Cal. Code Regs. tit. 18, § 1591
(a) Definitions.
(4) Health Facility. “Health Facility” as used herein has the meaning ascribed to the term in section 1250 of the Health and Safety Code, and also includes “clinic” as defined in sections 1200 and 1200.1 of the Health and Safety Code.
(7) Prescription. “Prescription” means an oral, written, or electronic transmission order that is issued by a physician, dentist, optometrist, or podiatrist licensed in this state and given individually for the person or persons for whom ordered. The order must include all of the following:
(9) Medicines. “Medicines” means:
(B) Any substance or preparation intended for use by external or internal application to the human body in the diagnosis, cure, mitigation, treatment or prevention of disease and which is commonly recognized as a substance or preparation intended for that use.
The term medicines also includes certain articles, devices, and appliances as described in subdivision (b) of this regulation.
For purposes of subdivision (a)(9)(A), products “approved by the United States Food and Drug Administration” means any product for which a premarket notification was cleared by the United States Food and Drug Administration or for which an application for premarket approval was approved by the United States Food and Drug Administration.
Medicines are further defined in subdivisions (b) and (c) below.
(b) “Medicines.” In addition to the definition set forth in subdivision (a)(9) of this regulation, the term “medicines” means and includes the following items:
(1) Preparations and Similar Substances. Preparations and similar substances intended for use by external or internal application to the human body in the diagnosis, cure, mitigation, treatment or prevention of disease and which are commonly recognized as a substance or preparation intended for such use qualify as medicines. Tax does not apply to the sale or use of such medicines sold or furnished under one of the conditions provided in subdivision (d)(1) through (d)(6).
“Preparations and similar substances” include, but are not limited to, drugs such as penicillin, and other antibiotics, “dangerous drugs” (drugs that require dispensing only on prescription); alcohol (70% solution) and isopropyl; aspirin; baby lotion, oil, and powder; enema preparations; hydrogen peroxide; lubricating jelly; medicated skin creams; oral contraceptives; measles and other types of vaccines; topical creams and ointments; and sterile nonpyrogenic distilled water. Preparations and similar substances applied to the human body in the diagnosis, cure, mitigation, treatment, or prevention of disease qualify as medicines. “Preparations and similar substances” also include Total Parenteral Nutrition (also called TPN), Intradialytic Parenteral Nutrition (also called IDPN), and food provided by way of enteral feeding, except when the TPN, IDPN, or food provided by enteral feeding qualifies as a meal under Regulation 1503. For purposes of this regulation, TPN, IDPN, and enteral feeding are means of providing complete nutrition to the patient; TPN and IDPN are provided in the form of a collection of glucose, amino acids, vitamins, minerals, and lipids, TPN being administered intravenously to a patient who is unable to digest food through the gastrointestinal tract and IDPN being administered to hemodialysis patients as an integral part of the hemodialysis treatment; enteral feeding is the feeding of the patient directly into the gastrointestinal tract.
(2) Permanently Implanted Articles. Articles permanently implanted in the human body to assist the functioning of, as distinguished from replacing all or any part of, any natural organ, artery, vein or limb and which remain or dissolve in the body qualify as medicines. In addition, articles permanently implanted in the human body to mark the location of a medical condition, such as breast tissue markers, qualify as medicines. An article is considered to be permanently implanted if its removal is not otherwise anticipated. Except for devices excluded from the definition of “medicines,” permanently implanted articles include the interdependent internal and external components that operate together as one device in and on the person in whom the device is implanted. Tax does not apply to the sale or use of articles permanently implanted in the human body to assist the functioning of any natural organ, artery, vein or limb or mark the location of a medical condition, and which remain or dissolve in the body when such articles are sold or furnished under one of the conditions provided in subdivision (d)(1) through (d)(6).
Permanently implanted articles include, but are not limited to, permanently implanted artificial sphincters; bone screws and bone pins; dental implant systems including dental bone screws and abutments; permanently implanted catheters; permanently implanted hydrocephalus devices and their implanted pressure regulating components; implanted defibrillators and implanted leads; pacemakers; tendon implants; testicular gel implants; and ear implants, including the ear implant's interdependent internal and external components. Sutures are also included whether or not they are permanently implanted. A non-returnable, nonreusable needle fused or prethreaded to a suture is regarded as part of the suture.
Implantable articles that do not qualify as “permanently” implanted medicines include, but are not limited to, Chemoport implantable fluid systems; Port-a-Cath systems used for drug infusion purposes; disposable urethral catheters; temporary myocardial pacing leads used during surgery and recovery; and defibrillator programmer and high voltage stimulator used with an implanted defibrillator.
(4) Orthotic Devices. Orthotic devices and their replacement parts, designed to be worn on the person of the user as a brace, support or correction for the body structure are medicines as provided under Revenue and Taxation Code section 6369(c)(3). The sale or use of orthotic devices and their replacement parts is not subject to tax when sold or furnished under one of the conditions provided in subdivision (d)(1) through (d)(6). Orthotic devices and their replacement parts do not need to be furnished by a pharmacist, within the meaning of subdivision (d)(1), to be considered dispensed on prescription provided the devices are furnished pursuant to a written order of a physician or podiatrist. For the purposes of this regulation, orthotic devices furnished pursuant to a written order of a physician or podiatrist by, but not limited to, medical device retailers, clinics, physical therapists, device suppliers, intermediate care facilities, or other such persons, are deemed to be dispensed on prescription within the meaning of subdivision (d)(1).
Orthotic devices worn on the body of the person include, but are not limited to, abdominal binders and supports, ace bandages, ankle braces, anti-embolism stockings, athletic supporters (only for patients recovering from rectal or genital surgery), casts, and cast components, cervical supports, neck collars, cervical traction devices, clavicular splints, post-surgical corsets, elbow supports, head halters, pelvic traction devices, post-operative knee immobilizers and braces, legging orthoses, rib belts and immobilizers, rupture holders, sacral belts, sacro-lumbar back braces, shoulder immobilizers, slings, stump shrinkers, sternum supports, support hose (and garter belts used to hold them in place), thumb and finger splints, trusses, and wrist and arm braces. All of the above must be worn on the body of the person and act as a brace, support or correction for body structure to qualify as a medicine. If any part of the orthotic device is not worn on the person, the device is not a medicine for the purposes of this regulation.
Orthopedic shoes and supportive devices for the foot do not qualify as medicines unless they are an integral part of a leg brace or artificial leg or are custom-made biomechanical foot orthoses. “Custom-made biomechanical foot orthosis” means a device that is made on a positive model of the individual patient's foot. The model may be individually constructed from suitable model material such as plaster of Paris, stone, or wax, and may be manually constructed or fabricated using electronic technology.
“Custom-made biomechanical foot orthosis” do not include:
(5) Prosthetic Devices. Prosthetic devices and their replacement parts designed to be worn on or in the patient to replace or assist the functioning of a natural part of the human body are medicines as provided under Revenue and Taxation Code section 6369(c)(4). The sale or use of prosthetic devices and their replacement parts is not subject to tax when sold or furnished under one of the conditions provided in subdivision (d)(1) through (d)(6). Prosthetic devices and their replacement parts do not need to be furnished by a pharmacist, within the meaning of subdivision (d)(1), to be considered dispensed on prescription provided the devices are furnished pursuant to a written order of a physician or podiatrist. For the purposes of this regulation, prosthetic devices furnished pursuant to a written order of a physician or podiatrist by, but not limited to, medical device retailers, clinics, physical therapists, device suppliers, intermediate care facilities, or other such persons, are deemed to be dispensed on prescription within the meaning of subdivision (d)(1). For purposes of this regulation only, prosthetic devices include bags and tubing, as well as filters, locks, tape, clamps, and connectors which are integral to the tubing, each of which is used to dispense enteral feeding to the patient, including: gastrostomy tubes (also called G tubes) which are used to deliver the nutrition directly into the stomach; jejunostomy tubes (also called J tubes) which are used to deliver the nutrition directly into the intestinal tract; and nasogastric tubes (also called NG tubes) which are used to deliver the nutrition directly through the nasal passage to the stomach. For purposes of this regulation only, prosthetic devices also include needles, syringes, cannulas, bags, and tubing, as well as filters, locks, tape, clamps, and connectors which are integral to the tubing, each of which is used to dispense TPN or IDPN to the patient, provided each of these items is used primarily to dispense the TPN or IDPN.
Prosthetic devices that are considered medicines when worn on or in the patient include, but are not limited to, acetabular cups, atrial valves, breast tissue expanders and tissue expanders, cervical cuffs, dacron grafts, heart valves, orbital implant, nerve cups, rhinoplasty prosthesis, neuromuscular electrical stimulators, transcutaneous nerve stimulators, urinary incontinent devices, and wigs and hairpieces prescribed by a physician or podiatrist.
Prosthetic devices that do not qualify as “medicines” include, but are not limited to, air compression pumps and pneumatic garments; noninvasive, temporary pace makers; vacuum/constriction devices used to treat male impotency; auditory, ophthalmic and ocular devices or appliances; and dental prosthetic devices and materials such as dentures, removable or fixed bridges, crowns, caps, inlays, artificial teeth, and other dental prosthetic materials and devices. Sales of such items are subject to tax in the same manner as any other sale of tangible personal property.
(c) Exclusions from the Definition of “Medicines.”
Except as otherwise provided in subdivision (b), the following items are specifically excluded from the definition of medicines. Sales of these items are subject to tax in the same manner as any other sale of tangible personal property.
(d) Application of Tax -- In General. Tax applies to retail sales, including over-the-counter sales of drugs and medicines, and other tangible personal property by pharmacists and others. However, tax does not apply to the sale or use of medicines when sold or furnished under one of the following conditions:
(e) Specific Tax Applications.
(4) Pharmaceutical Manufacturer or Distributor. Tax does not apply to the storage, use or consumption of medicines furnished by a pharmaceutical manufacturer or distributor without charge to a licensed physician, surgeon, dentist, podiatrist, or health facility for the treatment of a human being or furnished without charge to an institution of higher education for instruction or research provided the medicines furnished are of a type that can be dispensed only (1) on prescription by persons authorized to prescribe and (2) for the treatment of a human being. The exemption from tax includes the costs of the materials used to package the “sample” medicines, such as bottles, boxes, blister packs, patches impregnated with medicines, or pre-filled syringes, and the elements and ingredients used to produce the “samples” whether or not such items are purchased under a resale certificate in this state or outside this state. When a pre-filled syringe or other such delivery device is used to package and contain a sample medicine (i.e., pre-filled with the medicine) as well as to inject or otherwise administer the medicine to the patient, the exemption from tax will not be lost due to the fact that the device is used for a dual purpose. However, the use of empty syringes or other such delivery devices, furnished to the licensed physician separately or included in the packages with the medicines, is subject to tax.
This exemption applies in the same manner to the use of clinical trial medicines during the United States Food and Drug Administration's drug development and approval process. “Clinical trial medicines” are substances or preparations approved as “Investigational New Drugs” by the United States Food and Drug Administration intended for treatment of, and application to, the human body, which are furnished by a pharmaceutical developer, manufacturer, or distributor to a licensed physician and subsequently dispensed, furnished, or administered pursuant to the order of the licensed physician. “Clinical trial medicines” do not include placebos. Placebos are not used for the treatment of a human being and, as such, do not qualify for the exemption provided under this subdivision. Thus, the use of placebos is subject to tax.
(8) Diagnostic Substances, Test Kits, and Equipment. Tax applies to the sale or use of diagnostic substances applied to samples of cells, tissues, organs, or bodily fluids and waste after such samples have been removed, withdrawn, or eliminated from the human body. Diagnostic substances are applied to the samples outside the living body (“in vitro”) in an artificial environment. They are not administered in the living body (“in vivo”). As the substances are not applied internally or externally to the body of the patient, they do not qualify as medicines under Revenue and Taxation Code section 6369.
Except as provided in Regulation 1591.1(b)(4), tax applies to the sale or use of test kits and equipment used to analyze, monitor, or test samples of cells, tissues, organs and blood, saliva, or other bodily fluids. Such items do not qualify as medicines regardless of whether they are prescribed for an individual by a person authorized to prescribe and dispensed pursuant to a prescription.
(f) Insurance Payments
(2) Medicare
(g) Records. Any pharmacy whether in a health facility or not must keep records in support of all deductions claimed on account of medicines. Section 4081 of the Business and Professions Code requires that all prescriptions filled shall be kept on file and open for inspection by duly constituted authorities.
(1) The following written information constitutes acceptable documentation for retailers in those cases where sales are made of supplies which are “deemed to be dispensed on prescription” within the meaning of section 6369:
Name of purchaser
Name of doctor
Date of sale
Item sold
The sale price
Pursuant to section 4081 of the Business and Professions Code, physicians and surgeons and podiatrists must keep accurate records of drugs furnished by them. Any deduction on account of sales of medicines shall be supported by appropriate records.
Note: Authority cited: Section 7051, Revenue and Taxation Code. Reference: Sections 6006 and 6369, Revenue and Taxation Code; and Sections 1200, 1200.1, 1204.1 and 1250, Health and Safety Code.
1. Amendment filed 3-30-78; effective thirtieth day thereafter (Register 78, No. 13). For prior history, see Register 77, No. 52.
2. Amendment filed 7-31-78 as an emergency; effective upon filing (Register 78, No. 31).
3. Certificate of Compliance filed 10-19-78 (Register 78, No. 42).
4. Amendment of subsections (b)(5) and (c) filed 10-19-78; effective thirtieth day thereafter (Register 78, No. 42).
5. Amendment filed 10-17-79; effective thirtieth day thereafter (Register 79, No. 42).
6. Amendment filed 10-18-83; effective thirtieth day thereafter (Register 83, No. 43).
7. Amendment of subsections (a)-(i), (k)-(m) and (p) filed 9-7-89; operative 10-7-89 (Register 89, No. 36).
8. Amendment of subsections (b)(4), (b)(7), (h), (k) and (m) filed 1-18-94; operative 2-17-94 (Register 94, No. 3).
9. Editorial correction of printing errors in subsections (a)(6) and (l) (Register 94, No. 3).
10. New subsection (n) and subsection relettering filed 7-24-96; operative 8-23-96 (Register 96, No. 30).
11. Change without regulatory effect amending subsection (a)(6) and adding new subsection (a)(7) filed 11-19-96 pursuant to section 100, title 1, California Code of Regulations (Register 96, No. 47).
12. Change without regulatory effect amending subsections (a)(6), (b)(4)(A) and (b)(5), redesignating of former section (c)(4) to new (c)(3), and amending subsections (d)-(h), (k), (l)(1) and (l)(3)(B), filed 9-17-98 pursuant to section 100, title 1, California Code of Regulations (Register 98, No. 38).
13. Amendment of section heading, section and Note filed 2-9-2000; operative 3-10-2000 (Register 2000, No. 6).
14. Amendment of subsections (b)(1), (b)(2) and (b)(5) filed 3-13-2001; operative 4-12-2001 (Register 2001, No. 11).
15. Amendment of subsections (b)(2), (b)(4) and (b)(5) filed 1-26-2004; operative 2-25-2004 (Register 2004, No. 5).
16. Amendment of subsection (a)(9), new subsections (a)(9)(A)-(B) and amendment of subsections (b), (c)(1) and (g) filed 7-27-2006; operative 8-26-2006 (Register 2006, No. 30).
17. Change without regulatory effect amending subsection (a)(4), adding subsections (a)(4)(A)-(B), amending subsections (f)(2)(B) and (g)(3) and amending Note filed 7-30-2007 pursuant to section 100, title 1, California Code of Regulations (Register 2007, No. 31).
18. New subsection (e)(7) and subsection renumbering filed 11-14-2008; operative 12-14-2008 (Register 2008, No. 46).
19. Amendment of subsection (b)(2) filed 4-29-2009; operative 5-29-2009 (Register 2009, No. 18).
20. Editorial correction of subsections (a)(5) and (e)(6) (Register 2015, No. 26).
21. Amendment of subsections (a)(4), (a)(4)(C)-(a)(6), (a)(8), (a)(9)(A)-(B), (b), (b)(2), (b)(5), (c)(3), (d), (e)(7) and (g)-(g)(1) filed 6-25-2015; operative 10-1-2015 (Register 2015, No. 26).
22. Governor Newsom issued Executive Order N-46-20 (2019 CA EO 46-20), dated April 7, 2020, which suspends certain provisions of this section relating to the purchase of personal protective equipment by the state, due to the COVID-19 pandemic.
23. Amendment of subsection (f)(2)(A) filed 3-17-2021; operative 3-17-2021. Submitted to OAL for filing and printing only pursuant to Government Code section 15570.40(b) (Register 2021, No. 12).