6.3 Pharmacist Prescribing Under Utah Code § 58-17b-627: Tobacco Cessation, HIV PrEP/PEP, Fluoride & Epinephrine
Key Takeaways
Since January 1, 2022, a Utah pharmacist may prescribe a drug or device DOPL designates by rule if it is within the pharmacist's training and is not a Schedule I–IV controlled substance (Utah Code § 58-17b-627).
A Utah pharmacist who prescribes under § 58-17b-627 must notify the patient's primary care or other provider within five business days and keep the notification for five years (R156-17b-627(1)(e)).
Under Utah's tobacco cessation guidance, a first prescription may be up to 30 days, total treatment up to 12 weeks, at most twice in a rolling 12 months, with follow-up within 7–21 days.
Utah's tobacco cessation guidance requires the pharmacist to take the patient's blood pressure and to refer patients who are under 18, pregnant or nursing, or have blood pressure over 160/100.
Utah's PEP guidance stresses the 72-hour post-exposure window, and its PrEP guidance allows a 30-day supply when baseline labs are unavailable or a 90-day supply when labs are available.
6.3 Pharmacist Prescribing Under Utah Code § 58-17b-627: Tobacco Cessation, HIV PrEP/PEP, Fluoride & Epinephrine
The statute (§ 58-17b-627)
Beginning January 1, 2022, a pharmacist may prescribe a prescription drug or device if:
- it is within the scope of the pharmacist's training and experience;
- it is designated by DOPL rule; and
- it is not a controlled substance in Schedule I, II, III, or IV (Utah or federal).
A pharmacist is never required to prescribe. DOPL designates drugs starting with public-health concerns identified by DHHS, which the statute lists as HIV PEP, HIV PrEP, self-administered hormonal contraceptives, smoking cessation, naloxone, fluoride, vaccines, and epinephrine. DOPL's rules must include guidelines for notifying the patient's providers and preventing over-prescription (including of antibiotics), and must address when to refer.
General duties when prescribing (R156-17b-627(1))
Prescribing is done from a Class A or Class B pharmacy. Before prescribing, the pharmacist must:
- Assess the patient: current health status, past medical history, allergies, medication sensitivities, rationale for care, current medications, and whether to refer.
- Follow guidelines from the CDC, nationally accepted sources, and the DHHS/DOPL guidance documents.
- Meet the prescription and refill requirements of §§ 58-17b-602 and -609.
- Create a follow-up care plan covering monitoring for efficacy and safety, adverse reactions, and further care.
- Notify the patient's primary care or other provider within five business days, in writing, electronically, or by phone. If the patient has no provider, give the notification to the patient. The notice must identify the prescribing pharmacist, pharmacy name and phone, patient and date of birth, drug or device, quantity dispensed, directions, refills, and the patient's provider. Keep the notification for five years.
DOPL reviews the guidance documents at least every two years. Currently posted guidance covers tobacco cessation, HIV PrEP and PEP (updated July 31, 2026), naloxone (Section 7.1), self-administered hormonal contraceptives (Section 6.2), fluoride (approved November 18, 2025), and epinephrine.
Tobacco cessation (Utah Guidance for Smoking Cessation, approved Sept. 28, 2021)
Screening and referral (care pathway)
| Screen | Action |
|---|---|
| Under 18, or pregnant, nursing, or planning either within 6 months | Refer to a primary care provider and the Utah Quit Line |
| Blood pressure (must be taken by the pharmacist) | If over 160/100, refer to the PCP and the Quit Line |
| Heart attack, arrhythmia, angina, or chest pain in the past two weeks; stomach ulcers | Refer (NRT questions) |
| Dentures or TMJ / chronic nasal disorder / asthma or COPD | Avoid gum / nasal spray / inhaler, respectively |
| Eating disorder; seizure, significant head trauma, brain surgery, stroke, or epilepsy | Avoid bupropion |
| Chronic kidney disease, liver disease, or mental illness treated in the past two years | Avoid varenicline (and bupropion); refer if the patient still wants it |
| MAOI, linezolid, alcohol use, or recent sedative discontinuation | Avoid bupropion |
| PHQ-2 score of 3 or more | Avoid bupropion and varenicline; refer; NRT may be offered |
| Any positive suicide screen | Immediate referral; call the PCP (after hours, the crisis line) |
Every patient is referred to the Utah Quit Line (1-800-QUIT-NOW).
Products and dosing highlights
- Combination NRT is preferred (a patch plus a short-acting form).
- Patch: 21 mg/day if smoking more than 10 cigarettes a day, stepping down to 14 and then 7 mg. 14 mg/day if smoking fewer than 10 a day.
- Gum or lozenge: 4 mg if the first cigarette is within 30 minutes of waking, otherwise 2 mg.
- Bupropion SR: 150 mg daily for 3 days, then 150 mg twice daily for 8 weeks or longer. Quit day after day 7.
- Varenicline: 0.5 mg daily for 3 days, 0.5 mg twice daily for 3 days, then 1 mg twice daily for 12–24 weeks. Quit day after day 7, or up to day 35.
Prescribing limits
- First prescription: up to 30 days
- Maximum duration: 12 weeks
- Maximum frequency: twice in a rolling 12 months
- Follow-up: documented within 7–21 days (a phone consult is allowed)
HIV PrEP and PEP (guidance approved July 31, 2026)
- PrEP. Anyone who seeks PrEP is eligible, though regimen choice depends on patient factors. Refer (don't prescribe) for hepatitis B infection, HIV infection or reactive or indeterminate HIV testing, creatinine clearance under 30 mL/min, or interacting or nephrotoxic drugs. With labs available, the pharmacist may prescribe 90 days and order the next labs. Without labs, the pharmacist may prescribe 30 days, and the patient must complete the required labs within 30 days. Notify the patient's provider.
- PEP. Time-critical: make sure referred patients can be seen within the 72-hour post-exposure window, and keep a low threshold for starting PEP. Preferred regimens follow the CDC 2025 nPEP guidelines. Refer patients with hepatitis B, kidney disease, or hepatic dysfunction. Evaluate hepatitis B immunization, give written notice to the provider, and contact the patient one month after the prescription.
Fluoride and epinephrine
- Fluoride (approved Nov. 18, 2025). Systemic fluoride supplements for children ages 3 to 16 at high risk for tooth decay. Dosing depends on the fluoride level of the home water supply, so private wells should be tested first. Counsel on use, adverse effects, fluorosis, storage, and poison control.
- Epinephrine. An epinephrine auto-injector for a person 18 or older at risk of anaphylaxis, or a person in a position to assist someone at risk. Before dispensing, the pharmacist must train the recipient on symptoms, calling 911, use, adverse effects, storage, and expiration. Written materials cannot replace this consultation.
Which drug could a Utah pharmacist never prescribe under Utah Code § 58-17b-627, even if DOPL guidance existed?
An epinephrine auto-injector for an adult at risk of anaphylaxis
Varenicline for smoking cessation
A Schedule IV benzodiazepine
Emtricitabine/tenofovir for HIV PrEP
After prescribing nicotine patches under Utah's pharmacist-prescribing rule, what must the pharmacist do about the patient's primary care provider?
Notify the provider only if the patient reports an adverse effect
Notify the provider within five business days, including required details, and keep the notification for five years
Nothing, because OTC-equivalent products need no notification
Obtain the provider's co-signature before dispensing
Under Utah's tobacco cessation guidance, which set of prescribing parameters is correct?
First prescription up to 90 days, maximum duration 24 weeks, unlimited courses
Maximum duration 6 weeks with no follow-up requirement
First prescription up to 30 days, maximum duration 12 weeks, maximum of two courses in a rolling 12 months, and follow-up within 7–21 days
First prescription up to 12 months with annual follow-up
A 45-year-old smoker wants varenicline. The pharmacist takes his blood pressure and gets 172/104 mmHg. What does Utah's tobacco cessation care pathway require?
Prescribe varenicline, because blood pressure is not part of the pathway
Prescribe bupropion instead, because it lowers blood pressure
Ask the patient to take his own reading at home and prescribe if he reports a normal value
Refer the patient to his primary care provider and the Utah Quit Line instead of prescribing
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