Board committee weighs flexible approach to implementing AB 1902 accessible prescription labels

Chair Maria Serpa, chairperson of the Enforcement and Compounding Committee of the California State Board of Pharmacy, opened discussion on agenda item 4: the implementation of Assembly Bill 1902, a state law requiring prescription drug labels be made accessible to patients with disabilities and limited English proficiency in a "timely manner comparable to other patient wait times."

The committee repeatedly returned to the core question of whether the board should define "timely manner" in regulation or require pharmacies to adopt internal policies and procedures that explain how they will meet the law. Several committee members said a flexible, policy-driven approach would let different pharmacy business models—retail, closed-door, mail-order, and small independent pharmacies—determine how to comply. "I don't think that timely manner can be defined," said President Seung Oh, adding that rules should let businesses document how they will deliver accessible labels rather than imposing a one-size-fits-all deadline.

The committee heard public comment from pharmacists and trade groups. John Gray, a registered pharmacist with Kaiser Permanente, said a policy-and-procedure approach is “rational” and noted an operational tension in the law: generating accessible or translated labels often requires additional steps in a separate system. Gray suggested the statute might be improved to require that accessible labels not create "any unnecessary delay in the person receiving their medication." Sean Kim of the California Pharmacists Association asked the board to consider an exemption for nonchain pharmacies, arguing that independent pharmacies may not have the infrastructure and that compliance costs could be disproportionate.

Committee members discussed other technical questions the law raises: whether a pharmacy must offer all formats (audible, large print, braille, translated) or only the format requested by the patient; whether the board should set a minimum font size for "large print;" and whether accessible labels should follow the board's patient-centered label format. Members generally favored allowing pharmacies flexibility to meet an individual patient's needs and recommended that any regulation focus on requiring pharmacies to document their approach in policies or standard operating procedures (SOPs). Nicole Thibault, licensee member, emphasized patient choice: "It shouldn't be that a patient has to receive these things if they choose not to, and you need to be able to pick which they need to be able to choose which thing that they want."

The committee also discussed implementation mechanics. Committee member Song noted the technology vendors consulted by some providers estimate initial costs of "about 10 to $20,000" and ongoing subscriptions, a reality that could burden small pharmacies. Board counsel Corinne advised that the board likely cannot grant statutory exemptions and suggested enforcement discretion could be the practical mechanism to account for differing capabilities among pharmacies. Members asked staff to explore whether regulations could explicitly allow cooperative arrangements—such as agreements between pharmacies to provide accessible labels on behalf of others—if legally permissible.

Members raised related operational items for future rulemaking: requiring pharmacies to document policies that define how they will provide accessible formats and whether staff training or a designated responsible person should be required. Some committee members urged relying on national standards where available, including guidance from the United States Access Board and the national standards for culturally and linguistically appropriate services, rather than re-defining technical details within state regulation. John Gray suggested a practical default for large print in documents frequently used in health care: "Arial ... 20 [point] for document headers, 18 [point] for body."

The committee concluded the discussion without taking formal action. Chair Serpa said she would bring the committee's direction—favoring SOPs/policy documentation and flexibility—to the full board and work with staff to draft proposed regulatory language for future committee review. The board noted that specific language will be debated later and that the committee will incorporate public comment and counsel guidance into any proposed text.

The committee also recorded several clarifying points during the discussion: (1) the statute requires accessibility "in a timely manner comparable to other patient wait times," but what that means operationally remains undefined; (2) vendors and pilot users reported implementation costs and subscription fees; (3) patient preference and choice of format were emphasized as central to what constitutes an appropriate accessible label.

Members said the committee will present recommended next steps to the full board and return with draft language for later committee review and public comment.