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General Prescriptive Delegation FAQs

Does the physician's name need to be included on the prescription?

Yes, the physician’s name, address and telephone number are required to be included on the prescription drug order.  If the prescription is for a controlled substance, the physician’s DEA number is also required to be included on the prescription.  SB 406 did not change the requirements for what needs to be included on a prescription drug order.   

Is there still a ratio for the number of APRNs or PAs to whom a physician may delegate prescriptive authority?

The answer to the question depends on the practice setting.  In facility-based hospital practices and in practices that serve medically underserved populations, there are no limitations.  In all other practice settings, one physician may delegate to no more than seven full time equivalent APRNs and PAs (1:7 FTEs).  

Is there a waiver if a physician wants to delegate prescriptive authority to more than seven full time equivalent APRNs and PAs?

No, the waiver process no longer exists.  A physician may only delegate prescriptive authority to more than seven full time equivalent APRNs and PAs in facility based hospital practices and in practices that serve medically underserved populations.  In all other settings and practice scenarios, the 1:7 FTE ratios applies.  

How many delegating physicians may one APRN or PA have?

There is no limit to the number of physicians who may delegate prescriptive authority to an APRN or PA provided all requirements for such delegation are met.

Do the requirements for types of practice sites still apply?

No.  The old site-based prescriptive authority system is no longer in effect.  

What is a dangerous drug?  Are these legend drugs?

Texas is one of just a few states that use the term “dangerous drugs.”  The Dangerous Drug Act defines a dangerous drug as a device or drug that is unsafe for self-medication and that is not included in Schedules I through V or Penalty Groups 1 through 4 of Chapter 481, Health and Safety Code (Texas Controlled Substances Act). The term includes a device or drug that bears, or is required to bear, the legend: “Caution: federal law prohibits dispensing without prescription” or “Rx only” or another legend that complies with federal law.  Many other states use the term “legend drugs.”

Is prescriptive authority required to order durable medical equipment (DME)?

Yes.  SB 406 clarified that it is necessary to have prescriptive authority to order these devices.  In the past, it was not clear to DME suppliers that APRNs and PAs had this authority.  The changes to the law as a result of the passage of SB 406 clearly indicate that APRNs and PAs may order or prescribe this equipment provided all requirements for delegation of prescriptive authority are met.  

Do I have to produce my prescriptive authority agreement or facility-based protocol if a licensing board asks to see it?

Yes.  You are required to provide a copy of the prescriptive authority agreement to the board that requested it within three business days.  Although SB 406 did not specifically note that facility-based protocols must also be submitted within this time frame, each licensing board has the authority to request this information.  Failure to provide the requested information could result in disciplinary action against the professional license.

What is the difference between medication orders and prescriptions?

A medication order is an order for administration of a drug or device to a patient in a hospital for administration while the patient is in the hospital or for emergency use on the patient’s release from the hospital, as defined by §551.003, Occupations Code and §481.002, Health and Safety Code.  A prescription is an order to dispense a drug or device to a patient for self-administration as defined by §551.003, Occupations Code

How many miles from my delegating physician can my practice site be?

SB 406 eliminated site based prescriptive authority.  The law is silent regarding the practice location of the physician and its proximity to the practice site of the APRN or PA. That said, there has been no change in the law that requires that a physician must provide adequate supervision of delegates. In any given case, the distance between a physician’s primary practice and the practice site at which the physician’s delegates provide medical services may be an important factor in determining the quality of the physician’s supervision. 

What are the Texas Medical Board’s requirements for a physician who delegates to an APRN or PA?

All prescriptive delegation requires adequate supervision under the Medical Practice Act.  As such, a physician delegating to an APRN or PA must adequately supervise those individuals.  An individual physician may serve in both the supervising and delegating role and does not need to be physically present at all times to be considered to have adequate supervision.