Bill Text: FL S1192 | 2019 | Regular Session | Comm Sub


Bill Title: Electronic Prescribing

Spectrum:

Status: (Introduced) 2019-05-01 - Laid on Table, refer to CS/HB 831 [S1192 Detail]

Download: Florida-2019-S1192-Comm_Sub.html
       Florida Senate - 2019                      CS for CS for SB 1192
       
       
        
       By the Committees on Appropriations; and Health Policy; and
       Senators Bean, Baxley, and Rouson
       
       
       
       
       576-04635-19                                          20191192c2
    1                        A bill to be entitled                      
    2         An act relating to electronic prescribing; amending s.
    3         456.42, F.S.; requiring certain health care
    4         practitioners to electronically generate and transmit
    5         prescriptions for medicinal drugs upon license renewal
    6         or by a specified date; providing exceptions;
    7         authorizing the Department of Health, in consultation
    8         with the Board of Medicine, the Board of Osteopathic
    9         Medicine, the Board of Podiatric Medicine, the Board
   10         of Dentistry, the Board of Nursing, and the Board of
   11         Optometry, to adopt rules; amending s. 456.43, F.S.;
   12         revising the definitions of the terms “prescribing
   13         decision” and “point of care”; revising the authority
   14         for electronic prescribing software to display
   15         information regarding a payor’s formulary under
   16         certain circumstances; amending ss. 409.912, 456.0392,
   17         458.3265, 458.331, 459.0137, and 459.015, F.S.;
   18         conforming provisions to changes made by the act;
   19         providing an effective date.
   20          
   21  Be It Enacted by the Legislature of the State of Florida:
   22  
   23         Section 1. Section 456.42, Florida Statutes, is amended to
   24  read:
   25         456.42 Written prescriptions for medicinal drugs.—
   26         (1) A written prescription for a medicinal drug issued by a
   27  health care practitioner licensed by law to prescribe such drug
   28  must be legibly printed or typed so as to be capable of being
   29  understood by the pharmacist filling the prescription; must
   30  contain the name of the prescribing practitioner, the name and
   31  strength of the drug prescribed, the quantity of the drug
   32  prescribed, and the directions for use of the drug; must be
   33  dated; and must be signed by the prescribing practitioner on the
   34  day when issued. However, a prescription that is electronically
   35  generated and transmitted must contain the name of the
   36  prescribing practitioner, the name and strength of the drug
   37  prescribed, the quantity of the drug prescribed in numerical
   38  format, and the directions for use of the drug and must contain
   39  the date and an electronic signature, as defined in s.
   40  668.003(4), be dated and signed by the prescribing practitioner
   41  only on the day issued, which signature may be in an electronic
   42  format as defined in s. 668.003(4).
   43         (2) A written prescription for a controlled substance
   44  listed in chapter 893 must have the quantity of the drug
   45  prescribed in both textual and numerical formats, must be dated
   46  in numerical, month/day/year format, or with the abbreviated
   47  month written out, or the month written out in whole, and must
   48  be either written on a standardized counterfeit-proof
   49  prescription pad produced by a vendor approved by the department
   50  or electronically prescribed as that term is used in s.
   51  408.0611. As a condition of being an approved vendor, a
   52  prescription pad vendor must submit a monthly report to the
   53  department that, at a minimum, documents the number of
   54  prescription pads sold and identifies the purchasers. The
   55  department may, by rule, require the reporting of additional
   56  information.
   57         (3) A health care practitioner licensed by law to prescribe
   58  a medicinal drug who maintains a system of electronic health
   59  records as defined in s. 408.051(2)(a), or who prescribes
   60  medicinal drugs as an owner, an employee, or a contractor of a
   61  licensed health care facility or practice that maintains such a
   62  system and who is prescribing in his or her capacity as such an
   63  owner, an employee, or a contractor, may only electronically
   64  transmit prescriptions for such drugs. This requirement applies
   65  to such a health care practitioner upon renewal of the health
   66  care practitioner’s license or by July 1, 2021, whichever is
   67  earlier, but does not apply if:
   68         (a) The practitioner and the dispenser are the same entity;
   69         (b) The prescription cannot be transmitted electronically
   70  under the most recently implemented version of the National
   71  Council for Prescription Drug Programs SCRIPT Standard;
   72         (c) The practitioner has been issued a waiver by the
   73  department, not to exceed 1 year in duration, from the
   74  requirement to use electronic prescribing due to demonstrated
   75  economic hardship, technological limitations that are not
   76  reasonably within the control of the practitioner, or another
   77  exceptional circumstance demonstrated by the practitioner;
   78         (d) The practitioner reasonably determines that it would be
   79  impractical for the patient in question to obtain a medicinal
   80  drug prescribed by electronic prescription in a timely manner
   81  and such delay would adversely impact the patient’s medical
   82  condition;
   83         (e) The practitioner is prescribing a drug under a research
   84  protocol;
   85         (f) The prescription is for a drug for which the federal
   86  Food and Drug Administration requires the prescription to
   87  contain elements that may not be included in electronic
   88  prescribing; or
   89         (g) The prescription is issued to an individual receiving
   90  hospice care or who is a resident of a nursing home facility.
   91         (h) The practitioner determines that it is in the best
   92  interest of the patient, or the patient determines that it is in
   93  his or her own best interest, to compare prescription drug
   94  prices among area pharmacies. The practitioner must document
   95  such determination in the patient’s medical record.
   96  
   97  The department, in consultation with the Board of Medicine, the
   98  Board of Osteopathic Medicine, the Board of Podiatric Medicine,
   99  the Board of Dentistry, the Board of Nursing, and the Board of
  100  Optometry, may adopt rules to implement this subsection.
  101         Section 2. Section 456.43, Florida Statutes, is amended to
  102  read:
  103         456.43 Electronic prescribing for medicinal drugs.—
  104         (1) Electronic prescribing may shall not interfere with a
  105  patient’s freedom to choose a pharmacy.
  106         (2) Electronic prescribing software may shall not use any
  107  means or permit any other person to use any means to influence
  108  or attempt to influence, through economic incentives or
  109  otherwise, the prescribing decision of a prescribing
  110  practitioner or his or her agent at the point of care,
  111  including, but not limited to, means such as advertising,
  112  instant messaging, and pop-up ads, and similar means to
  113  influence or attempt to influence, through economic incentives
  114  or otherwise, the prescribing decision of a prescribing
  115  practitioner at the point of care. Such means shall not be
  116  triggered by or in specific response to the input, selection, or
  117  act of a prescribing practitioner or his or her agent in
  118  prescribing a certain medicinal drug pharmaceutical or directing
  119  a patient to a certain pharmacy. For purposes of this
  120  subsection, the term:
  121         (a) The term “Prescribing decision” means a prescribing
  122  practitioner’s or his or her agent’s decision to prescribe any
  123  medicinal drug a certain pharmaceutical.
  124         (b) The term “Point of care” means the time at which that a
  125  prescribing practitioner or his or her agent prescribes any
  126  medicinal drug is in the act of prescribing a certain
  127  pharmaceutical.
  128         (3) Electronic prescribing software may display show
  129  information regarding a payor’s formulary if as long as nothing
  130  is designed to preclude or make more difficult the selection of
  131  the act of a prescribing practitioner or patient selecting any
  132  particular pharmacy by a patient or the selection of a certain
  133  medicinal drug by a prescribing practitioner or his or her agent
  134  pharmaceutical.
  135         Section 3. Paragraph (a) of subsection (5) of section
  136  409.912, Florida Statutes, is amended to read:
  137         409.912 Cost-effective purchasing of health care.—The
  138  agency shall purchase goods and services for Medicaid recipients
  139  in the most cost-effective manner consistent with the delivery
  140  of quality medical care. To ensure that medical services are
  141  effectively utilized, the agency may, in any case, require a
  142  confirmation or second physician’s opinion of the correct
  143  diagnosis for purposes of authorizing future services under the
  144  Medicaid program. This section does not restrict access to
  145  emergency services or poststabilization care services as defined
  146  in 42 C.F.R. s. 438.114. Such confirmation or second opinion
  147  shall be rendered in a manner approved by the agency. The agency
  148  shall maximize the use of prepaid per capita and prepaid
  149  aggregate fixed-sum basis services when appropriate and other
  150  alternative service delivery and reimbursement methodologies,
  151  including competitive bidding pursuant to s. 287.057, designed
  152  to facilitate the cost-effective purchase of a case-managed
  153  continuum of care. The agency shall also require providers to
  154  minimize the exposure of recipients to the need for acute
  155  inpatient, custodial, and other institutional care and the
  156  inappropriate or unnecessary use of high-cost services. The
  157  agency shall contract with a vendor to monitor and evaluate the
  158  clinical practice patterns of providers in order to identify
  159  trends that are outside the normal practice patterns of a
  160  provider’s professional peers or the national guidelines of a
  161  provider’s professional association. The vendor must be able to
  162  provide information and counseling to a provider whose practice
  163  patterns are outside the norms, in consultation with the agency,
  164  to improve patient care and reduce inappropriate utilization.
  165  The agency may mandate prior authorization, drug therapy
  166  management, or disease management participation for certain
  167  populations of Medicaid beneficiaries, certain drug classes, or
  168  particular drugs to prevent fraud, abuse, overuse, and possible
  169  dangerous drug interactions. The Pharmaceutical and Therapeutics
  170  Committee shall make recommendations to the agency on drugs for
  171  which prior authorization is required. The agency shall inform
  172  the Pharmaceutical and Therapeutics Committee of its decisions
  173  regarding drugs subject to prior authorization. The agency is
  174  authorized to limit the entities it contracts with or enrolls as
  175  Medicaid providers by developing a provider network through
  176  provider credentialing. The agency may competitively bid single
  177  source-provider contracts if procurement of goods or services
  178  results in demonstrated cost savings to the state without
  179  limiting access to care. The agency may limit its network based
  180  on the assessment of beneficiary access to care, provider
  181  availability, provider quality standards, time and distance
  182  standards for access to care, the cultural competence of the
  183  provider network, demographic characteristics of Medicaid
  184  beneficiaries, practice and provider-to-beneficiary standards,
  185  appointment wait times, beneficiary use of services, provider
  186  turnover, provider profiling, provider licensure history,
  187  previous program integrity investigations and findings, peer
  188  review, provider Medicaid policy and billing compliance records,
  189  clinical and medical record audits, and other factors. Providers
  190  are not entitled to enrollment in the Medicaid provider network.
  191  The agency shall determine instances in which allowing Medicaid
  192  beneficiaries to purchase durable medical equipment and other
  193  goods is less expensive to the Medicaid program than long-term
  194  rental of the equipment or goods. The agency may establish rules
  195  to facilitate purchases in lieu of long-term rentals in order to
  196  protect against fraud and abuse in the Medicaid program as
  197  defined in s. 409.913. The agency may seek federal waivers
  198  necessary to administer these policies.
  199         (5)(a) The agency shall implement a Medicaid prescribed
  200  drug spending-control program that includes the following
  201  components:
  202         1. A Medicaid preferred drug list, which shall be a listing
  203  of cost-effective therapeutic options recommended by the
  204  Medicaid Pharmacy and Therapeutics Committee established
  205  pursuant to s. 409.91195 and adopted by the agency for each
  206  therapeutic class on the preferred drug list. At the discretion
  207  of the committee, and when feasible, the preferred drug list
  208  should include at least two products in a therapeutic class. The
  209  agency may post the preferred drug list and updates to the list
  210  on an Internet website without following the rulemaking
  211  procedures of chapter 120. Antiretroviral agents are excluded
  212  from the preferred drug list. The agency shall also limit the
  213  amount of a prescribed drug dispensed to no more than a 34-day
  214  supply unless the drug products’ smallest marketed package is
  215  greater than a 34-day supply, or the drug is determined by the
  216  agency to be a maintenance drug in which case a 100-day maximum
  217  supply may be authorized. The agency may seek any federal
  218  waivers necessary to implement these cost-control programs and
  219  to continue participation in the federal Medicaid rebate
  220  program, or alternatively to negotiate state-only manufacturer
  221  rebates. The agency may adopt rules to administer this
  222  subparagraph. The agency shall continue to provide unlimited
  223  contraceptive drugs and items. The agency must establish
  224  procedures to ensure that:
  225         a. There is a response to a request for prior consultation
  226  by telephone or other telecommunication device within 24 hours
  227  after receipt of a request for prior consultation; and
  228         b. A 72-hour supply of the drug prescribed is provided in
  229  an emergency or when the agency does not provide a response
  230  within 24 hours as required by sub-subparagraph a.
  231         2. Reimbursement to pharmacies for Medicaid prescribed
  232  drugs shall be set at the lowest of: the average wholesale price
  233  (AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
  234  plus 1.5 percent, the federal upper limit (FUL), the state
  235  maximum allowable cost (SMAC), or the usual and customary (UAC)
  236  charge billed by the provider.
  237         3. The agency shall develop and implement a process for
  238  managing the drug therapies of Medicaid recipients who are using
  239  significant numbers of prescribed drugs each month. The
  240  management process may include, but is not limited to,
  241  comprehensive, physician-directed medical-record reviews, claims
  242  analyses, and case evaluations to determine the medical
  243  necessity and appropriateness of a patient’s treatment plan and
  244  drug therapies. The agency may contract with a private
  245  organization to provide drug-program-management services. The
  246  Medicaid drug benefit management program shall include
  247  initiatives to manage drug therapies for HIV/AIDS patients,
  248  patients using 20 or more unique prescriptions in a 180-day
  249  period, and the top 1,000 patients in annual spending. The
  250  agency shall enroll any Medicaid recipient in the drug benefit
  251  management program if he or she meets the specifications of this
  252  provision and is not enrolled in a Medicaid health maintenance
  253  organization.
  254         4. The agency may limit the size of its pharmacy network
  255  based on need, competitive bidding, price negotiations,
  256  credentialing, or similar criteria. The agency shall give
  257  special consideration to rural areas in determining the size and
  258  location of pharmacies included in the Medicaid pharmacy
  259  network. A pharmacy credentialing process may include criteria
  260  such as a pharmacy’s full-service status, location, size,
  261  patient educational programs, patient consultation, disease
  262  management services, and other characteristics. The agency may
  263  impose a moratorium on Medicaid pharmacy enrollment if it is
  264  determined that it has a sufficient number of Medicaid
  265  participating providers. The agency must allow dispensing
  266  practitioners to participate as a part of the Medicaid pharmacy
  267  network regardless of the practitioner’s proximity to any other
  268  entity that is dispensing prescription drugs under the Medicaid
  269  program. A dispensing practitioner must meet all credentialing
  270  requirements applicable to his or her practice, as determined by
  271  the agency.
  272         5. The agency shall develop and implement a program that
  273  requires Medicaid practitioners who issue written prescriptions
  274  for medicinal prescribe drugs to use a counterfeit-proof
  275  prescription pad for Medicaid prescriptions. The agency shall
  276  require the use of standardized counterfeit-proof prescription
  277  pads by Medicaid-participating prescribers or prescribers who
  278  issue written write prescriptions for Medicaid recipients. The
  279  agency may implement the program in targeted geographic areas or
  280  statewide.
  281         6. The agency may enter into arrangements that require
  282  manufacturers of generic drugs prescribed to Medicaid recipients
  283  to provide rebates of at least 15.1 percent of the average
  284  manufacturer price for the manufacturer’s generic products.
  285  These arrangements shall require that if a generic-drug
  286  manufacturer pays federal rebates for Medicaid-reimbursed drugs
  287  at a level below 15.1 percent, the manufacturer must provide a
  288  supplemental rebate to the state in an amount necessary to
  289  achieve a 15.1-percent rebate level.
  290         7. The agency may establish a preferred drug list as
  291  described in this subsection, and, pursuant to the establishment
  292  of such preferred drug list, negotiate supplemental rebates from
  293  manufacturers that are in addition to those required by Title
  294  XIX of the Social Security Act and at no less than 14 percent of
  295  the average manufacturer price as defined in 42 U.S.C. s. 1936
  296  on the last day of a quarter unless the federal or supplemental
  297  rebate, or both, equals or exceeds 29 percent. There is no upper
  298  limit on the supplemental rebates the agency may negotiate. The
  299  agency may determine that specific products, brand-name or
  300  generic, are competitive at lower rebate percentages. Agreement
  301  to pay the minimum supplemental rebate percentage guarantees a
  302  manufacturer that the Medicaid Pharmaceutical and Therapeutics
  303  Committee will consider a product for inclusion on the preferred
  304  drug list. However, a pharmaceutical manufacturer is not
  305  guaranteed placement on the preferred drug list by simply paying
  306  the minimum supplemental rebate. Agency decisions will be made
  307  on the clinical efficacy of a drug and recommendations of the
  308  Medicaid Pharmaceutical and Therapeutics Committee, as well as
  309  the price of competing products minus federal and state rebates.
  310  The agency may contract with an outside agency or contractor to
  311  conduct negotiations for supplemental rebates. For the purposes
  312  of this section, the term “supplemental rebates” means cash
  313  rebates. Value-added programs as a substitution for supplemental
  314  rebates are prohibited. The agency may seek any federal waivers
  315  to implement this initiative.
  316         8. The agency shall expand home delivery of pharmacy
  317  products. The agency may amend the state plan and issue a
  318  procurement, as necessary, in order to implement this program.
  319  The procurements must include agreements with a pharmacy or
  320  pharmacies located in the state to provide mail order delivery
  321  services at no cost to the recipients who elect to receive home
  322  delivery of pharmacy products. The procurement must focus on
  323  serving recipients with chronic diseases for which pharmacy
  324  expenditures represent a significant portion of Medicaid
  325  pharmacy expenditures or which impact a significant portion of
  326  the Medicaid population. The agency may seek and implement any
  327  federal waivers necessary to implement this subparagraph.
  328         9. The agency shall limit to one dose per month any drug
  329  prescribed to treat erectile dysfunction.
  330         10.a. The agency may implement a Medicaid behavioral drug
  331  management system. The agency may contract with a vendor that
  332  has experience in operating behavioral drug management systems
  333  to implement this program. The agency may seek federal waivers
  334  to implement this program.
  335         b. The agency, in conjunction with the Department of
  336  Children and Families, may implement the Medicaid behavioral
  337  drug management system that is designed to improve the quality
  338  of care and behavioral health prescribing practices based on
  339  best practice guidelines, improve patient adherence to
  340  medication plans, reduce clinical risk, and lower prescribed
  341  drug costs and the rate of inappropriate spending on Medicaid
  342  behavioral drugs. The program may include the following
  343  elements:
  344         (I) Provide for the development and adoption of best
  345  practice guidelines for behavioral health-related drugs such as
  346  antipsychotics, antidepressants, and medications for treating
  347  bipolar disorders and other behavioral conditions; translate
  348  them into practice; review behavioral health prescribers and
  349  compare their prescribing patterns to a number of indicators
  350  that are based on national standards; and determine deviations
  351  from best practice guidelines.
  352         (II) Implement processes for providing feedback to and
  353  educating prescribers using best practice educational materials
  354  and peer-to-peer consultation.
  355         (III) Assess Medicaid beneficiaries who are outliers in
  356  their use of behavioral health drugs with regard to the numbers
  357  and types of drugs taken, drug dosages, combination drug
  358  therapies, and other indicators of improper use of behavioral
  359  health drugs.
  360         (IV) Alert prescribers to patients who fail to refill
  361  prescriptions in a timely fashion, are prescribed multiple same
  362  class behavioral health drugs, and may have other potential
  363  medication problems.
  364         (V) Track spending trends for behavioral health drugs and
  365  deviation from best practice guidelines.
  366         (VI) Use educational and technological approaches to
  367  promote best practices, educate consumers, and train prescribers
  368  in the use of practice guidelines.
  369         (VII) Disseminate electronic and published materials.
  370         (VIII) Hold statewide and regional conferences.
  371         (IX) Implement a disease management program with a model
  372  quality-based medication component for severely mentally ill
  373  individuals and emotionally disturbed children who are high
  374  users of care.
  375         11. The agency shall implement a Medicaid prescription drug
  376  management system.
  377         a. The agency may contract with a vendor that has
  378  experience in operating prescription drug management systems in
  379  order to implement this system. Any management system that is
  380  implemented in accordance with this subparagraph must rely on
  381  cooperation between physicians and pharmacists to determine
  382  appropriate practice patterns and clinical guidelines to improve
  383  the prescribing, dispensing, and use of drugs in the Medicaid
  384  program. The agency may seek federal waivers to implement this
  385  program.
  386         b. The drug management system must be designed to improve
  387  the quality of care and prescribing practices based on best
  388  practice guidelines, improve patient adherence to medication
  389  plans, reduce clinical risk, and lower prescribed drug costs and
  390  the rate of inappropriate spending on Medicaid prescription
  391  drugs. The program must:
  392         (I) Provide for the adoption of best practice guidelines
  393  for the prescribing and use of drugs in the Medicaid program,
  394  including translating best practice guidelines into practice;
  395  reviewing prescriber patterns and comparing them to indicators
  396  that are based on national standards and practice patterns of
  397  clinical peers in their community, statewide, and nationally;
  398  and determine deviations from best practice guidelines.
  399         (II) Implement processes for providing feedback to and
  400  educating prescribers using best practice educational materials
  401  and peer-to-peer consultation.
  402         (III) Assess Medicaid recipients who are outliers in their
  403  use of a single or multiple prescription drugs with regard to
  404  the numbers and types of drugs taken, drug dosages, combination
  405  drug therapies, and other indicators of improper use of
  406  prescription drugs.
  407         (IV) Alert prescribers to recipients who fail to refill
  408  prescriptions in a timely fashion, are prescribed multiple drugs
  409  that may be redundant or contraindicated, or may have other
  410  potential medication problems.
  411         12. The agency may contract for drug rebate administration,
  412  including, but not limited to, calculating rebate amounts,
  413  invoicing manufacturers, negotiating disputes with
  414  manufacturers, and maintaining a database of rebate collections.
  415         13. The agency may specify the preferred daily dosing form
  416  or strength for the purpose of promoting best practices with
  417  regard to the prescribing of certain drugs as specified in the
  418  General Appropriations Act and ensuring cost-effective
  419  prescribing practices.
  420         14. The agency may require prior authorization for
  421  Medicaid-covered prescribed drugs. The agency may prior
  422  authorize the use of a product:
  423         a. For an indication not approved in labeling;
  424         b. To comply with certain clinical guidelines; or
  425         c. If the product has the potential for overuse, misuse, or
  426  abuse.
  427  
  428  The agency may require the prescribing professional to provide
  429  information about the rationale and supporting medical evidence
  430  for the use of a drug. The agency shall post prior
  431  authorization, step-edit criteria and protocol, and updates to
  432  the list of drugs that are subject to prior authorization on the
  433  agency’s Internet website within 21 days after the prior
  434  authorization and step-edit criteria and protocol and updates
  435  are approved by the agency. For purposes of this subparagraph,
  436  the term “step-edit” means an automatic electronic review of
  437  certain medications subject to prior authorization.
  438         15. The agency, in conjunction with the Pharmaceutical and
  439  Therapeutics Committee, may require age-related prior
  440  authorizations for certain prescribed drugs. The agency may
  441  preauthorize the use of a drug for a recipient who may not meet
  442  the age requirement or may exceed the length of therapy for use
  443  of this product as recommended by the manufacturer and approved
  444  by the Food and Drug Administration. Prior authorization may
  445  require the prescribing professional to provide information
  446  about the rationale and supporting medical evidence for the use
  447  of a drug.
  448         16. The agency shall implement a step-therapy prior
  449  authorization approval process for medications excluded from the
  450  preferred drug list. Medications listed on the preferred drug
  451  list must be used within the previous 12 months before the
  452  alternative medications that are not listed. The step-therapy
  453  prior authorization may require the prescriber to use the
  454  medications of a similar drug class or for a similar medical
  455  indication unless contraindicated in the Food and Drug
  456  Administration labeling. The trial period between the specified
  457  steps may vary according to the medical indication. The step
  458  therapy approval process shall be developed in accordance with
  459  the committee as stated in s. 409.91195(7) and (8). A drug
  460  product may be approved without meeting the step-therapy prior
  461  authorization criteria if the prescribing physician provides the
  462  agency with additional written medical or clinical documentation
  463  that the product is medically necessary because:
  464         a. There is not a drug on the preferred drug list to treat
  465  the disease or medical condition which is an acceptable clinical
  466  alternative;
  467         b. The alternatives have been ineffective in the treatment
  468  of the beneficiary’s disease; or
  469         c. Based on historic evidence and known characteristics of
  470  the patient and the drug, the drug is likely to be ineffective,
  471  or the number of doses have been ineffective.
  472  
  473  The agency shall work with the physician to determine the best
  474  alternative for the patient. The agency may adopt rules waiving
  475  the requirements for written clinical documentation for specific
  476  drugs in limited clinical situations.
  477         17. The agency shall implement a return and reuse program
  478  for drugs dispensed by pharmacies to institutional recipients,
  479  which includes payment of a $5 restocking fee for the
  480  implementation and operation of the program. The return and
  481  reuse program shall be implemented electronically and in a
  482  manner that promotes efficiency. The program must permit a
  483  pharmacy to exclude drugs from the program if it is not
  484  practical or cost-effective for the drug to be included and must
  485  provide for the return to inventory of drugs that cannot be
  486  credited or returned in a cost-effective manner. The agency
  487  shall determine if the program has reduced the amount of
  488  Medicaid prescription drugs which are destroyed on an annual
  489  basis and if there are additional ways to ensure more
  490  prescription drugs are not destroyed which could safely be
  491  reused.
  492         Section 4. Section 456.0392, Florida Statutes, is amended
  493  to read:
  494         456.0392 Prescription labeling.—
  495         (1) A prescription issued written by a practitioner who is
  496  authorized under the laws of this state to prescribe write
  497  prescriptions for drugs that are not listed as controlled
  498  substances in chapter 893 but who is not eligible for a federal
  499  Drug Enforcement Administration number shall include that
  500  practitioner’s name and professional license number. The
  501  pharmacist or dispensing practitioner must include the
  502  practitioner’s name on the container of the drug that is
  503  dispensed. A pharmacist shall be permitted, upon verification by
  504  the prescriber, to document any information required by this
  505  section.
  506         (2) A prescription for a drug that is not listed as a
  507  controlled substance in chapter 893 which is issued written by
  508  an advanced practice registered nurse licensed under s. 464.012
  509  is presumed, subject to rebuttal, to be valid and within the
  510  parameters of the prescriptive authority delegated by a
  511  practitioner licensed under chapter 458, chapter 459, or chapter
  512  466.
  513         (3) A prescription for a drug that is not listed as a
  514  controlled substance in chapter 893 which is issued written by a
  515  physician assistant licensed under chapter 458 or chapter 459 is
  516  presumed, subject to rebuttal, to be valid and within the
  517  parameters of the prescriptive authority delegated by the
  518  physician assistant’s supervising physician.
  519         Section 5. Paragraph (d) of subsection (3) of section
  520  458.3265, Florida Statutes, is amended to read:
  521         458.3265 Pain-management clinics.—
  522         (3) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  523  apply to any physician who provides professional services in a
  524  pain-management clinic that is required to be registered in
  525  subsection (1).
  526         (d) A physician authorized to prescribe controlled
  527  substances who practices at a pain-management clinic is
  528  responsible for maintaining the control and security of his or
  529  her prescription blanks or electronic prescribing software and
  530  any other method used for prescribing controlled substance pain
  531  medication. A The physician who issues written prescriptions
  532  shall comply with the requirements for counterfeit-resistant
  533  prescription blanks in s. 893.065 and the rules adopted pursuant
  534  to that section. A The physician shall notify, in writing, the
  535  department within 24 hours after following any theft or loss of
  536  a prescription blank or breach of his or her electronic
  537  prescribing software used any other method for prescribing pain
  538  medication.
  539         Section 6. Paragraph (qq) of subsection (1) of section
  540  458.331, Florida Statutes, is amended to read:
  541         458.331 Grounds for disciplinary action; action by the
  542  board and department.—
  543         (1) The following acts constitute grounds for denial of a
  544  license or disciplinary action, as specified in s. 456.072(2):
  545         (qq) Failing to timely notify the department of the theft
  546  of prescription blanks from a pain-management clinic or a breach
  547  of a physician’s electronic prescribing software other methods
  548  for prescribing within 24 hours as required by s. 458.3265(3).
  549         Section 7. Paragraph (d) of subsection (3) of section
  550  459.0137, Florida Statutes, is amended to read:
  551         459.0137 Pain-management clinics.—
  552         (3) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  553  apply to any osteopathic physician who provides professional
  554  services in a pain-management clinic that is required to be
  555  registered in subsection (1).
  556         (d) An osteopathic physician authorized to prescribe
  557  controlled substances who practices at a pain-management clinic
  558  is responsible for maintaining the control and security of his
  559  or her prescription blanks or electronic prescribing software
  560  and any other method used for prescribing controlled substance
  561  pain medication. An The osteopathic physician who issues written
  562  prescriptions shall comply with the requirements for
  563  counterfeit-resistant prescription blanks in s. 893.065 and the
  564  rules adopted pursuant to that section. An The osteopathic
  565  physician shall notify, in writing, the department within 24
  566  hours after following any theft or loss of a prescription blank
  567  or breach of his or her electronic prescribing software used any
  568  other method for prescribing pain medication.
  569         Section 8. Paragraph (ss) of subsection (1) of section
  570  459.015, Florida Statutes, is amended to read:
  571         459.015 Grounds for disciplinary action; action by the
  572  board and department.—
  573         (1) The following acts constitute grounds for denial of a
  574  license or disciplinary action, as specified in s. 456.072(2):
  575         (ss) Failing to timely notify the department of the theft
  576  of prescription blanks from a pain-management clinic or a breach
  577  of an osteopathic physician’s electronic prescribing software
  578  other methods for prescribing within 24 hours as required by s.
  579  459.0137(3).
  580         Section 9. This act shall take effect January 1, 2020.

feedback