AND DRUG INTERACTION IN TREATING OCULAR
DISEASE AND BE TAUGHT THROUGH CLINICAL CASE SCENARIOS AND EMPHASIZE
CLINICAL DECISION MAKING AND SHALL BE NO LESS THAN FORTY HOURS, OF WHICH
NO LESS THAN TWENTY-FOUR HOURS SHALL BE LIVE INSTRUCTION.
(II) SUCH COURSE SHALL QUALIFY TOWARDS MEETING THE CONTINUING EDUCA-
TION PER TRIENNIAL REGISTRATION REQUIREMENT PURSUANT TO SUBDIVISION
SEVEN OF THIS SECTION.
(III) THE EXAMINATION SHALL TEST THE KNOWLEDGE OF MATERIALS IN THE
CURRICULUM AND REFLECT THE PROVISIONS OF PARAGRAPH (G) OF SUBDIVISION
ONE OF THIS SECTION, AND SHALL BE ACCEPTABLE TO THE DEPARTMENT. IF AN
OPTOMETRIST FAILS TO PASS THE EXAMINATION, SUCH OPTOMETRIST MAY RETAKE
THE EXAMINATION; PROVIDED, HOWEVER, THAT IF AN OPTOMETRIST FAILS TO PASS
THE EXAMINATION AFTER THREE ATTEMPTS, SUCH OPTOMETRIST MUST AGAIN
COMPLETE THE CERTIFICATION COURSE IN ORDER TO RETAKE THE EXAMINATION. AN
A. 6751--A 4
OPTOMETRIST SHALL BE REQUIRED TO COMPLETE THE CERTIFICATION COURSE AFTER
EACH SUBSEQUENT FAILURE TO PASS THE EXAMINATION THREE TIMES. IF AN OPTO-
METRIST REQUIRES MORE TIME TO PASS THE EXAMINATION AND TO BECOME CERTI-
FIED THAN THE FIVE-YEAR PERIOD PROVIDED FOR IN THIS PARAGRAPH, SUCH
OPTOMETRIST MAY BE AUTHORIZED TO RETAKE THE EXAMINATION AND TO BECOME
CERTIFIED BEYOND SUCH PERIOD UPON APPLICATION BY THE OPTOMETRIST AND A
SHOWING OF GOOD CAUSE AS MAY BE ACCEPTABLE TO THE COMMISSIONER.
(IV) THE INITIAL, AND ANY SUBSEQUENT, CURRICULUM AND EXAMINATION SHALL
BE SUBJECT TO REVIEW AND APPROVAL BY THE DEPARTMENT.
(V) THE REQUIREMENT FOR THE ORAL THERAPEUTIC PHARMACEUTICAL AGENT
CERTIFICATION COURSE AND EXAMINATION SHALL NOT APPLY TO THOSE OPTOME-
TRISTS WHO GRADUATED FROM AN ACCREDITED COLLEGE OF OPTOMETRY SUBSEQUENT
TO JANUARY FIRST, TWO THOUSAND SEVEN AND HAVE TAKEN AND SUCCESSFULLY
PASSED THE NATIONAL BOARD OF EXAMINERS IN OPTOMETRY TEST OR AN EXAMINA-
TION ACCEPTABLE TO THE DEPARTMENT.
§ 7. Subdivision 5 of section 7101-a of the education law, as added by
chapter 517 of the laws of 1995, is amended to read as follows:
5. Suspension of certification. The department shall suspend the
certification for the use and prescribing of [phase one] TOPICAL thera-
peutic agents of any optometrist who fails to receive certification for
[phase two] therapeutic pharmaceutical agents FOR TREATMENT OF GLAUCOMA
AND OCULAR HYPERTENSION within three years of having been certified for
[phase one] TOPICAL therapeutic pharmaceutical agents.
§ 8. The subdivision heading of subdivision 6 of section 7101-a of the
education law, as added by chapter 517 of the laws of 1995, is amended
to read as follows:
Consultation WITH USE OF CERTAIN TOPICAL THERAPEUTIC PHARMACEUTICAL
AGENTS FOR TREATMENT OF GLAUCOMA AND OCULAR HYPERTENSION.
§ 9. Subdivision 7 of section 7101-a of the education law, as added by
chapter 517 of the laws of 1995, is amended to read as follows:
7. Continuing education. Each optometrist certified to use [phase one
or phase two] TOPICAL THERAPEUTIC PHARMACEUTICAL AGENTS AND therapeutic
pharmaceutical agents FOR TREATMENT OF GLAUCOMA AND OCULAR HYPERTENSION,
shall complete a minimum of thirty-six hours of continuing education IN
THE AREA OF OCULAR DISEASE AND PHARMACOLOGY per triennial registration
period. [The education shall be in the area of ocular disease and phar-
macology and may include both didactic and clinical components.] EACH
OPTOMETRIST CERTIFIED TO USE ORAL THERAPEUTIC PHARMACEUTICAL AGENTS
SHALL, IN ADDITION TO THE MINIMUM THIRTY-SIX HOURS OF CONTINUING EDUCA-
TION PROVIDED FOR IN THIS SUBDIVISION, COMPLETE AN ADDITIONAL MINIMUM OF
THIRTY-NINE HOURS OF CONTINUING EDUCATION RELATED TO SYSTEMIC DISEASE
AND THERAPEUTIC TREATMENT PER TRIENNIAL REGISTRATION PERIOD. Such educa-
tional programs MAY INCLUDE BOTH DIDACTIC AND CLINICAL COMPONENTS AND
shall be approved in advance by the department and evidence of the
completion of this requirement shall be submitted with each application
for license renewal as required by section sixty-five hundred two of
this chapter.
§ 10. The subdivision heading and subparagraph (i) of paragraph (a) of
subdivision 8 of section 7101-a of the education law, as added by chap-
ter 517 of the laws of 1995, are amended to read as follows:
Notice to patient WITH THE USE OR PRESCRIPTION OF TOPICAL THERAPEUTIC
PHARMACEUTICAL AGENTS AND THERAPEUTIC PHARMACEUTICAL AGENTS FOR TREAT-
MENT OF GLAUCOMA AND OCULAR HYPERTENSION.
(i) An optometrist prescribing TOPICAL steroids or antiviral medica-
tion shall inform each patient that in the event the condition does not
A. 6751--A 5
improve within five days, a physician of the patient's choice will be
notified.
§ 11. Subdivision 10 of section 7101-a of the education law, as added
by chapter 517 of the laws of 1995, is amended to read as follows:
10. Pharmaceutical agents. Optometrists who have been approved and
certified by the department shall be permitted to use the following
drugs:
(a) Diagnostic pharmaceuticals.
(b) Those optometrists having been certified for [phase one] TOPICAL
therapeutic pharmaceutical agents shall be authorized [(i) to use and
recommend all nonprescription medications appropriate for ocular disease
whether intended for topical or oral use; and (ii)] to use and prescribe
all [phase one] TOPICAL therapeutic pharmaceutical agents SPECIFIED IN
PARAGRAPH (E) OF SUBDIVISION ONE OF THIS SECTION, which are FDA approved
and commercially available FOR TOPICAL USE.
In the event an optometrist treats a patient with topical antiviral or
steroidal drugs and the patient's condition either fails to improve or
worsens within five days, the optometrist shall notify a physician
designated by the patient or, if none, by the treating optometrist.
(c) Those optometrists having been certified for [phase two] therapeu-
tic pharmaceutical agents FOR TREATMENT OF GLAUCOMA AND OCULAR HYPERTEN-
SION shall be authorized to use and prescribe [phase two] therapeutic
pharmaceutical agents FOR TREATMENT OF GLAUCOMA AND OCULAR HYPERTENSION
SPECIFIED IN PARAGRAPH (F) OF SUBDIVISION ONE OF THIS SECTION, which are
FDA approved and commercially available.
(D) THOSE OPTOMETRISTS HAVING BEEN CERTIFIED FOR ORAL THERAPEUTIC
PHARMACEUTICAL AGENTS SHALL BE AUTHORIZED TO USE AND PRESCRIBE ORAL
THERAPEUTIC PHARMACEUTICAL AGENTS SPECIFIED IN PARAGRAPH (G) OF SUBDIVI-
SION ONE OF THIS SECTION, WHICH ARE FDA APPROVED AND COMMERCIALLY AVAIL-
ABLE AND SHALL COMPLY WITH ALL SAFETY INFORMATION AND SIDE-EFFECT AND
WARNING ADVISORIES CONTAINED IN THE MOST CURRENT PHYSICIANS' DESK REFER-
ENCE.
(E) THOSE OPTOMETRISTS HAVING BEEN CERTIFIED FOR TOPICAL THERAPEUTIC
PHARMACEUTICAL AGENTS, THERAPEUTIC PHARMACEUTICAL AGENTS FOR TREATMENT
OF GLAUCOMA AND OCULAR HYPERTENSION OR ORAL THERAPEUTIC PHARMACEUTICAL
AGENTS SHALL BE AUTHORIZED TO USE AND RECOMMEND ALL NONPRESCRIPTION
MEDICATIONS, WHETHER INTENDED FOR TOPICAL OR ORAL USE, APPROPRIATE FOR
THE TREATMENT OF THE EYE AND ADNEXA.
§ 12. Subdivision 8 of section 7104 of the education law, as amended
by chapter 517 of the laws of 1995, is amended to read as follows:
(8) Fees: pay a fee of two hundred twenty dollars to the department
for admission to a department conducted examination and for an initial
license, a fee of one hundred fifteen dollars for each reexamination, a
fee of one hundred thirty-five dollars for an initial license for
persons not requiring admission to a department conducted examination,
[and] a fee of two hundred ten dollars for each triennial registration
period, [and] for additional authorization for the purpose of utilizing
diagnostic pharmaceutical agents, a fee of sixty dollars, AND FOR
CERTIFICATION TO USE OR PRESCRIBE ORAL THERAPEUTIC PHARMACEUTICAL
AGENTS, A FEE OF TWO HUNDRED FIFTY DOLLARS.
§ 13. Oral therapeutic pharmaceutical agent implementation review. 1.
For purposes of this section, the term "commissioner" shall mean the
commissioner of the state education department; and the term "depart-
ment" shall mean the state education department.
2. Each optometrist certified to use oral therapeutic pharmaceutical
agents pursuant to paragraph (c) of subdivision four of section 7101-a
A. 6751--A 6
of the education law shall provide the department with information, on a
form prescribed by the commissioner, related to the prescription or use
of oral therapeutic pharmaceutical agents provided for in section 7101-a
of the education law. Such information shall include the optometrist's
license number and the national provider identifier as established by
the centers for medicare and medicaid services, whether no oral
prescriptions have been issued and in the event that oral prescriptions
have been issued, then the following information shall be required: the
prescribed or used oral therapeutic pharmaceutical agent, the dosage of
such agent, the date of the prescription, the diagnosis of the patient
for which the agent was prescribed or used, and whether a referral was
made in accordance with paragraph (g) of subdivision one of section
7101-a of the education law. Such information shall not include any
patient identifying information and must otherwise be in compliance with
all state and federal requirements related to protected health informa-
tion. Each form shall be submitted by mail or electronic means to the
department on a quarterly basis. If a database of all oral therapeutic
pharmaceutical agents prescribed or used by optometrists is, or becomes,
available to the committee provided for in this act, then optometrists
shall be advised by the commissioner that quarterly reporting forms will
no longer be required. The requirements of this section shall remain in
effect for five years following approval by the department of the
initial oral therapeutic pharmaceutical agent certification course and
examination pursuant to paragraph (c) of subdivision four of section
7101-a of the education law, after which time these requirements shall
expire and no longer have effect.
3. The commissioner shall appoint a committee to advise and assist the
commissioner in evaluating compliance with the provisions of section
7101-a of the education law and to identify any necessary enhancements
to the curriculum provided for in such section and other educational
materials and to assist in ensuring patient safety. The committee shall
consist of one pharmacist, one optometrist upon the recommendation of a
statewide professional organization consisting of optometrists, one
ophthalmologist upon the recommendation of a statewide professional
organization consisting of ophthalmologists, and one expert in the field
of public health who shall be designated as chair by the commissioner in
consultation with the commissioner of the department of health and who
shall be neither an ophthalmologist nor an optometrist.
4. The commissioner shall submit each form received pursuant to this
section to the committee, except as otherwise provided in this subdivi-
sion. The committee shall review the forms and shall randomly cross-
check such submissions with a publicly available or other database
containing electronic prescriber information. Should a database of all
oral therapeutic pharmaceutical agents prescribed or used by optome-
trists pursuant to section 7101-a of the education law become available,
and the commissioner determines and advises optometrists that quarterly
reports are no longer necessary, then the committee shall review the
database and ascertain the prescribing information for all optometrists
consistent with section 7101-a of the education law. The committee
shall advise the commissioner as to compliance with the provisions of
section 7101-a of the education law for the purpose of evaluating
compliance with the provisions of section 7101-a of the education law
including the applicable referrals and dosing limitations and to identi-
fy any necessary enhancements to the curriculum provided for in para-
graph (c) of subdivision 4 of section 7101-a of the education law and
other educational materials and to assist in ensuring patient safety.
A. 6751--A 7
Upon finding evidence of non-compliance by any optometrist, the commit-
tee shall refer such information to the commissioner and to the office
of professions within the department for investigation and, if applica-
ble, disciplinary action. Nothing in this subdivision is intended to
modify or otherwise limit the department's authority or discretion to
review, investigate and refer matters related to the professional
conduct of a licensed provider.
§ 14. This act shall take effect eighteen months after it shall have
become a law; provided that:
(a) section thirteen of this act shall expire and be deemed repealed
five years following the approval by the department of education of the
initial certification course or the initial examination, whichever is
later, pursuant to paragraph (c) of subdivision 4 of section 7101-a of
the education law as added by section six of this act;
(b) the commissioner of education shall notify the legislative bill
drafting commission upon approval of the initial certification course
and examination required in section six of this act in order that the
commission may maintain an accurate and timely effective data base of
the official text of the laws of the state of New York in furtherance of
effectuating the provisions of section 44 of the legislative law and
section 70-b of the public officers law; and
(c) any rule or regulation necessary for the timely implementation of
this act on its effective date shall be promulgated on or before such
effective date.