Prescription Drug Prescribing Requirements | APN and PA Prescription Drug Authority
PRESCRIPTION DRUG PRESCRIBING REQUIREMENTS
Unlike sessions past, where physicians and allied health professionals frequently squared off, the 77th legislature involved few altercations on scope of practice issues.
Despite the peace, one bill did emerge late in the session that undermines physicians' long-standing relationship and trust with the Texas Pharmacy Association and large chain pharmacies.
SB 768 by Sen. Frank Madla (D-San Antonio) and Rep. Patricia Gray (D-Galveston) wound its way through the legislative session aiming only to update provisions of the Texas Pharmacy Act. However, two weeks prior to the end of the legislative session, an amendment instigated by the Texas Retailers Association, which represents large chain pharmacies and supported by the Texas Pharmacy Association, was added to the bill that:
- Repealed the legal requirement that a pharmacist dispense as directed by a physician;
- Repealed the current two-line prescription form and empowered the Texas State Board of Pharmacy to write rules relating to the "formatting and security" requirements for a new prescription form;
- Required all Texas prescription forms to conform with a federal Medicaid regulation requiring physicians and other prescribers to write, in their own handwriting, "brand necessary" or "brand medically necessary" (The Medicaid requirement is a payment standard that allows a pharmacist to be reimbursed a higher rate for a multi-source drug. The pharmacists argued that applying the same standard to all prescriptions would reduce medication costs for patients and health plans.); and
- Legalized pre-printed prescription forms.
TMA argued vigorously against the bill. The added requirement creates additional work with seemingly little value. TMA survey data indicates that the vast majority of physicians already routinely prescribe generics. When brand name medications are medically necessary, physicians will be forced to comply with the extra requirement. Additionally, it is unclear how the amendment will impact the use of electronic prescriptions. While the bill authors added language allowing the Board of Pharmacy to develop rules to minimize the impact on electronic prescriptions, the bill also states that the rules must comply with the federal Medicaid rules. Currently, Medicaid does not have a means to accept electronic prescriptions for brand necessary drugs because the federal rule specifically states that "brand necessary" must be written in the prescriber's own handwriting.
In conference committee, the legal requirement that a pharmacist dispense as directed by a physician was reinstated, but the other provisions were essentially left intact. The Texas State Board of Pharmacy is charged with implementing rules for the bill, including a new prescription pad. The pharmacy board must consult with the Texas State Board of Medical Examiners (TSBME) and other licensing boards, including nurses, dentists, and podiatrists, about the rules. TMA will actively engage in the rulemaking process to minimize the administrative impact on physicians. SB 768 becomes effective Sept. 1, 2001, although the rules implementing the changes outlined above will not be adopted until June 1, 2002.
APN and PA PRESCRIPTION DRUG AUTHORITY
SB 1166 by Senator Madla expands eligible sites where a physician can delegate prescriptive authority to an advanced practice nurse (APN) or physician assistant (PA), limited to three APNs or PAs, including a physician's primary practice site or alternate practice site
The bill authorizes TSBME to waive or modify any of the site or supervision requirements for a physician to delegate prescriptive authority and prohibits the board from waiving the limitation on the number of practice sites or number of practitioners with delegated prescriptive authority. The board is directed to appoint an advisory committee to review waiver requests. Finally, the bill requires the board to submit a report to the legislature of the number of waiver applications submitted and granted no later than Dec. 1, 2004.
TMA supported the bill, which was developed and endorsed by the association's Ad Hoc Committee on Collaborative Practice. The committee includes five practicing physicians, five advanced practice nurses, and five physician assistants.
SB 1166 became effective May 11, 2001.
Scope of Practice TMA Staff Contact
C.J. Francisco, JD, Senior Counsel, Office of the General Counsel, (512) 370-1339
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