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2018 SESSION
18101556DBe it enacted by the General Assembly of Virginia:
1. That § 54.1-3303 of the Code of Virginia is amended and reenacted as follows:
§ 54.1-3303. Prescriptions to be issued and drugs to be dispensed for medical or therapeutic purposes only.
A. A prescription for a controlled substance may be issued only by a practitioner of medicine, osteopathy, podiatry, dentistry or veterinary medicine who is authorized to prescribe controlled substances, or by a licensed nurse practitioner pursuant to § 54.1-2957.01, a licensed physician assistant pursuant to § 54.1-2952.1, or a TPA-certified optometrist pursuant to Article 5 (§ 54.1-3222 et seq.) of Chapter 32.
The B. A prescription
shall be issued for a medicinal or
therapeutic purpose and may be issued only to persons or
animals with whom the practitioner has a bona fide practitioner-patient
relationship.
For purposes of this
section, a bona fide practitioner-patient-pharmacist relationship is one in
which a practitioner prescribes, and a pharmacist dispenses, controlled
substances in good faith to his patient for a medicinal or therapeutic purpose
within the course of his professional practice. In addition, a A bona
fide practitioner-patient relationship means
that shall
exist if the practitioner shall has
(i) ensure that obtained or caused to
be obtained a medical or drug history is
obtained of
the patient; (ii) provide provided
information to the patient about the benefits and risks of the drug being
prescribed; (iii) perform performed
or have caused to be
performed an appropriate examination of the patient, either physically or by
the use of instrumentation and diagnostic equipment through which images and
medical records may be transmitted electronically;
except for medical emergencies, the examination of the patient shall have been
performed by the practitioner himself, within the group in which he practices,
or by a consulting practitioner prior to issuing a prescription;
and (iv) initiate initiated
additional interventions and follow-up care, if necessary, especially if a
prescribed drug may have serious side effects.
Except in cases involving a medical emergency, the examination required
pursuant to clause (iii) shall be performed
by the practitioner prescribing the controlled substance, a practitioner who
practices in the same group as the practitioner prescribing the controlled
substance, or a consulting practitioner. In
cases in which the practitioner is an employee of the Department of Health and
is providing expedited
partner therapy, as defined by the Department of
Health and consistent with the
recommendations of the Centers for Disease Control and Prevention, to a person
18 years of age or older for the
purpose of treating a diagnosed or
suspected case of chlamydia or gonorrhea, the
examination required by clause (iii) shall not be required.
A practitioner who performs
or has performed an appropriate examination of the patient required pursuant to
clause (iii), either physically or by the use of instrumentation and diagnostic
equipment through which images and medical records may be transmitted
electronically, for the purpose of establishing a bona fide
practitioner-patient relationship, has
established a bona fide practitioner-patient relationship with a patient
in accordance with the provisions of this subsection may
prescribe Schedule II through VI controlled substances to the that
patient, provided that, in cases in which
the practitioner has performed the examination required pursuant to clause
(iii) by use of instrumentation and diagnostic equipment through which images
and medical records may be transmitted electronically, the
prescribing of such Schedule II through V controlled substance is in compliance
with federal requirements for the practice of telemedicine.
For the purpose of prescribing a Schedule VI controlled substance to a patient via telemedicine services as defined in § 38.2-3418.16, a prescriber may establish a bona fide practitioner-patient relationship by an examination through face-to-face interactive, two-way, real-time communications services or store-and-forward technologies when all of the following conditions are met: (a) the patient has provided a medical history that is available for review by the prescriber; (b) the prescriber obtains an updated medical history at the time of prescribing; (c) the prescriber makes a diagnosis at the time of prescribing; (d) the prescriber conforms to the standard of care expected of in-person care as appropriate to the patient's age and presenting condition, including when the standard of care requires the use of diagnostic testing and performance of a physical examination, which may be carried out through the use of peripheral devices appropriate to the patient's condition; (e) the prescriber is actively licensed in the Commonwealth and authorized to prescribe; (f) if the patient is a member or enrollee of a health plan or carrier, the prescriber has been credentialed by the health plan or carrier as a participating provider and the diagnosing and prescribing meets the qualifications for reimbursement by the health plan or carrier pursuant to § 38.2-3418.16; and (g) upon request, the prescriber provides patient records in a timely manner in accordance with the provisions of § 32.1-127.1:03 and all other state and federal laws and regulations. Nothing in this paragraph shall permit a prescriber to establish a bona fide practitioner-patient relationship for the purpose of prescribing a Schedule VI controlled substance when the standard of care dictates that an in-person physical examination is necessary for diagnosis. Nothing in this paragraph shall apply to: (1) a prescriber providing on-call coverage per an agreement with another prescriber or his prescriber's professional entity or employer; (2) a prescriber consulting with another prescriber regarding a patient's care; or (3) orders of prescribers for hospital out-patients or in-patients.
Any C. A prescription shall only be issued for a medicinal
or therapeutic purpose in the usual course of treatment or for authorized
research. A prescription not issued in the usual course of treatment or for
authorized research is not a valid prescription. A practitioner
who prescribes any controlled substance with the knowledge that the controlled
substance will be used otherwise than medicinally
or for medicinal
or therapeutic purposes shall be subject to the criminal
penalties provided in § 18.2-248 for violations of the provisions of law
relating to the distribution or possession of controlled substances.
B. D. No prescription shall
be filled unless a bona fide practitioner-patient-pharmacist relationship
exists. A bona fide practitioner-patient-pharmacist
relationship shall exist in cases in which a practitioner prescribes, and a
pharmacist dispenses, controlled substances in good faith to a patient for a
medicinal or therapeutic purpose within the course of his professional
practice.
In order
to determine whether a prescription that appears questionable to the pharmacist
results from cases
in which it is not clear to a pharmacist that a bona fide
practitioner-patient relationship exists between a
prescriber and a patient, the a
pharmacist shall contact the prescribing practitioner or his agent and verify
the identity of the patient and name and quantity of the drug prescribed.
The Any person
knowingly filling an invalid prescription shall be subject to the criminal
penalties provided in § 18.2-248 for violations of the provisions of law
relating to the sale, distribution or possession of controlled substances.
No prescription shall
be filled unless there is a bona fide practitioner-patient-pharmacist
relationship.
A prescription not
issued in the usual course of treatment or for authorized research is not a
valid prescription.
C. E. Notwithstanding any
provision of law to the contrary and consistent with recommendations of the
Centers for Disease Control and Prevention or the Department of Health, a
practitioner may prescribe Schedule VI antibiotics and antiviral agents to
other persons in close contact with a diagnosed patient when (i) the
practitioner meets all requirements of a bona fide practitioner-patient
relationship, as defined in subsection A B,
with the diagnosed patient; (ii) in the practitioner's professional judgment,
the practitioner deems there is urgency to begin treatment to prevent the
transmission of a communicable disease; (iii) the practitioner has met all
requirements of a bona fide practitioner-patient relationship, as defined in
subsection A B,
for the close contact except for the physical examination required in clause
(iii) of subsection A B;
and (iv) when such emergency treatment is necessary to prevent imminent risk of
death, life-threatening illness, or serious disability.
D. F. A pharmacist may dispense a
controlled substance pursuant to a prescription of an out-of-state practitioner
of medicine, osteopathy, podiatry, dentistry, optometry, or veterinary
medicine, a nurse practitioner, or a physician assistant authorized to issue
such prescription if the prescription complies with the requirements of this
chapter and the Drug Control Act (§ 54.1-3400 et seq.).
E. G. A licensed nurse
practitioner who is authorized to prescribe controlled substances pursuant to §
54.1-2957.01 may issue prescriptions or provide manufacturers' professional
samples for controlled substances and devices as set forth in the Drug Control
Act (§ 54.1-3400 et seq.) in good faith to his patient for a medicinal or
therapeutic purpose within the scope of his professional practice.
F. H. A licensed physician
assistant who is authorized to prescribe controlled substances pursuant to §
54.1-2952.1 may issue prescriptions or provide manufacturers' professional
samples for controlled substances and devices as set forth in the Drug Control
Act (§ 54.1-3400 et seq.) in good faith to his patient for a medicinal or
therapeutic purpose within the scope of his professional practice.
G. I. A TPA-certified optometrist
who is authorized to prescribe controlled substances pursuant to Article 5 (§
54.1-3222 et seq.) of Chapter 32 may issue prescriptions in good faith or
provide manufacturers' professional samples to his patients for medicinal or
therapeutic purposes within the scope of his professional practice for the
drugs specified on the TPA-Formulary, established pursuant to § 54.1-3223,
which shall be limited to (i) analgesics included on Schedule II controlled
substances as defined in § 54.1-3448 of the Drug Control Act (§ 54.1-3400 et
seq.) consisting of hydrocodone in combination with acetaminophen; (ii) oral
analgesics included in Schedules III through VI, as defined in §§ 54.1-3450 and
54.1-3455 of the Drug Control Act (§ 54.1-3400 et seq.), which are appropriate
to relieve ocular pain; (iii) other oral Schedule VI controlled substances, as
defined in § 54.1-3455 of the Drug Control Act, appropriate to treat diseases
and abnormal conditions of the human eye and its adnexa; (iv) topically applied
Schedule VI drugs, as defined in § 54.1-3455 of the Drug Control Act; and (v)
intramuscular administration of epinephrine for treatment of emergency cases of
anaphylactic shock.
H. J. The requirement for a bona
fide practitioner-patient relationship shall be deemed to be satisfied by a
member or committee of a hospital's medical staff when approving a standing order
or protocol for the administration of influenza vaccinations and pneumococcal
vaccinations in a hospital in compliance with § 32.1-126.4.
2. That the Commissioner of Health shall convene a workgroup consisting of staff of the Department of Health and practitioners engaged in private practice to evaluate services provided by the Department of Health pursuant to this act and to make appropriate recommendations for the use of expedited partner therapy in the Commonwealth. The Commissioner of Health shall report to the Secretary of Health and Human Resources concerning his findings and recommendations by July 1, 2019.
3. That the provisions of this act shall expire on July 1, 2020.