Yes, if you are a physician or a physician assistant. 

Physicians are required to register all PAs and APRNs that they supervise prior to the delegates beginning to work for them.  If there is a change to the scope of the delegation, physicians must notify the Board within 30 days of this change.

PAs are likewise required to register their supervising physicians with the Board prior to beginning to practice under the employment or prescriptive authority agreement.  They are also required to notify the Board within 30 days of any change to the scope of the delegation. 

APRNs should look to guidance provided by the Texas Board of Nursing for how to register their delegating physicians, as the Medical Board does not have licensing authority for nurses.

To return to practice from retired status, a physician must submit an application online for re-activation/re-licensure and meet all of the current requirements for licensure. 

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.

The TMB cannot tell providers how to use the information they obtain through the PMP check.  Providers should follow the standard of care and utilize the information they gain to make educated and informed prescribing decisions.

Yes. For patients with the following documented conditions, a PMP check is not required: a documented cancer diagnosis, sickle cell disease, patients receiving care through a licensed hospice provider, or if  the prescriber makes and documents a good faith attempt to comply but is unable to access the PMP because of circumstances outside the control of the prescriber.

In addition, a PMP check is not required:

1. Before or during an inpatient stay, such as a hospital admission, or

2. During an outpatient encounter in settings such as an emergency department or ambulatory surgical center visit.

There is nothing that discusses how far ahead of time the PMP check can be undertaken, however the reason for the requirement is to ensure that prescribers have as much information as possible in order to make informed decisions about prescribing certain controlled substances.  If the PMP check is completed too far ahead of time, then there may be new information in the PMP that the prescriber is not considering.

The PMP is updated on a 24-hour basis and therefore contains information accurate up to 24 hours prior to completion of the check.

There are three different ways you can qualify for a waiver. If you or your practice is experiencing any of the following, you may qualify for a waiver:

1. By experiencing economic hardship. When evaluating whether you are experiencing economic hardship, consider:
   1. special situational factors which affect either the cost of compliance or your ability to comply;
   2. the likely impact of compliance on profitability or viability; and
   3. the availability of measures that would mitigate the economic impact of complying.

2. If your practice has technological limitations not reasonably within your control.   
3. Other exceptional circumstances that would lead to you or your practice being unable to set up an e-prescribing process.

On the waiver form, you will have to specify any of the above categories you are experiencing. 

If you are granted a waiver, it will be displayed on your public physician profile.  This alone will serve as proof of your waiver.  Generally, waiver requests are determined within 2-3 business days.  You are encouraged to check your profile daily upon submitting your waiver request. You may also choose to print a simple copy of the ‘Verified Information’ section of your profile, which includes your waiver status, by choosing the “Print Verification” option on your profile.

Currently, each individual physician who needs a waiver will have to apply for their own individual waiver. Although this may change in the future, TMB is currently unable to track waivers by group.      

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.

 If a physician has a waiver from e-prescribing, it is viewable on their public profile page, under the section entitled “Verified Information.”   If you want to verify that a PA or nurse practitioner has a waiver, you will have to look at the delegating physician’s public profile.  You can look up a prescriber’s public profile here: Look up a License

NOTE: Per the Texas State Board of Pharmacy, a “pharmacist is not responsible for ensuring there is a waiver. In addition, there is no requirement of the pharmacist to ensure an appropriate waiver is granted.”