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RULE §130.59Opioid Prescription Limits and Required Electronic Prescribing

(a) In this section, "acute pain" means the normal, predicted, physiological response to a stimulus such as trauma, disease, and operative procedures. Acute pain is time limited and the term does not include:

  (1) chronic pain;

  (2) pain being treated as part of cancer care;

  (3) pain being treated as part of hospice or other end-of-life care; or

  (4) pain being treated as part of palliative care.

(b) For the treatment of acute pain, a podiatrist may not:

  (1) issue a prescription for an opioid in an amount that exceeds a 10-day supply; or

  (2) provide for a refill of an opioid.

(c) After January 1, 2021, all controlled substances must be prescribed electronically except:

  (1) in an emergency or in circumstances in which electronic prescribing is not available due to temporary technological or electronic failure, in a manner provided for by the Texas State Board of Pharmacy rules;

  (2) by a practitioner to be dispensed by a pharmacy located outside this state, in a manner provided for by the Texas State Board of Pharmacy rules;

  (3) when the prescriber and dispenser are in the same location or under the same license;

  (4) in circumstances in which necessary elements are not supported by the most recently implemented national data standard that facilitates electronic prescribing;

  (5) for a drug for which the United States Food and Drug Administration requires additional information in the prescription that is not possible with electronic prescribing;

  (6) for a non-patient-specific prescription pursuant to a standing order, approved protocol for drug therapy, collaborative drug management, or comprehensive medication management, in response to a public health emergency or in other circumstances in which the practitioner may issue a non-patient-specific prescription;

  (7) for a drug under a research protocol;

  (8) by a practitioner who has received a waiver under Section 481.0756 of the Texas Health and Safety Code from the requirement to use electronic prescribing, as provided by subsections (d) - (e); or

  (9) under circumstances in which the practitioner has the present ability to submit an electronic prescription but reasonably determines that it would be impractical for the patient to obtain the drugs prescribed under the electronic prescription in a timely manner and that a delay would adversely impact the patient's medical condition.

(d) To obtain a waiver of the requirement to use electronic prescribing, a practitioner must submit a waiver request on a form approved by the department. The waiver request form must document sufficient evidence of the circumstances justifying the waiver as outlined in subsection (e). A waiver granted by the department under this section shall expire one year after the date of approval. A practitioner may reapply for a subsequent waiver not earlier than the 30th day before the date the waiver expires if the circumstances that necessitated the waiver continue.

(e) A practitioner's waiver of electronic prescribing request form must contain sufficient evidence of one or more of the following that, in the judgment of the executive director, justify the issuance of a waiver:

  (1) economic hardship, including:

    (A) any special situational factors affecting either the cost of compliance or ability to comply;

    (B) the likely impact of compliance on profitability or viability; and

    (C) the availability of measures that would mitigate the economic impact of compliance;

  (2) technological limitations not reasonably within the control of the practitioner;

  (3) issuance of fifty or fewer prescriptions for controlled substances in the year immediately prior to the application for a waiver, as documented by the Texas Prescription Monitoring Program; or

  (4) other exceptional circumstances demonstrated by the practitioner.

(f) The department may revoke or refuse to issue a waiver under this section if the practitioner violates any provision of Texas Occupations Code, Chapters 51 or 202, this chapter, or any rule or order of the executive director or commission.

Source Note: The provisions of this §130.59 adopted to be effective July 1, 2020, 45 TexReg 4333; amended to be effective April 1, 2021, 46 TexReg 2006

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