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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: Medical Board 2018 - June - Full Board Minutes
Document: ... 0.5
Definitions
170.6 Opioid Antagonist Prescription Guidelines
170.7 Liability for Act or Omission with Respect to Prescribing an Opioid Antagonist
170.8 Documentation
B.
Chapter 172 Temporary and Limited License
172.19 Sports Team Physician Limited Licen ...
Description: TMB disciplines 34 physicians at October meeting, adopts rules changes
Document: ... duties
at the practice, allowed staff to access prescription medications with little or no supervision in an unsecured area,
allowed a registered nurse to dispense medications without orders or supervision, and admitted that he d
id not
personally evaluate patients before the patients were treat ...
Description: Medical Board 2018 - October - Full Board Minutes
Document: ... the MOU
, such as
self
-
referrals
.
c.
Prescription Dispensing Issues
-
Dr. Z
aafran
reported on
several
prescription dispensing
issues
, including the
consequences
of a pharmacist not filling a
prescription as prescribed
by
a
physician.
Dr. Zaafran reported that ther ...
Description: TMB disciplines 36 physicians at March meeting, adopts rule changes
Document: ... examination and
document justification for his prescription of
controlled substances, failed to refer the patient to a pain specialist and failed to maintain adequate medical records.
INADEQUATE MEDICAL RECORDS
Hussain, Syed K., M.D., Lic. No. M1157, Brownsville
On March 1, 2019, the B ...
Description: TMB disciplines 80 physicians at June meeting, adopts rule changes
Document: ... s medical records do not adequately reflect his prescription rationale, nor do they adequately
document the care and treatment provided to
the patients and did not keep protocols for his nurse delegates.
Long, John K., M.D., Lic. No. E4487, Houston
On June 14, 2019, the Board and John K. ...
Description: Legislative Update - 86th Legislature (2019)
Document: ... to a pregnant woman. 9/1/19
SB 683 (Buckingham)Prescription Monitoring Program (PMP) Contains a provision authorizingphysicians to request information on the prescribing activity of an individual to whom the practitioner has delegated prescribing authority. 9/1/19
SB 1264 (Hancock)Consumer Prot ...
Description: TMB disciplines 44 physicians at August meeting, adopts rule changes
Document: ... utory Durable Power of Attorney͘ Dr͘ :owell’s prescription pad was obtained by a
former patient who
used it to fraudulently write a prescription͕ and as a result͕ Dr͘ :owell’s Durable Power of Attorney
permanently surrendered Dr͘ Powell’s DEA registration on March 20͕ 2019͘
Vil ...
Description: TMB Initial Guidance on House Bill 2174
Document: ... acute
pain, a practitioner may not: (1) issue a prescription for an opioid in an amount that exceeds a
10
-
day supply; or (2) provide for a refill of an opioid.”
The Texas Medical Board interprets this section to mean a practitione
r may write an opioid
prescription for up to 10 days withou ...
Description: Respiratory Care Board Full Board Minutes (February 14, 2019)
Document: ... .
Currently, the requirement to
check
the
prescription monitoring program before
prescribing
certain drugs
, such as,
opioids,
benzodiazepines,
barbiturates or carisoprodol
,
will
be e
ffective September
1, 2019
.
Texas Board of Respiratory Care
February 14, 2019
Agend ...
Description: TMB Initial Guidance on New Opioid Continuing Medical Education (CME) Requirements
Document: ...
afe and effective pain management related to the prescription of opioids
and
other controlled substances, including education regarding:
i.
r
easonable standard of care;
ii.
t
he identification of drug
-
seeking behavior in patients; and
iii.
e
ffectively communicating with patients ...
Description: Medical Board 2020 - March - Licensure - Committee Minutes
Document: ... o prescribe c
ontrolled 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 and necessary fee sufficient to
cover the Board's re
sponsible portion for cost ...
Description: TMB Waiver for Chronic Pain Patients Granted by Governor Abbott
Document: ... waiver
allow
s
te
lephone refill(s) of a valid prescription for treatment of chronic pain by a
physician with an established chronic pain patient
.
Due to the seriousness of the opioid crisis
and the need to ensure there is proper oversight of chronic pain management,
this s
uspension
is onl ...
Description: TMB COVID-19 Telemedicine FAQs
Document: ... D
-
19 pandemic, the physician may issue a refill prescription to established
chronic
pain
patients
for
a
controlled substance prescription
utilizing telemedicine. For
such chroni
c pain treatment, the
provider must document
:
•
Whether the patient is being seen due to the COVID ...
Description: TMB Waiver for Chronic Pain Patients Extended by Governor Abbott
Document: ... ues to allow for
telephone refill(s) of a valid prescription for
treatment of chronic pain by a physician with an established chronic pain patient
.
The
physician(s) remains responsible
for meeting the standard of care and
all other
laws and rules
relat
ed to the practice o
f medicine.
...
Description: Waiver for Chronic Pain Patients Extended by Governor Abbott
Document: ... ues to allow for
telephone refill(s) of a valid prescription for
treatment of chronic pain by a physician with an established chronic pain patient
.
The
physician(s) remains responsible
for meeting the standard of care and
all other
laws and rules
relat
ed to the practice o
f medicine.
...
“... 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.