FAQs - FACILITY-BASED DELEGATED PRESCRIBING OF SCHEDULE II CONTROLLED SUBSTANCES
Where and when may a physician assistant (PA) or advanced practice registered nurse (APRN) prescribe a Schedule II Controlled Substance?
Properly authorized APRNs and PAs may issue prescriptions for Schedule II controlled substances to patients who are admitted to a hospital for an intended length of stay of at least 24 hours, or who are receiving services in the hospital’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, has elected to receive hospice care, and is receiving hospice treatment from a qualified hospice provider.
Outside of such a hospital facility-based practice or qualified hospice provider setting, a PA or APRN may not issue prescriptions for Schedule II controlled substances.
HOSPITAL FACILITY-BASED CARE
Section 157.0511(b-1)(1) of the Medical Practice Act relates to prescribing to patients while in a hospital facility-based practice under Section 157.054. This language allows a properly authorized PA or APRN, consistent with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital bylaws, to issue a Schedule II controlled substance prescription as long as the prescription is filled at the in-hospital pharmacy for a patient who is either admitted to the hospital for an intended length of stay of at least 24 hours or is receiving services in the emergency department of the hospital.
May a PA or an APRN prescribe Schedule II prescriptions to the patient as part of the hospital’s discharge process?
The law does not allow Schedule II prescriptions to be written by PAs or APRNs with the intent that the prescription be filled outside of the hospital facility-based practice setting. In order for such a prescription to be lawful, it must be filled at the hospital’s facility-based pharmacy. PAs and APRNs who issue Schedule II prescriptions upon discharge must educate patients regarding the requirement to have the prescription filled at the facility-based pharmacy in order to avoid disruption of care. If a Schedule II prescription is to be filled anywhere outside the hospital facility-based setting, the prescription must be completed by a licensed physician.
In accordance with Section 157.054(a-1) of the Medical Practice Act and Board Rule §193.2(6), a hospital facility-based practice setting does not include free standing clinics—including clinics located on hospital grounds, but not physically attached to the hospital’s main structure—community health centers, or other medical practices associated with or owned and operated by the hospital.
HOSPICE CARE
Section 157.0511(b-1)(2) of the Medical Practice Act allows for PAs and APRNs to write Schedule II controlled substance prescriptions as part of the plan of care for the treatment of a person who has executed a written certification of a terminal illness, has elected to receive hospice care, and is receiving hospice treatment from a qualified hospice provider. Under this section, Schedule II prescriptions written by a PA or APRN may not be for any other purpose than hospice care being provided to a patient.
For additional FAQs on prescriptive delegation, visit: http://www.tmb.state.tx.us/page/prescriptive-delegation