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RULE §222.4Minimum Standards for Prescribing or Ordering Drugs and Devices

(a) The APRN with full licensure and a valid prescription authorization number shall:

  (1) order or prescribe only those drugs or devices that are:

    (A) authorized by a prescriptive authority agreement or, if practicing in a facility-based practice, authorized by either a prescriptive authority agreement or protocols or other written authorization; and

    (B) ordered or prescribed for patient populations within the accepted scope of professional practice for the APRN's license; and

  (2) comply with the requirements for chart reviews specified in the prescriptive authority agreement and periodic face to face meetings set forth in the prescriptive authority agreement; or

  (3) comply with the requirements set forth in protocols or other written authorization if ordering or prescribing drugs or devices under facility-based protocols or other written authorization.

(b) Prescription Information. The format and essential elements of a prescription drug order shall comply with the requirements of the Texas State Board of Pharmacy. The following information must be provided on each prescription:

  (1) the patient's name and address;

  (2) the name, strength, and quantity of the drug to be dispensed;

  (3) directions to the patient regarding taking of the drug and the dosage;

  (4) the intended use of the drug, if appropriate;

  (5) the name, address, and telephone number of the physician with whom the APRN has a prescriptive authority agreement or facility-based protocols or other written authorization;

  (6) address and telephone number of the site at which the prescription drug order was issued;

  (7) the date of issuance;

  (8) the number of refills permitted;

  (9) the name, prescription authorization number, and original signature of the APRN who authorized the prescription drug order; and

  (10) the United States Drug Enforcement Administration numbers of the APRN and the delegating physician, if the prescription drug order is for a controlled substance.

(c) Waivers from Electronic Prescribing Requirements.

  (1) Beginning January 1, 2021, licensee prescribers must issue prescriptions for controlled substances electronically unless one of the circumstances specified in Tex. Health & Safety Code §481.0755(a) applies.

  (2) A licensee prescriber may request a waiver from the electronic prescribing requirements by submitting a waiver request to the Board that demonstrates the circumstances necessitating a waiver from the electronic prescribing requirements, including:

    (A) economic hardship, taking into account factors including:

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

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

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

    (B) technological limitations not reasonably within the control of the licensee prescriber; and

    (C) other exceptional circumstances demonstrated in the waiver request.

  (3) A waiver may be granted for a period of one year. If circumstances that necessitated the waiver continue beyond that time period, a licensee prescriber may re-apply to the Board for a subsequent waiver no earlier than the 30th day prior to the expiration of the original waiver.

(d) Generic Substitution. The APRN shall authorize or prevent generic substitution on a prescription in compliance with the current rules of the Texas State Board of Pharmacy relating to generic substitution.

(e) An APRN may order or prescribe medications for sexually transmitted diseases for partners of an established patient, if the APRN assesses the patient and determines that the patient may have been infected with a sexually transmitted disease. Nothing in this subsection shall be construed to require the APRN to issue prescriptions for partners of patients.

(f) APRNs may order or prescribe only those medications that are FDA approved unless done through protocol registration in a United States Institutional Review Board or Expanded Access authorized clinical trial. "Off label" use, or prescription of FDA-approved medications for uses other than that indicated by the FDA, is permitted when such practices are:

  (1) within the current standard of care for treatment of the disease or condition; and

  (2) supported by evidence-based research.

(g) The APRN with full licensure and a valid prescriptive authorization number shall cooperate with representatives of the Board and the Texas Medical Board during an inspection and audit relating to the operation and implementation of a prescriptive authority agreement.

Source Note: The provisions of this §222.4 adopted to be effective November 20, 2013, 38 TexReg 8212; amended to be effective February 16, 2021, 46 TexReg 1062

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