Understanding the Texas Prescription Monitoring Program

The Texas Prescription Monitoring Program (PMP) is the state’s data collection and monitoring system for prescribed Schedule II, III, IV, and V controlled substances. The data collected includes all such prescriptions dispensed by Texas pharmacies and out-of-state pharmacies for Texas residents. The PMP also monitors the prescription information of patients for medical practitioners. 

As a result, pharmacies and medical professionals who prescribe controlled substances have certain duties and responsibilities concerning the PMP. Failure to comply with these laws can lead to disciplinary action by Texas licensing boards, including license revocation, suspension, or probation. With so much at stake, we urge you to seek the counsel of an experienced professional license defense attorney if you are facing allegations of misconduct related to the PMP. 

Pharmacy Obligations Under the PMP

All Texas-licensed pharmacies must report all controlled substance prescriptions they fill to the PMP no later than the next business day after filling the prescription. This reporting requirement applies to all Schedule II, III, IV, and V controlled substances. Failure to report the dispensing of prescriptions for controlled substances can result in administrative, civil, and even criminal penalties. 

Under 22 Tex. Admin. Code § 315.5, Texas pharmacists also must take note of the issuance dates of the prescriptions for controlled substances. For instance, prescriptions for Schedule II controlled substances must be presented within 30 days of issuance. If a practitioner issues multiple prescriptions allowing up to a 90-day supply of Schedule II controlled substances, the pharmacist must ensure that each prescription is not dispensed before the earliest date that the practitioner intended, nor beyond 30 days from the earliest date that it may be dispensed.

Likewise, prescriptions for Schedule II controlled substances become void 30 days after issuance or 30 days after their earliest dispense date. Prescriptions for Schedule III, IV, or V controlled substances become void six months after issuance or after being dispensed five times during the six months after issuance. 

Furthermore, as of March 1, 2020, pharmacists must check a patient’s PMP history before filling any prescription for opioids, benzodiazepines, barbiturates, or carisoprodol. The purpose of this requirement is to help prevent duplicate and excess prescribing of controlled substances to patients and obtain critical controlled substance history information for patients. 

Physician Obligations Under the PMP

Physicians also have requirements under the PMP, according to 22 Tex. Admin. Code § 170.9. Like pharmacists, physicians must check a patient’s PMP history before prescribing opioids, benzodiazepines, barbiturates, or carisoprodol. The physician must complete this review every time they issue a prescription for one of these controlled substances in any of the following situations:

  • take-home use, upon leaving an outpatient setting, such as a doctor’s office or ambulatory surgical center; or
  • upon discharge from an inpatient setting, such as a hospital admission or an emergency department visit.

However, a physician need not check the PMP before prescribing one of these controlled substances before or during an inpatient stay, such as in the context of a hospital admission, or during certain outpatient encounters, such as in the emergency room or an ambulatory surgery center. Furthermore, PMP checks are not mandatory when a physician issues these drugs to a patient receiving hospice care, cancer treatment, or treatment for sickle cell disease, as documented in the patient’s medical records. A PMP check is also unnecessary when a physician makes a good faith effort to comply but cannot access the PMP due to circumstances beyond their control. 

APRNs, PAs, and the PMP

Like physicians and pharmacists, advanced practice registered nurses (APRNs) with prescriptive authority generally must access and review the PMP for patients before prescribing opioids, benzodiazepines, barbiturates, or carisoprodol under 22 Tex. Admin. Code § 222.8. The only exception is if the APRN prescribes the drug as a part of cancer treatment or hospice care, and that treatment is documented in the patient’s electronic prescription record. Whenever an APRN prescribes a controlled substance, documentation that the APRN reviewed the PMP and their rationale for prescribing it must be included in the patient’s medical record. 

APRNs are not subject to discipline if they make a good-faith effort to access the PMP and cannot do so due to circumstances outside their control. In this situation, the APRN must document their attempt to access the PMP on the patient’s prescription or electronic prescription record and why their attempt was unsuccessful. 

Under Tex. Occ. Code § 157.0511(b)(2), a physician may delegate the task of prescribing Schedule III, IV, or V controlled substances to APRNs or PAs, so long as the total amount of the prescription, including refills, does not exceed 90 days. 

Furthermore, APRNs may prescribe Schedule II controlled substances only in the following scenarios:

  • In a hospital facility-based practice, according to hospital policies, as part of care to a patient who:
    • Has been admitted to the hospital for a stay of 24 hours or later; or
    • Is receiving services in the emergency department; or
  • As part of a care plan for a person with a terminal illness who has elected for hospice care and is receiving hospice care from a qualified hospice provider.

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We Can Help Protect Your Professional License

If you are facing allegations of misconduct concerning your PMP duties and responsibilities under the law, you should immediately contact your attorney. 

Our law firm helps professionals like you safeguard their licenses when those licenses are under attack by a licensing board. We are here to help you fight back to protect your professional license and preserve your career. Call us today at (512) 515-9518 to reach the offices of Bertolino LLP, or contact us online.

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