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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 2008 - June - Full board Committee Meeting Minutes
Document: ... rd of the current confusing regulations regarding prescription delegation. The board directed staff not to address any changes to the statutes regarding prescription delegation.
Ms. Garanflo reviewed statutory requirements and board rules regarding education and licensure of international medical g ...
Description: Medical Board 2009 - August - Standing Orders Committee Meeting Minutes
Document: ... .6 - Delegation of the Carrying Out or Signing of Prescription Drug Orders to Physician Assistants and Advanced Practice Nurses, and 22 TAC 193.7 Delegated Drug Therapy Management. The Committee discussed the requirements of physicians related to delegated prescriptive authority. The Committee direc ...
Description: Medical Board 2009 - November - Full board Committee Meeting Minutes
Document: ... g to Delegation of the Carrying Out or Signing of Prescription Drug; and 193.7, relating to Delegated Drug Therapy Management. o. Chapter 194. Non-Certified Radiologic Technicians , with proposed amendments to 194.2, relating to Definitions; 194.3, relating to Registration; and 194.5, relating to No ...
Description: Medical Board 2010 - April - Licensure Committee Meeting Minutes
Document: ... w related to the applicants practice of medicine; prescription of medication inconsistent with public health and welfare; past disciplinary history with the Board; and submission of a false statement to the Board on application for licensure. Factors
contributing to this recommendation include tha ...
Description: Medical Board 2010 - August - Full board Committee Meeting Minutes
Document: ... 3.6, Delegation of the Carrying Out or Signing of Prescription Drug Orders to Physician Assistants and Advanced Practice Nurses .
No written comments were received. No one signed-in to present oral comments. After discussion, the agenda item was deferred to later in the meeting. After discussion, t ...
Description: Medical Board 2010 - August - Licensure Committee Meeting Minutes
Document: ... to the practice of medicine ; and writing a false prescription for a controlled substance or dangerous drug. Factors contributing to this recommendation include: complaints against applicant during residency training that related to applicants aggressive behavior and verbal harassment directed towar ...
Description: Medical Board 2010 - June - Standing Orders Committee - Agenda Item 6 - Prescriptive Delegation Waiver Requests
Document: ... taff to delegate the carrying out or signing of a prescription drug order at the facility in which the physician assistant or advanced practice nurse practices. o delegating physician may not delegate at more than one licensed hospital without approval of the board . Facility-Based Site Licensed L ...
Description: Medical Board 2010 - June - Standing Orders Committee - Agenda Item 6 - Site-Specific Prescriptive Delegation Statute & Rule
Document: ... an supervision of the carrying out and signing of prescription drug orders must conform to what a reasonable, prudent physician would find consistent with sound medical judgment but may vary with the education and experience of the particular APN or PA.
Delegating physician is available through dir ...
Description: Medical Board 2010 - June - Standing Orders Committee Meeting Minutes
Document: ... .6 Delegation of the Carrying Out
or Signing of Prescription Drug Orders to Physician Assistants and Advanced Practice Nurses. Dr. Willeford moved to recommend to the full board that the rule be approved for publication. Mr. Baucom seconded. All voted in favor and the motion passed.
There being n ...
Description: Medical Board 2010 - October - Licensure Committee Meeting Minutes
Document: ... commendation include the applicants conviction of prescription fraud in 2001 for which the applicant was sentenced to one year imprisonment and one year supervised release; applicants surrender of California medical license in 1997 in lieu of further investigation and subsequent cancellation of said ...
Description: Medical Board 2011 - August - Licensure Committee - Agenda Item 9: Modifications to Board Rules - 22 TAC 172 - Temporary and Limited Licenses
Document: ... Caution: federal law prohibits dispensing without prescription." (4) Episodic consultation--Consultation on an irregular or infrequent basis involving no more than 24 patients of a physician's diagnostic or therapeutic practice per calendar year. Multiple consultations may be performed for one or mo ...
Description: Medical Board 2011 - August - Licensure Committee - Agenda Item 9: Modifications to Board Rules - 22 TAC 192 - Office-Based Anesthesia Services
Document: ... Health and Safety Code. Dangerous drugs require a prescription, but are not included in the list of scheduled drugs. A dangerous drug bears the legend "Caution: federal law prohibits dispensing without a prescription" or "Prescription Only." (13) Level I services--delivery of analgesics or anxiolyti ...
Description: Medical Board 2011 - June - Full Board Committee Meeting Minutes
Document: ... s for cosmetic procedures that include the use of prescription medications. Ms. Leshikar reported receiving a number of questions regarding who can administer Botox. After discussion, the board set the matter pending for discussion later in the meeting. Agenda items #11 through 26 were deferred to l ...
Description: Medical Board 2011 - November - Licensure Committee Meeting Minutes
Document: ... law in connection with the practice of medicine; prescription of a dangerous drug and a controlled substance in a manner inconsistent with public health and welfare; and time out of the active practice of medicine. Factors contributing to this recommendation include: substance abuse history includi ...
Description: Medical Board 2012 - April - Standing Orders Committee Meeting Minutes
Document: ... 93.6 Delegation of the Carrying Out or Signing of Prescription Drug Orders to Physician Assistants and Advanced Practice Nurses
b.
22 TAC 193.13 Nonsurgical medical cosmetic procedures
Ms. Kaufman reviewed the proposed amendments to Board rules 193.6 and 193.13 and the comments that have been rec ...
“... 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.