Bill Amendment: FL H0831 | 2019 | Regular Session
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: Electronic Prescribing
Status: 2019-06-18 - Chapter No. 2019-112 [H0831 Detail]
Download: Florida-2019-H0831-Senate_Floor_Amendment_Delete_All_161690.html
Bill Title: Electronic Prescribing
Status: 2019-06-18 - Chapter No. 2019-112 [H0831 Detail]
Download: Florida-2019-H0831-Senate_Floor_Amendment_Delete_All_161690.html
Florida Senate - 2019 SENATOR AMENDMENT Bill No. CS for HB 831 Ì161690*Î161690 LEGISLATIVE ACTION Senate . House . . . Floor: 1/AD/3R . 05/01/2019 02:31 PM . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— Senator Bean moved the following: 1 Senate Amendment (with title amendment) 2 3 Delete everything after the enacting clause 4 and insert: 5 Section 1. Section 456.42, Florida Statutes, is amended to 6 read: 7 456.42 Written prescriptions for medicinal drugs.— 8 (1) A written prescription for a medicinal drug issued by a 9 health care practitioner licensed by law to prescribe such drug 10 must be legibly printed or typed so as to be capable of being 11 understood by the pharmacist filling the prescription; must 12 contain the name of the prescribing practitioner, the name and 13 strength of the drug prescribed, the quantity of the drug 14 prescribed, and the directions for use of the drug; must be 15 dated; and must be signed by the prescribing practitioner on the 16 day when issued. However, a prescription that is electronically 17 generated and transmitted must contain the name of the 18 prescribing practitioner, the name and strength of the drug 19 prescribed, the quantity of the drug prescribed in numerical 20 format, and the directions for use of the drug and must contain 21 the date and an electronic signature, as defined in s. 22 668.003(4),be dated and signedby the prescribing practitioner 23 only on the day issued, which signature may be in an electronic24format as defined in s. 668.003(4). 25 (2) A written prescription for a controlled substance 26 listed in chapter 893 must have the quantity of the drug 27 prescribed in both textual and numerical formats, must be dated 28 in numerical, month/day/year format, or with the abbreviated 29 month written out, or the month written out in whole, and must 30 be either written on a standardized counterfeit-proof 31 prescription pad produced by a vendor approved by the department 32 or electronically prescribed as that term is used in s. 33 408.0611. As a condition of being an approved vendor, a 34 prescription pad vendor must submit a monthly report to the 35 department that, at a minimum, documents the number of 36 prescription pads sold and identifies the purchasers. The 37 department may, by rule, require the reporting of additional 38 information. 39 (3) A health care practitioner licensed by law to prescribe 40 a medicinal drug who maintains a system of electronic health 41 records as defined in s. 408.051(2)(a), or who prescribes 42 medicinal drugs as an owner, an employee, or a contractor of a 43 licensed health care facility or practice that maintains such a 44 system and who is prescribing in his or her capacity as such an 45 owner, an employee, or a contractor, may only electronically 46 transmit prescriptions for such drugs. This requirement applies 47 to such a health care practitioner upon renewal of the health 48 care practitioner’s license or by July 1, 2021, whichever is 49 earlier, but does not apply if: 50 (a) The practitioner and the dispenser are the same entity; 51 (b) The prescription cannot be transmitted electronically 52 under the most recently implemented version of the National 53 Council for Prescription Drug Programs SCRIPT Standard; 54 (c) The practitioner has been issued a waiver by the 55 department, not to exceed 1 year in duration, from the 56 requirement to use electronic prescribing due to demonstrated 57 economic hardship, technological limitations that are not 58 reasonably within the control of the practitioner, or another 59 exceptional circumstance demonstrated by the practitioner; 60 (d) The practitioner reasonably determines that it would be 61 impractical for the patient in question to obtain a medicinal 62 drug prescribed by electronic prescription in a timely manner 63 and such delay would adversely impact the patient’s medical 64 condition; 65 (e) The practitioner is prescribing a drug under a research 66 protocol; 67 (f) The prescription is for a drug for which the federal 68 Food and Drug Administration requires the prescription to 69 contain elements that may not be included in electronic 70 prescribing; or 71 (g) The prescription is issued to an individual receiving 72 hospice care or who is a resident of a nursing home facility. 73 (h) The practitioner determines that it is in the best 74 interest of the patient, or the patient determines that it is in 75 his or her own best interest, to compare prescription drug 76 prices among area pharmacies. The practitioner must document 77 such determination in the patient’s medical record. 78 79 The department, in consultation with the Board of Medicine, the 80 Board of Osteopathic Medicine, the Board of Podiatric Medicine, 81 the Board of Dentistry, the Board of Nursing, and the Board of 82 Optometry, may adopt rules to implement this subsection. 83 Section 2. Section 456.43, Florida Statutes, is amended to 84 read: 85 456.43 Electronic prescribing for medicinal drugs.— 86 (1) Electronic prescribing mayshallnot interfere with a 87 patient’s freedom to choose a pharmacy. 88 (2) Electronic prescribing software mayshallnot use any 89 means or permit any other person to use any means to influence 90 or attempt to influence, through economic incentives or 91 otherwise, the prescribing decision of a prescribing 92 practitioner or his or her agent at the point of care, 93 including, but not limited to, means such as advertising, 94 instant messaging,andpop-up ads, and similar meansto95influence or attempt to influence, through economic incentives96or otherwise, the prescribing decision of a prescribing97practitioner at the point of care. Such means shall not be98 triggered by or in specific response to the input, selection, or 99 act of a prescribing practitioner or his or her agent in 100 prescribing a certain medicinal drugpharmaceuticalor directing 101 a patient to a certain pharmacy. For purposes of this 102 subsection, the term: 103 (a)The term“Prescribing decision” means a prescribing 104 practitioner’s or his or her agent’s decision to prescribe any 105 medicinal druga certain pharmaceutical. 106 (b)The term“Point of care” means the time at whichthata 107 prescribing practitioner or his or her agent prescribes any 108 medicinal drugis in the act of prescribing a certain109pharmaceutical. 110 (3) Electronic prescribing software may displayshow111 information regarding a payor’s formulary ifas long asnothing 112 is designed to preclude or make more difficult the selection of 113the act of a prescribing practitioner or patient selectingany 114 particular pharmacy by a patient or the selection of a certain 115 medicinal drug by a prescribing practitioner or his or her agent 116pharmaceutical. 117 Section 3. Paragraph (a) of subsection (5) of section 118 409.912, Florida Statutes, is amended to read: 119 409.912 Cost-effective purchasing of health care.—The 120 agency shall purchase goods and services for Medicaid recipients 121 in the most cost-effective manner consistent with the delivery 122 of quality medical care. To ensure that medical services are 123 effectively utilized, the agency may, in any case, require a 124 confirmation or second physician’s opinion of the correct 125 diagnosis for purposes of authorizing future services under the 126 Medicaid program. This section does not restrict access to 127 emergency services or poststabilization care services as defined 128 in 42 C.F.R. s. 438.114. Such confirmation or second opinion 129 shall be rendered in a manner approved by the agency. The agency 130 shall maximize the use of prepaid per capita and prepaid 131 aggregate fixed-sum basis services when appropriate and other 132 alternative service delivery and reimbursement methodologies, 133 including competitive bidding pursuant to s. 287.057, designed 134 to facilitate the cost-effective purchase of a case-managed 135 continuum of care. The agency shall also require providers to 136 minimize the exposure of recipients to the need for acute 137 inpatient, custodial, and other institutional care and the 138 inappropriate or unnecessary use of high-cost services. The 139 agency shall contract with a vendor to monitor and evaluate the 140 clinical practice patterns of providers in order to identify 141 trends that are outside the normal practice patterns of a 142 provider’s professional peers or the national guidelines of a 143 provider’s professional association. The vendor must be able to 144 provide information and counseling to a provider whose practice 145 patterns are outside the norms, in consultation with the agency, 146 to improve patient care and reduce inappropriate utilization. 147 The agency may mandate prior authorization, drug therapy 148 management, or disease management participation for certain 149 populations of Medicaid beneficiaries, certain drug classes, or 150 particular drugs to prevent fraud, abuse, overuse, and possible 151 dangerous drug interactions. The Pharmaceutical and Therapeutics 152 Committee shall make recommendations to the agency on drugs for 153 which prior authorization is required. The agency shall inform 154 the Pharmaceutical and Therapeutics Committee of its decisions 155 regarding drugs subject to prior authorization. The agency is 156 authorized to limit the entities it contracts with or enrolls as 157 Medicaid providers by developing a provider network through 158 provider credentialing. The agency may competitively bid single 159 source-provider contracts if procurement of goods or services 160 results in demonstrated cost savings to the state without 161 limiting access to care. The agency may limit its network based 162 on the assessment of beneficiary access to care, provider 163 availability, provider quality standards, time and distance 164 standards for access to care, the cultural competence of the 165 provider network, demographic characteristics of Medicaid 166 beneficiaries, practice and provider-to-beneficiary standards, 167 appointment wait times, beneficiary use of services, provider 168 turnover, provider profiling, provider licensure history, 169 previous program integrity investigations and findings, peer 170 review, provider Medicaid policy and billing compliance records, 171 clinical and medical record audits, and other factors. Providers 172 are not entitled to enrollment in the Medicaid provider network. 173 The agency shall determine instances in which allowing Medicaid 174 beneficiaries to purchase durable medical equipment and other 175 goods is less expensive to the Medicaid program than long-term 176 rental of the equipment or goods. The agency may establish rules 177 to facilitate purchases in lieu of long-term rentals in order to 178 protect against fraud and abuse in the Medicaid program as 179 defined in s. 409.913. The agency may seek federal waivers 180 necessary to administer these policies. 181 (5)(a) The agency shall implement a Medicaid prescribed 182 drug spending-control program that includes the following 183 components: 184 1. A Medicaid preferred drug list, which shall be a listing 185 of cost-effective therapeutic options recommended by the 186 Medicaid Pharmacy and Therapeutics Committee established 187 pursuant to s. 409.91195 and adopted by the agency for each 188 therapeutic class on the preferred drug list. At the discretion 189 of the committee, and when feasible, the preferred drug list 190 should include at least two products in a therapeutic class. The 191 agency may post the preferred drug list and updates to the list 192 on an Internet website without following the rulemaking 193 procedures of chapter 120. Antiretroviral agents are excluded 194 from the preferred drug list. The agency shall also limit the 195 amount of a prescribed drug dispensed to no more than a 34-day 196 supply unless the drug products’ smallest marketed package is 197 greater than a 34-day supply, or the drug is determined by the 198 agency to be a maintenance drug in which case a 100-day maximum 199 supply may be authorized. The agency may seek any federal 200 waivers necessary to implement these cost-control programs and 201 to continue participation in the federal Medicaid rebate 202 program, or alternatively to negotiate state-only manufacturer 203 rebates. The agency may adopt rules to administer this 204 subparagraph. The agency shall continue to provide unlimited 205 contraceptive drugs and items. The agency must establish 206 procedures to ensure that: 207 a. There is a response to a request for prior consultation 208 by telephone or other telecommunication device within 24 hours 209 after receipt of a request for prior consultation; and 210 b. A 72-hour supply of the drug prescribed is provided in 211 an emergency or when the agency does not provide a response 212 within 24 hours as required by sub-subparagraph a. 213 2. Reimbursement to pharmacies for Medicaid prescribed 214 drugs shall be set at the lowest of: the average wholesale price 215 (AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC) 216 plus 1.5 percent, the federal upper limit (FUL), the state 217 maximum allowable cost (SMAC), or the usual and customary (UAC) 218 charge billed by the provider. 219 3. The agency shall develop and implement a process for 220 managing the drug therapies of Medicaid recipients who are using 221 significant numbers of prescribed drugs each month. The 222 management process may include, but is not limited to, 223 comprehensive, physician-directed medical-record reviews, claims 224 analyses, and case evaluations to determine the medical 225 necessity and appropriateness of a patient’s treatment plan and 226 drug therapies. The agency may contract with a private 227 organization to provide drug-program-management services. The 228 Medicaid drug benefit management program shall include 229 initiatives to manage drug therapies for HIV/AIDS patients, 230 patients using 20 or more unique prescriptions in a 180-day 231 period, and the top 1,000 patients in annual spending. The 232 agency shall enroll any Medicaid recipient in the drug benefit 233 management program if he or she meets the specifications of this 234 provision and is not enrolled in a Medicaid health maintenance 235 organization. 236 4. The agency may limit the size of its pharmacy network 237 based on need, competitive bidding, price negotiations, 238 credentialing, or similar criteria. The agency shall give 239 special consideration to rural areas in determining the size and 240 location of pharmacies included in the Medicaid pharmacy 241 network. A pharmacy credentialing process may include criteria 242 such as a pharmacy’s full-service status, location, size, 243 patient educational programs, patient consultation, disease 244 management services, and other characteristics. The agency may 245 impose a moratorium on Medicaid pharmacy enrollment if it is 246 determined that it has a sufficient number of Medicaid 247 participating providers. The agency must allow dispensing 248 practitioners to participate as a part of the Medicaid pharmacy 249 network regardless of the practitioner’s proximity to any other 250 entity that is dispensing prescription drugs under the Medicaid 251 program. A dispensing practitioner must meet all credentialing 252 requirements applicable to his or her practice, as determined by 253 the agency. 254 5. The agency shall develop and implement a program that 255 requires Medicaid practitioners who issue written prescriptions 256 for medicinalprescribedrugs to use a counterfeit-proof 257 prescription pad for Medicaid prescriptions. The agency shall 258 require the use of standardized counterfeit-proof prescription 259 pads byMedicaid-participating prescribers orprescribers who 260 issue writtenwriteprescriptions for Medicaid recipients. The 261 agency may implement the program in targeted geographic areas or 262 statewide. 263 6. The agency may enter into arrangements that require 264 manufacturers of generic drugs prescribed to Medicaid recipients 265 to provide rebates of at least 15.1 percent of the average 266 manufacturer price for the manufacturer’s generic products. 267 These arrangements shall require that if a generic-drug 268 manufacturer pays federal rebates for Medicaid-reimbursed drugs 269 at a level below 15.1 percent, the manufacturer must provide a 270 supplemental rebate to the state in an amount necessary to 271 achieve a 15.1-percent rebate level. 272 7. The agency may establish a preferred drug list as 273 described in this subsection, and, pursuant to the establishment 274 of such preferred drug list, negotiate supplemental rebates from 275 manufacturers that are in addition to those required by Title 276 XIX of the Social Security Act and at no less than 14 percent of 277 the average manufacturer price as defined in 42 U.S.C. s. 1936 278 on the last day of a quarter unless the federal or supplemental 279 rebate, or both, equals or exceeds 29 percent. There is no upper 280 limit on the supplemental rebates the agency may negotiate. The 281 agency may determine that specific products, brand-name or 282 generic, are competitive at lower rebate percentages. Agreement 283 to pay the minimum supplemental rebate percentage guarantees a 284 manufacturer that the Medicaid Pharmaceutical and Therapeutics 285 Committee will consider a product for inclusion on the preferred 286 drug list. However, a pharmaceutical manufacturer is not 287 guaranteed placement on the preferred drug list by simply paying 288 the minimum supplemental rebate. Agency decisions will be made 289 on the clinical efficacy of a drug and recommendations of the 290 Medicaid Pharmaceutical and Therapeutics Committee, as well as 291 the price of competing products minus federal and state rebates. 292 The agency may contract with an outside agency or contractor to 293 conduct negotiations for supplemental rebates. For the purposes 294 of this section, the term “supplemental rebates” means cash 295 rebates. Value-added programs as a substitution for supplemental 296 rebates are prohibited. The agency may seek any federal waivers 297 to implement this initiative. 298 8. The agency shall expand home delivery of pharmacy 299 products. The agency may amend the state plan and issue a 300 procurement, as necessary, in order to implement this program. 301 The procurements must include agreements with a pharmacy or 302 pharmacies located in the state to provide mail order delivery 303 services at no cost to the recipients who elect to receive home 304 delivery of pharmacy products. The procurement must focus on 305 serving recipients with chronic diseases for which pharmacy 306 expenditures represent a significant portion of Medicaid 307 pharmacy expenditures or which impact a significant portion of 308 the Medicaid population. The agency may seek and implement any 309 federal waivers necessary to implement this subparagraph. 310 9. The agency shall limit to one dose per month any drug 311 prescribed to treat erectile dysfunction. 312 10.a. The agency may implement a Medicaid behavioral drug 313 management system. The agency may contract with a vendor that 314 has experience in operating behavioral drug management systems 315 to implement this program. The agency may seek federal waivers 316 to implement this program. 317 b. The agency, in conjunction with the Department of 318 Children and Families, may implement the Medicaid behavioral 319 drug management system that is designed to improve the quality 320 of care and behavioral health prescribing practices based on 321 best practice guidelines, improve patient adherence to 322 medication plans, reduce clinical risk, and lower prescribed 323 drug costs and the rate of inappropriate spending on Medicaid 324 behavioral drugs. The program may include the following 325 elements: 326 (I) Provide for the development and adoption of best 327 practice guidelines for behavioral health-related drugs such as 328 antipsychotics, antidepressants, and medications for treating 329 bipolar disorders and other behavioral conditions; translate 330 them into practice; review behavioral health prescribers and 331 compare their prescribing patterns to a number of indicators 332 that are based on national standards; and determine deviations 333 from best practice guidelines. 334 (II) Implement processes for providing feedback to and 335 educating prescribers using best practice educational materials 336 and peer-to-peer consultation. 337 (III) Assess Medicaid beneficiaries who are outliers in 338 their use of behavioral health drugs with regard to the numbers 339 and types of drugs taken, drug dosages, combination drug 340 therapies, and other indicators of improper use of behavioral 341 health drugs. 342 (IV) Alert prescribers to patients who fail to refill 343 prescriptions in a timely fashion, are prescribed multiple same 344 class behavioral health drugs, and may have other potential 345 medication problems. 346 (V) Track spending trends for behavioral health drugs and 347 deviation from best practice guidelines. 348 (VI) Use educational and technological approaches to 349 promote best practices, educate consumers, and train prescribers 350 in the use of practice guidelines. 351 (VII) Disseminate electronic and published materials. 352 (VIII) Hold statewide and regional conferences. 353 (IX) Implement a disease management program with a model 354 quality-based medication component for severely mentally ill 355 individuals and emotionally disturbed children who are high 356 users of care. 357 11. The agency shall implement a Medicaid prescription drug 358 management system. 359 a. The agency may contract with a vendor that has 360 experience in operating prescription drug management systems in 361 order to implement this system. Any management system that is 362 implemented in accordance with this subparagraph must rely on 363 cooperation between physicians and pharmacists to determine 364 appropriate practice patterns and clinical guidelines to improve 365 the prescribing, dispensing, and use of drugs in the Medicaid 366 program. The agency may seek federal waivers to implement this 367 program. 368 b. The drug management system must be designed to improve 369 the quality of care and prescribing practices based on best 370 practice guidelines, improve patient adherence to medication 371 plans, reduce clinical risk, and lower prescribed drug costs and 372 the rate of inappropriate spending on Medicaid prescription 373 drugs. The program must: 374 (I) Provide for the adoption of best practice guidelines 375 for the prescribing and use of drugs in the Medicaid program, 376 including translating best practice guidelines into practice; 377 reviewing prescriber patterns and comparing them to indicators 378 that are based on national standards and practice patterns of 379 clinical peers in their community, statewide, and nationally; 380 and determine deviations from best practice guidelines. 381 (II) Implement processes for providing feedback to and 382 educating prescribers using best practice educational materials 383 and peer-to-peer consultation. 384 (III) Assess Medicaid recipients who are outliers in their 385 use of a single or multiple prescription drugs with regard to 386 the numbers and types of drugs taken, drug dosages, combination 387 drug therapies, and other indicators of improper use of 388 prescription drugs. 389 (IV) Alert prescribers to recipients who fail to refill 390 prescriptions in a timely fashion, are prescribed multiple drugs 391 that may be redundant or contraindicated, or may have other 392 potential medication problems. 393 12. The agency may contract for drug rebate administration, 394 including, but not limited to, calculating rebate amounts, 395 invoicing manufacturers, negotiating disputes with 396 manufacturers, and maintaining a database of rebate collections. 397 13. The agency may specify the preferred daily dosing form 398 or strength for the purpose of promoting best practices with 399 regard to the prescribing of certain drugs as specified in the 400 General Appropriations Act and ensuring cost-effective 401 prescribing practices. 402 14. The agency may require prior authorization for 403 Medicaid-covered prescribed drugs. The agency may prior 404 authorize the use of a product: 405 a. For an indication not approved in labeling; 406 b. To comply with certain clinical guidelines; or 407 c. If the product has the potential for overuse, misuse, or 408 abuse. 409 410 The agency may require the prescribing professional to provide 411 information about the rationale and supporting medical evidence 412 for the use of a drug. The agency shall post prior 413 authorization, step-edit criteria and protocol, and updates to 414 the list of drugs that are subject to prior authorization on the 415 agency’s Internet website within 21 days after the prior 416 authorization and step-edit criteria and protocol and updates 417 are approved by the agency. For purposes of this subparagraph, 418 the term “step-edit” means an automatic electronic review of 419 certain medications subject to prior authorization. 420 15. The agency, in conjunction with the Pharmaceutical and 421 Therapeutics Committee, may require age-related prior 422 authorizations for certain prescribed drugs. The agency may 423 preauthorize the use of a drug for a recipient who may not meet 424 the age requirement or may exceed the length of therapy for use 425 of this product as recommended by the manufacturer and approved 426 by the Food and Drug Administration. Prior authorization may 427 require the prescribing professional to provide information 428 about the rationale and supporting medical evidence for the use 429 of a drug. 430 16. The agency shall implement a step-therapy prior 431 authorization approval process for medications excluded from the 432 preferred drug list. Medications listed on the preferred drug 433 list must be used within the previous 12 months before the 434 alternative medications that are not listed. The step-therapy 435 prior authorization may require the prescriber to use the 436 medications of a similar drug class or for a similar medical 437 indication unless contraindicated in the Food and Drug 438 Administration labeling. The trial period between the specified 439 steps may vary according to the medical indication. The step 440 therapy approval process shall be developed in accordance with 441 the committee as stated in s. 409.91195(7) and (8). A drug 442 product may be approved without meeting the step-therapy prior 443 authorization criteria if the prescribing physician provides the 444 agency with additional written medical or clinical documentation 445 that the product is medically necessary because: 446 a. There is not a drug on the preferred drug list to treat 447 the disease or medical condition which is an acceptable clinical 448 alternative; 449 b. The alternatives have been ineffective in the treatment 450 of the beneficiary’s disease; or 451 c. Based on historic evidence and known characteristics of 452 the patient and the drug, the drug is likely to be ineffective, 453 or the number of doses have been ineffective. 454 455 The agency shall work with the physician to determine the best 456 alternative for the patient. The agency may adopt rules waiving 457 the requirements for written clinical documentation for specific 458 drugs in limited clinical situations. 459 17. The agency shall implement a return and reuse program 460 for drugs dispensed by pharmacies to institutional recipients, 461 which includes payment of a $5 restocking fee for the 462 implementation and operation of the program. The return and 463 reuse program shall be implemented electronically and in a 464 manner that promotes efficiency. The program must permit a 465 pharmacy to exclude drugs from the program if it is not 466 practical or cost-effective for the drug to be included and must 467 provide for the return to inventory of drugs that cannot be 468 credited or returned in a cost-effective manner. The agency 469 shall determine if the program has reduced the amount of 470 Medicaid prescription drugs which are destroyed on an annual 471 basis and if there are additional ways to ensure more 472 prescription drugs are not destroyed which could safely be 473 reused. 474 Section 4. Section 456.0392, Florida Statutes, is amended 475 to read: 476 456.0392 Prescription labeling.— 477 (1) A prescription issuedwrittenby a practitioner who is 478 authorized under the laws of this state to prescribewrite479prescriptions fordrugs that are not listed as controlled 480 substances in chapter 893 but who is not eligible for a federal 481 Drug Enforcement Administration number shall include that 482 practitioner’s name and professional license number. The 483 pharmacist or dispensing practitioner must include the 484 practitioner’s name on the container of the drug that is 485 dispensed. A pharmacist shall be permitted, upon verification by 486 the prescriber, to document any information required by this 487 section. 488 (2) A prescription for a drug that is not listed as a 489 controlled substance in chapter 893 which is issuedwrittenby 490 an advanced practice registered nurse licensed under s. 464.012 491 is presumed, subject to rebuttal, to be valid and within the 492 parameters of the prescriptive authority delegated by a 493 practitioner licensed under chapter 458, chapter 459, or chapter 494 466. 495 (3) A prescription for a drug that is not listed as a 496 controlled substance in chapter 893 which is issuedwrittenby a 497 physician assistant licensed under chapter 458 or chapter 459 is 498 presumed, subject to rebuttal, to be valid and within the 499 parameters of the prescriptive authority delegated by the 500 physician assistant’s supervising physician. 501 Section 5. Paragraph (d) of subsection (3) of section 502 458.3265, Florida Statutes, is amended to read: 503 458.3265 Pain-management clinics.— 504 (3) PHYSICIAN RESPONSIBILITIES.—These responsibilities 505 apply to any physician who provides professional services in a 506 pain-management clinic that is required to be registered in 507 subsection (1). 508 (d) A physician authorized to prescribe controlled 509 substances who practices at a pain-management clinic is 510 responsible for maintaining the control and security of his or 511 her prescription blanks or electronic prescribing softwareand512any other methodused for prescribing controlled substance pain 513 medication. AThephysician who issues written prescriptions 514 shall comply with the requirements for counterfeit-resistant 515 prescription blanks in s. 893.065 and the rules adopted pursuant 516 to that section. AThephysician shall notify, in writing, the 517 department within 24 hours afterfollowingany theft or loss of 518 a prescription blank or breach of his or her electronic 519 prescribing software usedany other methodfor prescribing pain 520 medication. 521 Section 6. Paragraph (qq) of subsection (1) of section 522 458.331, Florida Statutes, is amended to read: 523 458.331 Grounds for disciplinary action; action by the 524 board and department.— 525 (1) The following acts constitute grounds for denial of a 526 license or disciplinary action, as specified in s. 456.072(2): 527 (qq) Failing to timely notify the department of the theft 528 of prescription blanks from a pain-management clinic or a breach 529 of a physician’s electronic prescribing softwareother methods530for prescribingwithin 24 hours as required by s. 458.3265(3). 531 Section 7. Paragraph (d) of subsection (3) of section 532 459.0137, Florida Statutes, is amended to read: 533 459.0137 Pain-management clinics.— 534 (3) PHYSICIAN RESPONSIBILITIES.—These responsibilities 535 apply to any osteopathic physician who provides professional 536 services in a pain-management clinic that is required to be 537 registered in subsection (1). 538 (d) An osteopathic physician authorized to prescribe 539 controlled substances who practices at a pain-management clinic 540 is responsible for maintaining the control and security of his 541 or her prescription blanks or electronic prescribing software 542and any other methodused for prescribing controlled substance 543 pain medication. AnTheosteopathic physician who issues written 544 prescriptions shall comply with the requirements for 545 counterfeit-resistant prescription blanks in s. 893.065 and the 546 rules adopted pursuant to that section. AnTheosteopathic 547 physician shall notify, in writing, the department within 24 548 hours afterfollowingany theft or loss of a prescription blank 549 or breach of his or her electronic prescribing software usedany550other methodfor prescribing pain medication. 551 Section 8. Paragraph (ss) of subsection (1) of section 552 459.015, Florida Statutes, is amended to read: 553 459.015 Grounds for disciplinary action; action by the 554 board and department.— 555 (1) The following acts constitute grounds for denial of a 556 license or disciplinary action, as specified in s. 456.072(2): 557 (ss) Failing to timely notify the department of the theft 558 of prescription blanks from a pain-management clinic or a breach 559 of an osteopathic physician’s electronic prescribing software 560other methods for prescribingwithin 24 hours as required by s. 561 459.0137(3). 562 Section 9. This act shall take effect January 1, 2020. 563 564 ================= T I T L E A M E N D M E N T ================ 565 And the title is amended as follows: 566 Delete everything before the enacting clause 567 and insert: 568 A bill to be entitled 569 An act relating to electronic prescribing; amending s. 570 456.42, F.S.; requiring certain health care 571 practitioners to electronically generate and transmit 572 prescriptions for medicinal drugs upon license renewal 573 or by a specified date; providing exceptions; 574 authorizing the Department of Health, in consultation 575 with the Board of Medicine, the Board of Osteopathic 576 Medicine, the Board of Podiatric Medicine, the Board 577 of Dentistry, the Board of Nursing, and the Board of 578 Optometry, to adopt rules; amending s. 456.43, F.S.; 579 revising the definitions of the terms “prescribing 580 decision” and “point of care”; revising the authority 581 for electronic prescribing software to display 582 information regarding a payor’s formulary under 583 certain circumstances; amending ss. 409.912, 456.0392, 584 458.3265, 458.331, 459.0137, and 459.015, F.S.; 585 conforming provisions to changes made by the act; 586 providing an effective date.