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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: Press Release February 17, 2010 (PDF File)
Document: ... he lived and was romantically involved and on her prescription of controlled substances to the same individual, even though Dr. Dipprey knew or should have known this individual had a drug addiction, and on Dr. Dipprey's failure to maintain adequate medical records for these transactions. Miller, Je ...
Description: Press Release February 18, 2005 (PDF File)
Document: ... abuser who was found in possession of cocaine and prescription drugs. He was arrested for possession of cocaine on December 12, 2004. The length of a temporary suspension is indefinite and remains in effect until the board takes further ac tion.
The Texas State Board of Medical Examiners, the state ...
Description: Press Release February 18, 1998 (PDF File)
Document: ... a patient may request and receive a contact lens prescription and under which a physician shall provide such prescription, as mandated by the 75th Legislature through the Texas Contact Lens Prescription Act; Chapter 183, Acupuncture, repeal of current 183.17 and new sections 183.17 and 183.23, to i ...
Description: Press Release February 21, 2007 A (PDF File)
Document: ... r failing to abstain from alcohol and ingesting a prescription drug in violation of the terms and conditions of his probation. KILPATRICK, HAMILTON WRIGHT, M.D., UVALDE, TX, Lic. #C3109 On February 16, 2007, the Board and Dr. Kilpatrick entered into an Agreed Order accepting the voluntary surrender ...
Description: Press Release February 22, 2011 (PDF File)
Medical Board suspends license of doctor in Forney
Document: ... She saw all patients in her home, where she kept prescription pads unsecured and charged patients $20 per prescription given. The Temporary Suspension Hearing Without Notice took place under the Board's authority granted by the Medical Practice Act. The physician has the opportunity to have a Tempo ...
Description: Press Release March 09, 2011 (PDF File)
Document: ... rmometer found on the premises. Blank, pre-signed prescription pads were found in Dr. Stafford's office. The Temporary Suspension Hearing Without Notice took place under the Board's authority granted by the Medical Practice Act. The physician has the opportunity to have a Temporary Suspension Hearin ...
Description: Press Release April 07, 2004 (PDF File)
Document: ... ning Delegation of the Carrying Out or Signing of Prescription Drug Orders to Physician Assistants and Advanced Practice Nurses necessary for general cleanup of the section relating to controlled substances and triplicate prescriptions for obstetrical services.
Proposed Rule Changes
The Board propo ...
Description: Press Release April 07, 2005 (PDF File)
Document: ... ations that he diverted an associate's triplicate prescription pad to prescribe medications to himself and family members; he wrote false and fictitiou s prescriptions; and his hospital staff privileges were summarily suspended and that he presented a real danger to the health of his patients or to ...
Description: Press Release April 10, 2009 (PDF File)
Document: ... The action was based on Dr. Hamilton's writing a prescription for a co-worker in the name of someone he had never met or treated. Price, Clinton C., M.D., Lic. #L4657, Seguin TX On February 19, 2009, the board and Dr. Price entered into an Agreed Order requiring that within one year Dr. Price enrol ...
Description: Press Release April 13, 2005 (PDF File)
Document: ... ession of cocaine and the subsequent discovery of prescription drugs and syringes in his vehicle. The action was also based on findings by the Board that Dr. Sauceda is a known drug abuser who had been under two previous Board orders for substance abuse. SCALLY, MICHAEL CHARLES, M.D., HOUSTON, TX, L ...
Description: Press Release April 13, 2006 (PDF File)
Document: ... ependently established a diagnosis to support the prescription. Additionally, Dr. Delaney also accepted from one of her patients a supply of the same drug and dispensed it to the patient's mother without making a record or properly labeling the medication. DESHMUKH, AVI TRIMBAK, M.D., STEPHENVILLE, ...
Description: Press Release April 16, 2008 A (PDF File)
Document: ... 3.6, Delegation of the Carrying Out or Signing of Prescription Orders to Physician Assistants or Advance Practice Nurses , clarifies physician supervision at medically- underserved areas and alternate physician practice sites; §193.7, Delegated Drug Therapy Management , updates reference to the Texa ...
Description: Press Release April 18, 2007 A (PDF File)
Document: ... from administering, prescribing or delegating the prescription of intravenous Lidocaine or intravenous Colchicine or their generic counterparts; requiring that he complete additional continuing medical education in the areas of pain management and endocrinology; and assessing an administrative penal ...
Description: Press Release April 20, 2011 (PDF File)
Document: ... ilure to meet the standard of care; inappropriate prescription of dangerous drugs to oneself, family members or others in which there is a close personal relationship; failure to follow guidelines for the prescription of pain medications; becoming financially or personally involved with a patient in ...
Description: Press Release April 21, 2005 (PDF File)
Document: ... chronic neck and back pain. Her initial two-week prescription included 30 Xanax 2 mg., 90 Xenical 120, Estradiol 1 mg. with a one-year refill, 60 Hydrocodone/APAP 10/500, and 60 Soma 350. She was seen every two weeks through May 3, 2004, and progress notes included only symptoms. She was given 15 D ...
“... 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.