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“... rsquo;s emergency department, contingent upon the prescription being filled at the hospital’s facility-based pharmacy. A PA or APRN may also issue such prescriptions as part of the plan of care for the treatment of a person who has executed a written certification of a terminal illness, ... ”
“... nacted)
H.B. 2561 S. Thompson (V. Taylor) — Prescription Monitoring Program
S.B. 315 Hinojosa (Burkett) — Subpoena Authority and Pain Management Regulation
S.B. 674 Schwertner (S. Davis) — Licensing Provisions and Elimination of Dual Registration
S.B. 1625 Uresti (Cortez) — P ... ”
“... s been granted by the appropriate agency.
A prescription for a controlled substance is not required to be issued electronically and may be issued in writing if the prescription is issued:
by a veterinarian;
in circumstances in which electronic prescribing is not available due to temporary tec ... ”
“... ity of patients are issued, on a monthly basis, a prescription for opioids, benzodiazepines, barbiturates, or carisoprodol, but not including suboxone.
A pain management clinic may not operate in Texas without obtaining a certificate from the Texas Medical Board (TMB). Certain exemption ... ”
Description: TMB disciplines 45 physicians at February meeting, adopts rule changes
Document: ... roceedings. Dr. Cruz had been indicted for felony prescription fraud in the 158
th
Judicial District Court, in Denton
County, Texas. This order resolves a formal complaint filed at the State Office of Administrative Hearings.
Hewett, Bernie Gene, M.D., Lic. No. C7640, Not in practice
On Feb ...
Description: Acupuncture 2015 - May - Licensure Committee Minutes
Document: ... cant’s 2004 felony
deferred adjudication
for
prescription fraud
and past treatment for substance abuse.
Factors contributing to this
recommendation include the applicant’s current involvement
in AA and
no evidence of criminal
charges since 2004.
Ms. Chiang
seconded. All vote
d ...
Description: TMB disciplines 29 physicians at April meeting, adopts rule changes
Document: ... a admitted to inappropriately se
lf
-
prescribing prescription medications and was arrested for
unprofessional conduct at a high school football game, however the charges were dismissed.
REVOCATION
Khuu, Chau Doan, M.D., Lic. No. M4838, Houston
On April 10, 2015, the Board entered a Final ...
Description: Legislative Update 84th Legislature (2015)
Document: ... icensing and Enforcement, 2) Physician Practice & Prescription Monitoring, and 3) Miscellane
ous Health
Care Issues. A link to each bill's text and other information available from the Texas Legislature Online website is provide
d for each bill.
Bill # & Author
Subject
Key Provisions
Effe ...
Description: TMB disciplines 61 physicians at August meeting, adopts rule changes
Document: ... to prescribe controlled substances and access the Prescription Drug Monitoring Program described
by §§481.075, 481.076, and 481.0761 of the Texas Health and Safety Code, the Board shall charge an additional
reasonable a
nd necessary fee sufficient to cover the Board's responsible portion for costs ...
Description: TMB suspends Houston physician
Document: ...
linic
,
had seen the patient
an
d written the prescription.
The Board panel determined that Dr. Saqer’s continued practice of medicine, including improper
and illegal activities related to his operation of a pain management clinic, and including the
method and manner in which controlled
s ...
Description: Acupuncture 2015 - May - Full Board Minutes
Document: ... priority legislation
related to the transfer of Prescription
Access in Texas fr
om DPS to the Board of Pharmacy; the
composition of the Physician
Assistants Board;
the
Interstate Compact for Medical Licensure; and the Sunset
recommendations to transfer four regulatory programs from DSHS to ...
Description: Texas Physician Assistant Board suspends Houston physician assistant
Document: ... staff found Ms. Green in possession of
numerous prescription forms that had been pr
e
-
signed by Dr.
Blanchette.
Ms. Green’s conduct makes her a continuing threat to the public health and welfare.
A temporary suspension hearing with notice will be held as soon as practicable with 10 ...
Description: TMB disciplines 54 physicians at December meeting, adopts rule changes
Document: ... l
led
substances for which she did not provide a prescription, including opioids and barbiturates; failed to maintain a current,
accurate address with the Board and failed to respond to Board requests for information in a timely manner; and failed
to notify
the Board of medical conditions that b ...
Description: TMB disciplines 38 physicians at August meeting
Document: ... edical staff, violated state law by pre
-
signing prescription forms, and did not meet the
standard of care in his treatment of multiple patients for chronic pain. The action was based on the findings of an
admi
nistrative law judge at the State Office of Administrative Hearings (SOAH). This order ...
Description: TMB disciplines 62 physicians at March meeting
Document: ... d to destroy, or document the destruction of, his prescription pad, and failed to turn his
prescr
iption pads over to the Department of Public Safety; failed to report possible fraudulent prescriptions to DPS and
DEA after receiving notice and failed to
exercise adequate control over
his prescri ...
Description: Texas Physician Assistant Board suspends Brownsville physician assistant (Mendez)
Document: ... to fill a Zolpidem
(commonly known as Ambien)
prescription. Mr. Mendez is currently set
to be
tried in the prescription case on April 4, 2016.
A temporary suspension hearing with notice will be held as soon as
practicable with 10 days'
notice to Mr. Mendez, unless the hearing is specifica ...
Description: TMB disciplines 78 physicians at June meeting, adopts rule changes
Document: ... equirement that if such circumstances apply and a prescription is filled at a pharmacy other
than the designated pharmacy, the patient inform the primary or covering physician of the circumstances and the
name
of the pharmacy that dispensed the medication.
CHAPTER 171
.
POSTGRADUATE TRAININ ...
Description: TMB Legislative Appropriations Request FY 18-19
Document: ... license individuals or entiti
thorized to acc the prescription drug order monoring program, and ansferr to the
Board of macy. The Board of Pharmy, upon completion of nery actions to
or increa such additional fees, shall furnish copies of the Board of Pharmacy's minut and
other informaon supporng ...
Description: Medical Board 2016 - June - Full Board Minutes
Document: ... oard directed
staff to run reports
through the prescription
monitoring program
and
review for
a pattern of problems that may exist
underlying this incident.
Agenda Item # 14 Consideration and
Approval of Mediated Settlement Agreed
Orders.
(Continued)
After consideration
of ord ...
“... ian or advanced practice professional issuing the prescription. For providers seeking information on how to access the PMP, please review Pharmacy Board PMP information at https://www.pharmacy.texas.gov/pmp/. ”
Is the Prescription Monitoring Program (PMP) check mandated each and every time a physician or authorized delegate prescribes one of the four scheduled drug types?
Yes. Prior to and each and every time a physician or advanced practice professional (such as a physician assistant or advanced practice registered nurse acting under a physician’s delegated authority) prescribes opioids, benzodiazepines, barbiturates, or carisoprodol, the patient’s prescribing history must be reviewed by the physician or advanced practice professional issuing the prescription. For providers seeking information on how to access the PMP, please review Pharmacy Board PMP information at https://www.pharmacy.texas.gov/pmp/.
“... s are allowed in very limited circumstances). All prescription drugs that are not controlled substances fall into the category of "dangerous drugs." Physician assistants with prescriptive authority must have their own DEA numbers to prescribe controlled substances. In addition, physician assistants ... ”
Can a PA sign a prescription for controlled substances?
Yes, the PAs supervising physician must delegate prescriptive authority allowing a PA to sign prescriptions for controlled substances, also called scheduled drugs, as well as Dangerous Drugs. However, PA's are generally limited to Schedules III – V (Schedule IIs are allowed in very limited circumstances). All prescription drugs that are not controlled substances fall into the category of "dangerous drugs." Physician assistants with prescriptive authority must have their own DEA numbers to prescribe controlled substances. In addition, physician assistants must have the name of their current delegating physician authorizing prescriptive authority on file with DEA.
Please note: Under Senate Bill 195, the requirement for controlled substances registration (CSR) with the Texas Department of Public Safety (DPS) was eliminated as of September 1, 2016.
“Yes, a PA can call in a prescription to a pharmacy. However, the PA can only do so at the direction of a physician. ”
Can a PA call in a prescription to a pharmacy?
Yes, a PA can call in a prescription to a pharmacy. However, the PA can only do so at the direction of a physician.
“... rity of patients are issued on a monthly basis, a prescription for opioids, benzodiazepines, barbiturates, or carisoprodol, but not including suboxone. ”
What is a “pain management clinic”?
A pain management clinic is defined in statute and rule as a publicly or privately owned facility for which a majority of patients are issued on a monthly basis, a prescription for opioids, benzodiazepines, barbiturates, or carisoprodol, but not including suboxone.
“... atment, including surgery, with the issuance of a prescription for a majority of the patients. Note: The TMB cannot give legal advice. Please consult an attorney if you have questions regarding whether or not your clinic meets one of the exemptions listed above. However, the Board does have inspecti ... ”
Who does not need to register a pain management clinic?
Regulations regarding the registration and operation of pain management clinics do not apply to the following settings:
Note: The TMB cannot give legal advice. Please consult an attorney if you have questions regarding whether or not your clinic meets one of the exemptions listed above. However, the Board does have inspection authority, and owners of clinics that have not been properly registered can be investigated.
“... ts of which relate to the distribution of illegal prescription drugs or a controlled substance as defined by Texas Occupations Code Annotated §551.003(11) The medical director of a pain management clinic must operate the clinic in compliance with Drug Prevention and Control Act, 21 U.S.C ... ”
Who can own or operate a pain management clinic?
A pain management clinic may not operate in Texas unless the clinic is owned and operated by a medical director who: • is a physician who practices in Texas • has an unrestricted medical license • holds a certificate of registration for that pain management clinic In addition, the owner/operator of a pain management clinic, an employee of the clinic, or a person with whom a clinic contracts for services may not: • have been denied, by any jurisdiction, a license issued by the Drug Enforcement Agency or a state public safety agency under which the person may prescribe, dispense, administer, supply, or sell a controlled substance; • have held a license issued by the Drug Enforcement Agency or a state public safety agency in any jurisdiction, under which the person may prescribe, dispense, administer, supply, or sell a controlled substance, that has been restricted; or • have been subject to disciplinary action by any licensing entity for conduct that was a result of inappropriately prescribing, dispensing, administering, supplying, or selling a controlled substance A pain management clinic may not be owned wholly or partly by a person who has been convicted of, pled nolo contendere to, or received deferred adjudication for: • an offense that constitutes a felony; or • an offense that constitutes a misdemeanor, the facts of which relate to the distribution of illegal prescription drugs or a controlled substance as defined by Texas Occupations Code Annotated §551.003(11) The medical director of a pain management clinic must operate the clinic in compliance with Drug Prevention and Control Act, 21 U.S.C.A. 801 et.seq. and the Texas Controlled Substances Act, Chapter 481 of the Texas Health and Safety Code, relating to the prescribing and dispensing of controlled substances. The medical director of a pain management clinic must, on an annual basis, ensure that all personnel: • are properly licensed, if applicable, • are trained including 10 hours of continuing medical education related to pain management, and • are qualified for employment.
“... lephone 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 pr ... ”
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.
“... 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.” ”
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.”
“... nd §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. ”
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.
“... lt with the delegating physician for refills of a prescription for controlled substances after the initial 90 day supply. Consultation is also required when prescribing controlled substances for children under the age of two years. In both cases, the consultation must be documented in th ... ”
How often is physician consultation required when prescribing controlled substances?
APRNs and PAs must consult with the delegating physician for refills of a prescription for controlled substances after the initial 90 day supply. Consultation is also required when prescribing controlled substances for children under the age of two years. In both cases, the consultation must be documented in the patient’s medical record.
“... that the PMP has been checked prior to issuing a prescription. Certain electronic medical record systems, for example, may provide other ways to document that the review has been completed. ”
May I maintain a copy of the PMP history report in the patient’s medical record?
Yes. The provider may maintain a copy of the PMP history report in the patient’s medical record. There is no specific method required for documenting that the PMP has been checked prior to issuing a prescription. Certain electronic medical record systems, for example, may provide other ways to document that the review has been completed.
“Refills issued to the patient pursuant to a valid prescription and without any reauthorization from the prescriber do not require a PMP check by the prescriber. However, if a prescriber is issuing a prescription for a patient that is unchanged from a previous prescription issued to the patient ... ”
What if a prescriber is just approving a refill?
Refills issued to the patient pursuant to a valid prescription and without any reauthorization from the prescriber do not require a PMP check by the prescriber. However, if a prescriber is issuing a prescription for a patient that is unchanged from a previous prescription issued to the patient (often referred to as a refill), then this would be considered a new prescription and would require a PMP check.
“... count any relevant information prior to issuing a prescription. ”
Is only the prescriber allowed to check the PMP, or can someone else check on behalf of the physician?
A physician, their delegated midlevel provider, or any other qualified and licensed individual delegated authority to check the PMP may do so on behalf of the prescriber. Ultimately though, it is the prescriber’s responsibility to ensure that the PMP has been checked and that they have reviewed and taken into account any relevant information prior to issuing a prescription.
“... ans. If a prescribing delegate is issuing a prescription under the authority of a physician who does not have a waiver, then the prescribing delegate must issue the prescription via e-prescribing. If an individual wants to look up whether a prescribing delegate has a waver they can do so ... ”
Do delegates who have prescribing authority have to apply for their own waiver or are they covered by the supervising physician’s waiver?
If the supervising physician has a waiver, then the prescribing delegate is also covered under that waiver. So long as the prescribing delegate is prescribing under the authority of a physician who has been granted a waiver, then the prescribing delegate may use non-electronic prescribing means. If a prescribing delegate is issuing a prescription under the authority of a physician who does not have a waiver, then the prescribing delegate must issue the prescription via e-prescribing.
If an individual wants to look up whether a prescribing delegate has a waver they can do so as listed below:
For physician assistants: A PA’s waiver status will not be viewable on their TMB public profile. Each PA’s public profile has a link to their supervising physician’s profile page. The physician’s profile page will list the waiver status.
For nurse practitioners: APRN waivers are determined by the Texas Board of Nursing. Information on the waiver process for the APRNs is available on the Texas Board of Nursing Website.