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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 December 16, 2004 (PDF File)
Document: ... egarding delegation of carrying out or signing of prescription drug orders to Physician Assistants and Advanced Nurse Practitioners. Proposed Rule Changes The Board proposed the following rule changes for publication in the Texas Register and comment:
Chapter 170, Authority of Physician to Prescri ...
Description: Press Release December 17, 2003 (PDF File)
Document: ... controlled substance by the use of a false/forged prescription. The physician may file a Motion for Rehearing within 20 days of the Order. If a Motion for Rehearing is filed and the Board denies the motion, the Order is final. If a Motion for Rehearing is filed and the Board grants the motion, the O ...
Description: Press Release December 18, 2008 A (PDF File)
Document: ... taff who did not make a correction to a called-in prescription upon request of a patient. In addition, twelve licensees agreed to enter into administrative orders with the board for minimal statutory violations.
CEASE AND DESIST ORDER
Baughman, Liz, Austin, TX On December 12, 2008, the Board and Ms ...
Description: DISCIPLINE & ETHICS REVIEW & DECISIONS Texas Physician Health Program (Probationer/Licensee Violated PHP Agreement & Cases of Concern) December 14, 2012
Document: ... ugh syrup that she took and ensured a copy of the prescription would be provided to TXPHP. On 11/26/2012, a copy of a prescription for Phenergan with Codeine cough syrup, dated 10/15/2012, was provided to TXPHP. More importantly, the prescription was written by the participants Physician Assistant, ...
Description: PA Board 2004 July, Full Board
Document: ... e number of optimal sites for classifications for prescription delegation be reduced to facility based and non-facility based sites? d.) Should Physician Assistants under restriction in another state be eligible for Physician Assistant licensure in Texas? e.) Should the length of the temporary licen ...
Description: PA Board 2005 November, Full Board
Document: ... 93.6 Delegation of the Carrying Out or Signing of Prescription Drug Orders to Physician Assistants and Advanced Practice Nurses. Agenda item #4, Report of the Physician Assistant Workgroup meeting and presentation and discussion of draft rules. Ms. Shackelford stated that the purpose of the Physicia ...
Description: Medical Board 2006 April Dprc
Document: ... tanding Delegation Orders, to include new 193.13, Prescription Medical Devices. Staff was directed to make changes as discussed in the draft rule and discuss it in the Standing Orders Committee, to form a research group, and distribute the draft to that group for discussion. Report of the research g ...
Description: Acupuncture 2002 November, Educ Min
Document: ... eletal disorders - Physical examination, exercise prescription, and TCM treatment - 2 CAEs General bb) Modern scientific interpretation of acupuncture therapy - 2 CAEs General cc) Computerized Pulse and Tongue Examinations - 2 CAEs General dd) TCM supportive therapy for Chemotherapy and Radiotherapy ...
Description: TMB restricts Houston physician (Klein)
Document: ... sing controlled
substances in Texas other than a prescription written to him by a licensed provider for personal
use. Within seven days,
Dr. Klein shall surrender his Drug Enforcement Administration (DEA)
controlled substances registration certificates and not reregister or otherwise obtain reg ...
Description: TMB restricts Conroe physician (Lipscomb)
Document: ... sing controlled
substances in Texas other than a prescription written to him by a licensed provider for personal
use. Within sev
en days, Dr. Lipscomb shall surrender his Drug Enforcement Administration
(DEA) controlled substances registration certificates and not reregister or otherwise obtain
...
Description: Medical Board 2006 - June - Standing Orders Committee Meeting Minutes June 1, 2006
Document: ... A. Repeal of 193.11, Use of Lasers and new 193.11 Prescription Medical De vices.
Following discussion of the draft of 193.11 Prescription Medical Devices, Dr. Garza moved, Dr. Miller seconded, to direct staff to make changes in the draft as discussed and to proceed with review of the draft rules wi ...
Description: Medical Board 2007 - August - Full Board Committee Meeting Minutes
Document: ... 181.2 Definitions; 181.3 Release of Contact Lens Prescription; and 181.6 Physicians Prescriptions: Delegation, relating to establishing that the verification of a contact lens prescription may substitute for an original signature to create a valid contact lens prescription. No one signed up to pres ...
Description: Medical Board 2008 - April - Licensure Committee Action Item Agenda Item 2a Applicant #623 Licensure Committee Proposed Public Non-Disciplinary Rehabilitation Order Upon Applicants Submission of a Physician in Training Permit Application April 10, 2008 ...
Document: ... 03 placements on deferred adjudication for felony prescription fraud; and the applicants time away from the active practice of medicine.
Further, Mr. Turner recommended to the full Board that upon receipt, within one calendar year, of a request for a physician-in-training permit of no less than one ...
Description: Medical Board 2008 - April - Licensure Committee Meeting Minutes
Document: ... 03 placements on deferred adjudication for felony prescription fraud; and the applicants time away from the active practice of medicine. Further, Mr. Turner moved to recommend to the full Board that upon receipt, within one calendar year, of a request for a physician-in-training permit of no less th ...
Description: Medical Board 2008 - June - Executive Committee Meeting Minutes
Document: ... DEA and DPS regarding pill mills and oversight of prescription activities. Ms. Robinson reported that the legislature directed staff to facilitate a workgroup for Pain Treatment Review as required by SB1879. There being no further items the meeting was adjourned at 9:07 a.m.
...
“... 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.