Schedule II Prescriptive Authority

HB1948 (Howard)

Allows a physician to delegate the prescribing and ordering of a Schedule II medication to PAs and APRNs and will not impact the scope of practice for a PA.  This leaves the decision-making at the practice level between the PA and their delegating physician.

BACKGROUND

• Texas currently limits PAs to prescribing Schedule II medications to hospice and inpatient care settings. This limits their ability to effectively treat patients in outpatient settings. 
• These regulations create barriers to timely treatment and fail to prioritize patient care. 
• Upon hospital discharge, these medications can only be filled at inpatient pharmacies, limiting a patient's access to their preferred pharmacy. 
• PAs working in surgery, psychiatry, palliative care, and pain management are most affected by these restrictions (65.8% of the workforce per TX State profile).
• HB 2561, which became effective in 2017, mandates that all prescribers use the Prescription Monitoring Program (PMP) before prescribing controlled substances.
  •  The PMP, managed by the State Board of Pharmacy, tracks outpatient prescription data for Schedule II, III, IV, and V controlled substances dispensed by pharmacies.
  • This program ensures patient safety by providing a transparent and accountable process for prescribing scheduled medications. 
• In the past three legislative sessions, the House passed this bill, but it failed to advance in the Senate due to time constraints. 
  
• HB1948 does not and will not impact the scope of practice for a PA. This leaves the decision making at the practice level between the PA and their delegating physician. 

RATIONALE

When providing care for patients, the lack of full prescriptive authority in all clinical settings leads to unnecessary care delays and administrative burdens for clinical and operational care teams. 

PREVIOUS TEXAS BILLS INTRODUCED

• 88(R) - HB 1190
• 87(R) - HB 1524
• 86(R) - HB 2250; SB 1308
• 85(R) - HB 2548

STATES THAT ALLOW PAS TO PRESCRIBE SCHEDULE II MEDICATION

• 44 STATES ALLOW PAS TO PRESCRIBE SCHEDULE II MEDICATIONS 
• AL*, AK, AZ*, CA*, CO, CT, DE, DC, FL*, HI, ID, IL*, IN, IA, KS, LA, ME, MD, MA, MI, MN, MS, MT*, NE, NV, NH,  NJ*, NM*, NY, NC*, ND, OH*, OR, PA*, RI, SC*, SD*, TN, UT, VT, VA, WA, WI, WY

* Designates states with a formulary restriction on Schedule II Prescriptive Authority

SUPPORTED BY

• Texas Hospital Association
• University Health
• Methodist Healthcare Ministries of South Texas
• National Alliance for Mental Illness
• Opioid Treatment Coalition
• Texas Council of Community Centers
• Center for Health Care Services
• Texas Nurse Practitioners
• Texas Academy of Physician Assistants