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Controlled Substance Prescribing

27 Mar 2014 7:48 AM | monique Ochoa (Administrator)

In recent months, some PAs in Texas have met resistance with their patients getting CIII-V prescriptions filled.  This issue has been on TAPA’s radar since the beginning, and we have been working toward a resolution.  Some of you may not have noticed any change in the way your scripts were being managed, but for those of you who have had scripts mishandled, there is now a clarification on the matter.

First, for historical background, the original legislation that allowed for controlled substance prescribing to be delegated was passed in 1995.  Its intent was to allow for no more than a 90-day equivalent of the med, whether it be 30 days with 2 refills, or 90 days in one fill.  

With rising concerns about controlled substance diversion, pill mills, and regulation of these prescriptions, pharmacies across the country have taken a harder look at policies regarding these scripts.  In Texas, the Pharmacy Board arrived at a different interpretation of the long-standing legislation.  Some pharmacists, mostly from larger chains, began to interpret the law as meaning something different than originally intended.  

TAPA asked the TMB to offer clarification to the Pharmacy Board as to the original intent of the legislation.  As a result, the Texas Pharmacy Board has issued an update on their website.  Please see below:

Information on Controlled Substance Prescriptions from Advanced Practice Registered Nurses and Physician Assistants

At their December meeting, the Texas Medical Board reviewed Section 157.0511 (b)(2) [see below] of the Medical Practices Act and determined to interpret this portion of their Act to mean that, if delegated by the physician, an APRN or PA may issue prescriptions for a total of 90-days’ supply of a controlled substance including refills.  The intent of the section is to allow 90-days’ supply and not to limit the patient to one refill. This means the APRN or PA could issue a prescription with more than one refill provided the total quantity does not exceed more than a 90-day supply. Further discussions with staff of the Medical Board have also resulted in the interpretation that essentially a controlled substance prescription issued by an APRN or PA, expires 90-days after issuance.

Sec. 157.0511.  PRESCRIPTION DRUG ORDERS. 

(a)  A physician's authority to delegate the carrying out or signing 

     of a prescription drug order under this subchapter is limited to: 

          (1)  dangerous drugs;  and

          (2)  controlled substances to the extent provided by             

                Subsection (b).

(b)  A physician may delegate the carrying out or signing of a prescription drug order for a controlled substance only if:

         (1)  the prescription is for a controlled substance listed in Schedule III, IV, or V as established by the commissioner of public health under Chapter 481, Health and Safety Code;

          (2)  the prescription, including a refill of the prescription, is for a period not to exceed 90 days;

          (3)  with regard to the refill of a prescription, the refill is authorized after consultation with the delegating physician and the consultation is noted in the patient's chart; and

          (4)  with regard to a prescription for a child less than two years of age, the prescription is made after consultation with the delegating physician and the consultation is noted in the patient's chart.

When encountering any future road blocks with controlled substance prescribing, having this link (www.tsbp.state.tx.us) available will be vital in communicating with pharmacists.  If you continue to meet resistance, please let TAPA know.  It is imperative that we be able to practice at the fullest extent of our license, and that our patients have access to the care they need in a timely fashion without delay.  Advocacy works, PAs in Texas do have a voice.  Please share this info with your fellow PAs. 

Karrie Lynn Crosby, MPAS, PA-C

TAPA President 2013-2014

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