Bill Text: FL S1192 | 2019 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Electronic Prescribing
Spectrum:
Status: (Introduced - Dead) 2019-05-01 - Laid on Table, companion bill(s) passed, see CS/HB 831 (Ch. 2019-112) [S1192 Detail]
Download: Florida-2019-S1192-Introduced.html
Bill Title: Electronic Prescribing
Spectrum:
Status: (Introduced - Dead) 2019-05-01 - Laid on Table, companion bill(s) passed, see CS/HB 831 (Ch. 2019-112) [S1192 Detail]
Download: Florida-2019-S1192-Introduced.html
Florida Senate - 2019 SB 1192 By Senator Bean 4-01299-19 20191192__ 1 A bill to be entitled 2 An act relating to electronic prescribing; amending s. 3 456.42, F.S.; requiring all prescriptions to be 4 electronically generated and transmitted upon a 5 certain practitioner’s license renewal or by a 6 specified date; prohibiting electronic prescribing 7 from interfering with a patient’s freedom to choose a 8 pharmacy; providing restrictions for electronic 9 prescribing software; providing definitions; 10 authorizing electronic prescribing software to display 11 information regarding a payor’s formulary under 12 certain circumstances; amending ss. 409.91196, 13 409.912, 456.0392, 458.3265, 458.331, 458.347, 14 459.0137, 459.015, and 459.022, F.S.; conforming 15 provisions to changes made by the act; repealing ss. 16 456.43, 831.311, and 893.065, F.S., relating to 17 electronic prescribing for medicinal drugs, the 18 unlawful sale, manufacture, alteration, delivery, 19 uttering, or possession of counterfeit-resistant 20 prescription blanks for controlled substances, and 21 counterfeit-resistant prescription blanks for 22 controlled substances listed in Schedule II, Schedule 23 III, Schedule IV, or Schedule V, respectively; 24 providing an effective date. 25 26 Be It Enacted by the Legislature of the State of Florida: 27 28 Section 1. Section 456.42, Florida Statutes, is amended to 29 read: 30 456.42WrittenPrescriptions for medicinal drugs.— 31 (1) Upon renewal of the health care practitioner’s license 32 or by July 1, 2021, whichever is earlier,awritten prescription33for a medicinal drug issued bya health care practitioner 34 licensed by law to prescribe a medicinalsuchdrug may only 35 electronically transmit prescriptions for such drugsmust be36legibly printed or typed so as to be capable of being understood37by the pharmacist filling the prescription; must contain the38name of the prescribing practitioner, the name and strength of39the drug prescribed, the quantity of the drug prescribed, and40the directions for use of the drug; must be dated; and must be41signed by the prescribing practitioner on the day when issued. 42However,A prescriptionthat is electronically generated and43transmittedmust contain the name of the prescribing 44 practitioner, the name and strength of the drug prescribed, the 45 quantity of the drug prescribed in numerical format, and the 46 directions for use of the drug and must contain the date and an 47 electronic signature, as defined in s. 668.003(4),be dated and48signedby the prescribing practitioner only on the day issued,49which signature may be in an electronic format as defined in s.50668.003(4). 51 (2) Electronic prescribing may not interfere with a 52 patient’s freedom to choose a pharmacy. 53 (3) Electronic prescribing software may not use any means 54 or permit any other person to use any means, including, but not 55 limited to, advertising, instant messaging, and pop-up ads, to 56 influence or attempt to influence through economic incentives or 57 otherwise the prescribing decision of a prescribing practitioner 58 or his or her agent at the point of care. Such means may not be 59 triggered by or in specific response to the input, selection, or 60 act of a prescribing practitioner or his or her agent in 61 prescribing a certain medicinal drug or directing a patient to a 62 certain pharmacy. For purposes of this subsection, the term: 63 (a) “Point of care” means the time at which a prescribing 64 practitioner or his or her agent prescribes any medicinal drug. 65 (b) “Prescribing decision” means a prescribing 66 practitioner’s or his or her agent’s decision to prescribe any 67 medicinal drug. 68 (4) Electronic prescribing software may display information 69 regarding a payor’s formulary if nothing is designed to preclude 70 or make more difficult the selection of any particular pharmacy 71 by a patient or the selection of a certain medicinal drug by a 72 prescribing practitioner or his or her agent. 73(2)A written prescription for a controlled substance74listed in chapter 893 must have the quantity of the drug75prescribed in both textual and numerical formats, must be dated76in numerical, month/day/year format, or with the abbreviated77month written out, or the month written out in whole, and must78be either written on a standardized counterfeit-proof79prescription pad produced by a vendor approved by the department80or electronically prescribed as that term is used in s.81408.0611. As a condition of being an approved vendor, a82prescription pad vendor must submit a monthly report to the83department that, at a minimum, documents the number of84prescription pads sold and identifies the purchasers. The85department may, by rule, require the reporting of additional86information.87 Section 2. Subsection (1) of section 409.91196, Florida 88 Statutes, is amended to read: 89 409.91196 Supplemental rebate agreements; public records 90 and public meetings exemption.— 91 (1) The rebate amount, percent of rebate, manufacturer’s 92 pricing, and supplemental rebate, and other trade secrets as 93 defined in s. 688.002 that the agency has identified for use in 94 negotiations, held by the Agency for Health Care Administration 95 under s. 409.912(5)(a)6.s. 409.912(5)(a)7.are confidential and 96 exempt from s. 119.07(1) and s. 24(a), Art. I of the State 97 Constitution. 98 Section 3. Paragraph (a) of subsection (5) of section 99 409.912, Florida Statutes, is amended to read: 100 409.912 Cost-effective purchasing of health care.—The 101 agency shall purchase goods and services for Medicaid recipients 102 in the most cost-effective manner consistent with the delivery 103 of quality medical care. To ensure that medical services are 104 effectively utilized, the agency may, in any case, require a 105 confirmation or second physician’s opinion of the correct 106 diagnosis for purposes of authorizing future services under the 107 Medicaid program. This section does not restrict access to 108 emergency services or poststabilization care services as defined 109 in 42 C.F.R. s. 438.114. Such confirmation or second opinion 110 shall be rendered in a manner approved by the agency. The agency 111 shall maximize the use of prepaid per capita and prepaid 112 aggregate fixed-sum basis services when appropriate and other 113 alternative service delivery and reimbursement methodologies, 114 including competitive bidding pursuant to s. 287.057, designed 115 to facilitate the cost-effective purchase of a case-managed 116 continuum of care. The agency shall also require providers to 117 minimize the exposure of recipients to the need for acute 118 inpatient, custodial, and other institutional care and the 119 inappropriate or unnecessary use of high-cost services. The 120 agency shall contract with a vendor to monitor and evaluate the 121 clinical practice patterns of providers in order to identify 122 trends that are outside the normal practice patterns of a 123 provider’s professional peers or the national guidelines of a 124 provider’s professional association. The vendor must be able to 125 provide information and counseling to a provider whose practice 126 patterns are outside the norms, in consultation with the agency, 127 to improve patient care and reduce inappropriate utilization. 128 The agency may mandate prior authorization, drug therapy 129 management, or disease management participation for certain 130 populations of Medicaid beneficiaries, certain drug classes, or 131 particular drugs to prevent fraud, abuse, overuse, and possible 132 dangerous drug interactions. The Pharmaceutical and Therapeutics 133 Committee shall make recommendations to the agency on drugs for 134 which prior authorization is required. The agency shall inform 135 the Pharmaceutical and Therapeutics Committee of its decisions 136 regarding drugs subject to prior authorization. The agency is 137 authorized to limit the entities it contracts with or enrolls as 138 Medicaid providers by developing a provider network through 139 provider credentialing. The agency may competitively bid single 140 source-provider contracts if procurement of goods or services 141 results in demonstrated cost savings to the state without 142 limiting access to care. The agency may limit its network based 143 on the assessment of beneficiary access to care, provider 144 availability, provider quality standards, time and distance 145 standards for access to care, the cultural competence of the 146 provider network, demographic characteristics of Medicaid 147 beneficiaries, practice and provider-to-beneficiary standards, 148 appointment wait times, beneficiary use of services, provider 149 turnover, provider profiling, provider licensure history, 150 previous program integrity investigations and findings, peer 151 review, provider Medicaid policy and billing compliance records, 152 clinical and medical record audits, and other factors. Providers 153 are not entitled to enrollment in the Medicaid provider network. 154 The agency shall determine instances in which allowing Medicaid 155 beneficiaries to purchase durable medical equipment and other 156 goods is less expensive to the Medicaid program than long-term 157 rental of the equipment or goods. The agency may establish rules 158 to facilitate purchases in lieu of long-term rentals in order to 159 protect against fraud and abuse in the Medicaid program as 160 defined in s. 409.913. The agency may seek federal waivers 161 necessary to administer these policies. 162 (5)(a) The agency shall implement a Medicaid prescribed 163 drug spending-control program that includes the following 164 components: 165 1. A Medicaid preferred drug list, which shall be a listing 166 of cost-effective therapeutic options recommended by the 167 Medicaid Pharmacy and Therapeutics Committee established 168 pursuant to s. 409.91195 and adopted by the agency for each 169 therapeutic class on the preferred drug list. At the discretion 170 of the committee, and when feasible, the preferred drug list 171 should include at least two products in a therapeutic class. The 172 agency may post the preferred drug list and updates to the list 173 on an Internet website without following the rulemaking 174 procedures of chapter 120. Antiretroviral agents are excluded 175 from the preferred drug list. The agency shall also limit the 176 amount of a prescribed drug dispensed to no more than a 34-day 177 supply unless the drug products’ smallest marketed package is 178 greater than a 34-day supply, or the drug is determined by the 179 agency to be a maintenance drug in which case a 100-day maximum 180 supply may be authorized. The agency may seek any federal 181 waivers necessary to implement these cost-control programs and 182 to continue participation in the federal Medicaid rebate 183 program, or alternatively to negotiate state-only manufacturer 184 rebates. The agency may adopt rules to administer this 185 subparagraph. The agency shall continue to provide unlimited 186 contraceptive drugs and items. The agency must establish 187 procedures to ensure that: 188 a. There is a response to a request for prior consultation 189 by telephone or other telecommunication device within 24 hours 190 after receipt of a request for prior consultation; and 191 b. A 72-hour supply of the drug prescribed is provided in 192 an emergency or when the agency does not provide a response 193 within 24 hours as required by sub-subparagraph a. 194 2. Reimbursement to pharmacies for Medicaid prescribed 195 drugs shall be set at the lowest of: the average wholesale price 196 (AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC) 197 plus 1.5 percent, the federal upper limit (FUL), the state 198 maximum allowable cost (SMAC), or the usual and customary (UAC) 199 charge billed by the provider. 200 3. The agency shall develop and implement a process for 201 managing the drug therapies of Medicaid recipients who are using 202 significant numbers of prescribed drugs each month. The 203 management process may include, but is not limited to, 204 comprehensive, physician-directed medical-record reviews, claims 205 analyses, and case evaluations to determine the medical 206 necessity and appropriateness of a patient’s treatment plan and 207 drug therapies. The agency may contract with a private 208 organization to provide drug-program-management services. The 209 Medicaid drug benefit management program shall include 210 initiatives to manage drug therapies for HIV/AIDS patients, 211 patients using 20 or more unique prescriptions in a 180-day 212 period, and the top 1,000 patients in annual spending. The 213 agency shall enroll any Medicaid recipient in the drug benefit 214 management program if he or she meets the specifications of this 215 subparagraphprovisionand is not enrolled in a Medicaid health 216 maintenance organization. 217 4. The agency may limit the size of its pharmacy network 218 based on need, competitive bidding, price negotiations, 219 credentialing, or similar criteria. The agency shall give 220 special consideration to rural areas in determining the size and 221 location of pharmacies included in the Medicaid pharmacy 222 network. A pharmacy credentialing process may include criteria 223 such as a pharmacy’s full-service status, location, size, 224 patient educational programs, patient consultation, disease 225 management services, and other characteristics. The agency may 226 impose a moratorium on Medicaid pharmacy enrollment if it is 227 determined that it has a sufficient number of Medicaid 228 participating providers. The agency must allow dispensing 229 practitioners to participate as a part of the Medicaid pharmacy 230 network regardless of the practitioner’s proximity to any other 231 entity that is dispensing prescription drugs under the Medicaid 232 program. A dispensing practitioner must meet all credentialing 233 requirements applicable to his or her practice, as determined by 234 the agency. 2355.The agency shall develop and implement a program that236requires Medicaid practitioners who prescribe drugs to use a237counterfeit-proof prescription pad for Medicaid prescriptions.238The agency shall require the use of standardized counterfeit239proof prescription pads by Medicaid-participating prescribers or240prescribers who write prescriptions for Medicaid recipients. The241agency may implement the program in targeted geographic areas or242statewide.243 5.6.The agency may enter into arrangements that require 244 manufacturers of generic drugs prescribed to Medicaid recipients 245 to provide rebates of at least 15.1 percent of the average 246 manufacturer price for the manufacturer’s generic products. 247 These arrangements shall require that if a generic-drug 248 manufacturer pays federal rebates for Medicaid-reimbursed drugs 249 at a level below 15.1 percent, the manufacturer must provide a 250 supplemental rebate to the state in an amount necessary to 251 achieve a 15.1-percent rebate level. 252 6.7.The agency may establish a preferred drug list as 253 described in this subsection, and, pursuant to the establishment 254 of such preferred drug list, negotiate supplemental rebates from 255 manufacturers that are in addition to those required by Title 256 XIX of the Social Security Act and at no less than 14 percent of 257 the average manufacturer price as defined in 42 U.S.C. s. 1936 258 on the last day of a quarter unless the federal or supplemental 259 rebate, or both, equals or exceeds 29 percent. There is no upper 260 limit on the supplemental rebates the agency may negotiate. The 261 agency may determine that specific products, brand-name or 262 generic, are competitive at lower rebate percentages. Agreement 263 to pay the minimum supplemental rebate percentage guarantees a 264 manufacturer that the Medicaid Pharmaceutical and Therapeutics 265 Committee will consider a product for inclusion on the preferred 266 drug list. However, a pharmaceutical manufacturer is not 267 guaranteed placement on the preferred drug list by simply paying 268 the minimum supplemental rebate. Agency decisions will be made 269 on the clinical efficacy of a drug and recommendations of the 270 Medicaid Pharmaceutical and Therapeutics Committee, as well as 271 the price of competing products minus federal and state rebates. 272 The agency may contract with an outside agency or contractor to 273 conduct negotiations for supplemental rebates. For the purposes 274 of this section, the term “supplemental rebates” means cash 275 rebates. Value-added programs as a substitution for supplemental 276 rebates are prohibited. The agency may seek any federal waivers 277 to implement this initiative. 278 7.8.The agency shall expand home delivery of pharmacy 279 products. The agency may amend the state plan and issue a 280 procurement, as necessary, in order to implement this program. 281 The procurements must include agreements with a pharmacy or 282 pharmacies located in the state to provide mail order delivery 283 services at no cost to the recipients who elect to receive home 284 delivery of pharmacy products. The procurement must focus on 285 serving recipients with chronic diseases for which pharmacy 286 expenditures represent a significant portion of Medicaid 287 pharmacy expenditures or which impact a significant portion of 288 the Medicaid population. The agency may seek and implement any 289 federal waivers necessary to implement this subparagraph. 290 8.9.The agency shall limit to one dose per month any drug 291 prescribed to treat erectile dysfunction. 292 9.a.10.a.The agency may implement a Medicaid behavioral 293 drug management system. The agency may contract with a vendor 294 that has experience in operating behavioral drug management 295 systems to implement this program. The agency may seek federal 296 waivers to implement this program. 297 b. The agency, in conjunction with the Department of 298 Children and Families, may implement the Medicaid behavioral 299 drug management system that is designed to improve the quality 300 of care and behavioral health prescribing practices based on 301 best practice guidelines, improve patient adherence to 302 medication plans, reduce clinical risk, and lower prescribed 303 drug costs and the rate of inappropriate spending on Medicaid 304 behavioral drugs. The program may include the following 305 elements: 306 (I) Provide for the development and adoption of best 307 practice guidelines for behavioral health-related drugs such as 308 antipsychotics, antidepressants, and medications for treating 309 bipolar disorders and other behavioral conditions; translate 310 them into practice; review behavioral health prescribers and 311 compare their prescribing patterns to a number of indicators 312 that are based on national standards; and determine deviations 313 from best practice guidelines. 314 (II) Implement processes for providing feedback to and 315 educating prescribers using best practice educational materials 316 and peer-to-peer consultation. 317 (III) Assess Medicaid beneficiaries who are outliers in 318 their use of behavioral health drugs with regard to the numbers 319 and types of drugs taken, drug dosages, combination drug 320 therapies, and other indicators of improper use of behavioral 321 health drugs. 322 (IV) Alert prescribers to patients who fail to refill 323 prescriptions in a timely fashion, are prescribed multiple same 324 class behavioral health drugs, and may have other potential 325 medication problems. 326 (V) Track spending trends for behavioral health drugs and 327 deviation from best practice guidelines. 328 (VI) Use educational and technological approaches to 329 promote best practices, educate consumers, and train prescribers 330 in the use of practice guidelines. 331 (VII) Disseminate electronic and published materials. 332 (VIII) Hold statewide and regional conferences. 333 (IX) Implement a disease management program with a model 334 quality-based medication component for severely mentally ill 335 individuals and emotionally disturbed children who are high 336 users of care. 337 10.11.The agency shall implement a Medicaid prescription 338 drug management system. 339 a. The agency may contract with a vendor that has 340 experience in operating prescription drug management systems in 341 order to implement this system. Any management system that is 342 implemented in accordance with this subparagraph must rely on 343 cooperation between physicians and pharmacists to determine 344 appropriate practice patterns and clinical guidelines to improve 345 the prescribing, dispensing, and use of drugs in the Medicaid 346 program. The agency may seek federal waivers to implement this 347 program. 348 b. The drug management system must be designed to improve 349 the quality of care and prescribing practices based on best 350 practice guidelines, improve patient adherence to medication 351 plans, reduce clinical risk, and lower prescribed drug costs and 352 the rate of inappropriate spending on Medicaid prescription 353 drugs. The program must: 354 (I) Provide for the adoption of best practice guidelines 355 for the prescribing and use of drugs in the Medicaid program, 356 including translating best practice guidelines into practice; 357 reviewing prescriber patterns and comparing them to indicators 358 that are based on national standards and practice patterns of 359 clinical peers in their community, statewide, and nationally; 360 and determine deviations from best practice guidelines. 361 (II) Implement processes for providing feedback to and 362 educating prescribers using best practice educational materials 363 and peer-to-peer consultation. 364 (III) Assess Medicaid recipients who are outliers in their 365 use of a single or multiple prescription drugs with regard to 366 the numbers and types of drugs taken, drug dosages, combination 367 drug therapies, and other indicators of improper use of 368 prescription drugs. 369 (IV) Alert prescribers to recipients who fail to refill 370 prescriptions in a timely fashion, are prescribed multiple drugs 371 that may be redundant or contraindicated, or may have other 372 potential medication problems. 373 11.12.The agency may contract for drug rebate 374 administration, including, but not limited to, calculating 375 rebate amounts, invoicing manufacturers, negotiating disputes 376 with manufacturers, and maintaining a database of rebate 377 collections. 378 12.13.The agency may specify the preferred daily dosing 379 form or strength for the purpose of promoting best practices 380 with regard to the prescribing of certain drugs as specified in 381 the General Appropriations Act and ensuring cost-effective 382 prescribing practices. 383 13.14.The agency may require prior authorization for 384 Medicaid-covered prescribed drugs. The agency may prior 385 authorize the use of a product: 386 a. For an indication not approved in labeling; 387 b. To comply with certain clinical guidelines; or 388 c. If the product has the potential for overuse, misuse, or 389 abuse. 390 391 The agency may require the prescribing professional to provide 392 information about the rationale and supporting medical evidence 393 for the use of a drug. The agency shall post prior 394 authorization, step-edit criteria and protocol, and updates to 395 the list of drugs that are subject to prior authorization on the 396 agency’s Internet website within 21 days after the prior 397 authorization and step-edit criteria and protocol and updates 398 are approved by the agency. For purposes of this subparagraph, 399 the term “step-edit” means an automatic electronic review of 400 certain medications subject to prior authorization. 401 14.15.The agency, in conjunction with the Pharmaceutical 402 and Therapeutics Committee, may require age-related prior 403 authorizations for certain prescribed drugs. The agency may 404 preauthorize the use of a drug for a recipient who may not meet 405 the age requirement or may exceed the length of therapy for use 406 of this product as recommended by the manufacturer and approved 407 by the Food and Drug Administration. Prior authorization may 408 require the prescribing professional to provide information 409 about the rationale and supporting medical evidence for the use 410 of a drug. 411 15.16.The agency shall implement a step-therapy prior 412 authorization approval process for medications excluded from the 413 preferred drug list. Medications listed on the preferred drug 414 list must be used within the previous 12 months before the 415 alternative medications that are not listed. The step-therapy 416 prior authorization may require the prescriber to use the 417 medications of a similar drug class or for a similar medical 418 indication unless contraindicated in the Food and Drug 419 Administration labeling. The trial period between the specified 420 steps may vary according to the medical indication. The step 421 therapy approval process shall be developed in accordance with 422 the committee as stated in s. 409.91195(7) and (8). A drug 423 product may be approved without meeting the step-therapy prior 424 authorization criteria if the prescribing physician provides the 425 agency with additional written medical or clinical documentation 426 that the product is medically necessary because: 427 a. There is not a drug on the preferred drug list to treat 428 the disease or medical condition which is an acceptable clinical 429 alternative; 430 b. The alternatives have been ineffective in the treatment 431 of the beneficiary’s disease; or 432 c. Based on historic evidence and known characteristics of 433 the patient and the drug, the drug is likely to be ineffective, 434 or the number of doses have been ineffective. 435 436 The agency shall work with the physician to determine the best 437 alternative for the patient. The agency may adopt rules waiving 438 the requirements for written clinical documentation for specific 439 drugs in limited clinical situations. 440 16.17.The agency shall implement a return and reuse 441 program for drugs dispensed by pharmacies to institutional 442 recipients, which includes payment of a $5 restocking fee for 443 the implementation and operation of the program. The return and 444 reuse program shall be implemented electronically and in a 445 manner that promotes efficiency. The program must permit a 446 pharmacy to exclude drugs from the program if it is not 447 practical or cost-effective for the drug to be included and must 448 provide for the return to inventory of drugs that cannot be 449 credited or returned in a cost-effective manner. The agency 450 shall determine if the program has reduced the amount of 451 Medicaid prescription drugs which are destroyed on an annual 452 basis and if there are additional ways to ensure more 453 prescription drugs are not destroyed which could safely be 454 reused. 455 Section 4. Section 456.0392, Florida Statutes, is amended 456 to read: 457 456.0392 Prescription labeling.— 458 (1) A prescriptionwrittenby a practitioner who is 459 authorized under the laws of this state to prescribewrite460prescriptions fordrugs that are not listed as controlled 461 substances in chapter 893 but who is not eligible for a federal 462 Drug Enforcement Administration number shall include that 463 practitioner’s name and professional license number. The 464 pharmacist or dispensing practitioner must include the 465 practitioner’s name on the container of the drug that is 466 dispensed. A pharmacist shall be permitted, upon verification by 467 the prescriber, to document any information required by this 468 section. 469 (2) A prescription for a drug that is not listed as a 470 controlled substance in chapter 893which is writtenby an 471 advanced practice registered nurse licensed under s. 464.012 is 472 presumed, subject to rebuttal, to be valid and within the 473 parameters of the prescriptive authority delegated by a 474 practitioner licensed under chapter 458, chapter 459, or chapter 475 466. 476 (3) A prescription for a drug that is not listed as a 477 controlled substance in chapter 893which is writtenby a 478 physician assistant licensed under chapter 458 or chapter 459 is 479 presumed, subject to rebuttal, to be valid and within the 480 parameters of the prescriptive authority delegated by the 481 physician assistant’s supervising physician. 482 Section 5. Paragraph (d) of subsection (3) of section 483 458.3265, Florida Statutes, is amended to read: 484 458.3265 Pain-management clinics.— 485 (3) PHYSICIAN RESPONSIBILITIES.—These responsibilities 486 apply to any physician who provides professional services in a 487 pain-management clinic that is required to be registered in 488 subsection (1). 489 (d) A physician authorized to prescribe controlled 490 substances who practices at a pain-management clinic is 491 responsible for maintaining the control and security of his or 492 her electronic prescribing softwareprescription blanks and any493other methodused for prescribing controlled substance pain 494 medication.The physician shall comply with the requirements for495counterfeit-resistant prescription blanks in s. 893.065 and the496rules adopted pursuant to that section.The physician shall 497 notify, in writing, the department within 24 hours after 498followinganytheft or loss of a prescription blank orbreach of 499 his or her electronic prescribing softwareany other method for500prescribing pain medication. 501 Section 6. Paragraph (qq) of subsection (1) of section 502 458.331, Florida Statutes, is amended to read: 503 458.331 Grounds for disciplinary action; action by the 504 board and department.— 505 (1) The following acts constitute grounds for denial of a 506 license or disciplinary action, as specified in s. 456.072(2): 507 (qq) Failing to timely notify the department ofthe theft508of prescription blanks from a pain-management clinic ora breach 509 of a physician’s electronic prescribing softwareother methods510for prescribingwithin 24 hours as required by s. 458.3265(3). 511 Section 7. Paragraph (e) of subsection (4) of section 512 458.347, Florida Statutes, is amended to read: 513 458.347 Physician assistants.— 514 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.— 515 (e) A supervising physician may delegate to a fully 516 licensed physician assistant the authority to prescribe or 517 dispense any medication used in the supervising physician’s 518 practice unless such medication is listed on the formulary 519 created pursuant to paragraph (f). A fully licensed physician 520 assistant may only prescribe or dispense such medication under 521 the following circumstances: 522 1. A physician assistant must clearly identify to the 523 patient that he or she is a physician assistant and inform the 524 patient that the patient has the right to see the physician 525 before a prescription is prescribed or dispensed by the 526 physician assistant. 527 2. The supervising physician must notify the department of 528 his or her intent to delegate, on a department-approved form, 529 before delegating such authority and of any change in 530 prescriptive privileges of the physician assistant. Authority to 531 dispense may be delegated only by a supervising physician who is 532 registered as a dispensing practitioner in compliance with s. 533 465.0276. 534 3. The physician assistant must complete a minimum of 10 535 continuing medical education hours in the specialty practice in 536 which the physician assistant has prescriptive privileges with 537 each licensure renewal. Three of the 10 hours must consist of a 538 continuing education course on the safe and effective 539 prescribing of controlled substance medications which is offered 540 by a statewide professional association of physicians in this 541 state accredited to provide educational activities designated 542 for the American Medical Association Physician’s Recognition 543 Award Category 1 credit or designated by the American Academy of 544 Physician Assistants as a Category 1 credit. 545 4. The department may issue a prescriber number to the 546 physician assistant granting authority for the prescribing of 547 medicinal drugs authorized within this paragraph upon completion 548 of the requirements of this paragraph. The physician assistant 549 is not required to independently register pursuant to s. 550 465.0276. 551 5. The prescriptionmay be in paper or electronic form but552must comply with ss. 456.0392(1) and 456.42(1) and chapter 499553andmust contain, in addition to the supervising physician’s 554 name, address, and telephone number, the physician assistant’s 555 prescriber number. Unless it is a drug or drug sample dispensed 556 by the physician assistant, the prescription must be filled in a 557 pharmacy permitted under chapter 465 and must be dispensed in 558 that pharmacy by a pharmacist licensed under chapter 465. The 559 inclusion of the prescriber number creates a presumption that 560 the physician assistant is authorized to prescribe the medicinal 561 drug and the prescription is valid. 562 6. The physician assistant must note the prescription or 563 dispensing of medication in the appropriate medical record. 564 Section 8. Paragraph (d) of subsection (3) of section 565 459.0137, Florida Statutes, is amended to read: 566 459.0137 Pain-management clinics.— 567 (3) PHYSICIAN RESPONSIBILITIES.—These responsibilities 568 apply to any osteopathic physician who provides professional 569 services in a pain-management clinic that is required to be 570 registered in subsection (1). 571 (d) An osteopathic physician authorized to prescribe 572 controlled substances who practices at a pain-management clinic 573 is responsible for maintaining the control and security of his 574 or her electronic prescribing softwareprescription blanks and575any other methodused for prescribing controlled substance pain 576 medication.The osteopathic physician shall comply with the577requirements for counterfeit-resistant prescription blanks in s.578893.065 and the rules adopted pursuant to that section.The 579 osteopathic physician shall notify, in writing, the department 580 within 24 hours afterfollowinganytheft or loss of a581prescription blank orbreach of his or her electronic 582 prescribing softwareof any other method for prescribing pain583medication. 584 Section 9. Paragraph (ss) of subsection (1) of section 585 459.015, Florida Statutes, is amended to read: 586 459.015 Grounds for disciplinary action; action by the 587 board and department.— 588 (1) The following acts constitute grounds for denial of a 589 license or disciplinary action, as specified in s. 456.072(2): 590 (ss) Failing to timely notify the department ofthe theft591of prescription blanks from a pain-management clinic ora breach 592 of an osteopathic physician’s electronic prescribing softwareof593other methods for prescribingwithin 24 hours as required by s. 594 459.0137(3). 595 Section 10. Paragraph (e) of subsection (4) of section 596 459.022, Florida Statutes, is amended to read: 597 459.022 Physician assistants.— 598 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.— 599 (e) A supervising physician may delegate to a fully 600 licensed physician assistant the authority to prescribe or 601 dispense any medication used in the supervising physician’s 602 practice unless such medication is listed on the formulary 603 created pursuant to s. 458.347. A fully licensed physician 604 assistant may only prescribe or dispense such medication under 605 the following circumstances: 606 1. A physician assistant must clearly identify to the 607 patient that she or he is a physician assistant and must inform 608 the patient that the patient has the right to see the physician 609 before a prescription is prescribed or dispensed by the 610 physician assistant. 611 2. The supervising physician must notify the department of 612 her or his intent to delegate, on a department-approved form, 613 before delegating such authority and of any change in 614 prescriptive privileges of the physician assistant. Authority to 615 dispense may be delegated only by a supervising physician who is 616 registered as a dispensing practitioner in compliance with s. 617 465.0276. 618 3. The physician assistant must complete a minimum of 10 619 continuing medical education hours in the specialty practice in 620 which the physician assistant has prescriptive privileges with 621 each licensure renewal. 622 4. The department may issue a prescriber number to the 623 physician assistant granting authority for the prescribing of 624 medicinal drugs authorized within this paragraph upon completion 625 of the requirements of this paragraph. The physician assistant 626 is not required to independently register pursuant to s. 627 465.0276. 628 5. The prescriptionmay be in paper or electronic form but629must comply with ss. 456.0392(1) and 456.42(1) and chapter 499630andmust contain, in addition to the supervising physician’s 631 name, address, and telephone number, the physician assistant’s 632 prescriber number. Unless it is a drug or drug sample dispensed 633 by the physician assistant, the prescription must be filled in a 634 pharmacy permitted under chapter 465, and must be dispensed in 635 that pharmacy by a pharmacist licensed under chapter 465. The 636 inclusion of the prescriber number creates a presumption that 637 the physician assistant is authorized to prescribe the medicinal 638 drug and the prescription is valid. 639 6. The physician assistant must note the prescription or 640 dispensing of medication in the appropriate medical record. 641 Section 11. Sections 456.43, 831.311, and 893.065, Florida 642 Statutes, are repealed. 643 Section 12. This act shall take effect January 1, 2020.