BON: Clarification of the 90 day provision for prescriptions of narcotics

Please see the letter below that we received from the Board of Nursing this morning.
Thank you
Emily Eastin
TNP Executive Director

Good morning:

As some of you are aware, a number of APRNs have experienced difficulty with prescriptions that were written for controlled substances.  The difficulty arose as a result of the following statement in Section 157.0511(b) of the Medical Practice Act (Texas Occupations Code) that addresses physician delegation of prescriptive authority for controlled substances:

(2)  the prescription, including a refill of the prescription, is for a period not to exceed 90 days;

Although the law allows prescriptions for up to a 90 day supply of controlled substances, some pharmacists refused to fill prescriptions that were written with more than one refill (e.g. 30 day supply with two refills).  As rationale, the pharmacists cited the above section of the law and indicated that a refill means only one refill.  Therefore, in order to prescribe the 90 day supply, the prescription would have to be written to dispense the full 90 day supply or to dispense a 45 day supply with one refill.

In November 2013, staff of the BON, the Texas Medical Board, Texas Pharmacy Board, and the Texas Department of Public Safety met and agreed that the statute should be interpreted to allow a prescription for controlled substances for up to a 90 day supply.  As long as the original prescription plus the number of refills permitted does not exceed a 90 day supply of the controlled substance, the prescription should be filled as written.  At the December 2013 Board meeting, staff of the Texas Medical Board presented this information to the Texas Medical Board for discussion and approval of this interpretation of the Medical Practice Act.  The TMB approved this interpretation of the statute.

The Texas State Board of Pharmacy posted information regarding this issue on its website: www.tsbp.state.tx.us.  Scroll to the heading "Updates, News and Notices" and click on the link for information on controlled substance prescriptions from APRNs and PAs.  Should further concerns or issues arise, pharmacists may be referred to this page of the TSBP website for clarification.

For APNAC members, we are respectfully requesting that you share this information with your respective professional organizations.  Thank you for helping us get the word to APRNs as quickly as we can.  Please let me know if you have any questions or I can provide you with additional information.

Sincerely,
Jolene Zych, PhD, RN, WHNP-BC
Nurse Consultant--Advanced Practice