Florida Senate - 2019                          SENATOR AMENDMENT
       Bill No. CS for HB 831
       
       
       
       
       
       
                                Ì161690*Î161690                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                Floor: 1/AD/3R         .            Floor: C            
             05/01/2019 02:31 PM       .      05/02/2019 12:36 PM       
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       Senator Bean moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 456.42, Florida Statutes, is amended to
    6  read:
    7         456.42 Written prescriptions for medicinal drugs.—
    8         (1) A written prescription for a medicinal drug issued by a
    9  health care practitioner licensed by law to prescribe such drug
   10  must be legibly printed or typed so as to be capable of being
   11  understood by the pharmacist filling the prescription; must
   12  contain the name of the prescribing practitioner, the name and
   13  strength of the drug prescribed, the quantity of the drug
   14  prescribed, and the directions for use of the drug; must be
   15  dated; and must be signed by the prescribing practitioner on the
   16  day when issued. However, a prescription that is electronically
   17  generated and transmitted must contain the name of the
   18  prescribing practitioner, the name and strength of the drug
   19  prescribed, the quantity of the drug prescribed in numerical
   20  format, and the directions for use of the drug and must contain
   21  the date and an electronic signature, as defined in s.
   22  668.003(4), be dated and signed by the prescribing practitioner
   23  only on the day issued, which signature may be in an electronic
   24  format as defined in s. 668.003(4).
   25         (2) A written prescription for a controlled substance
   26  listed in chapter 893 must have the quantity of the drug
   27  prescribed in both textual and numerical formats, must be dated
   28  in numerical, month/day/year format, or with the abbreviated
   29  month written out, or the month written out in whole, and must
   30  be either written on a standardized counterfeit-proof
   31  prescription pad produced by a vendor approved by the department
   32  or electronically prescribed as that term is used in s.
   33  408.0611. As a condition of being an approved vendor, a
   34  prescription pad vendor must submit a monthly report to the
   35  department that, at a minimum, documents the number of
   36  prescription pads sold and identifies the purchasers. The
   37  department may, by rule, require the reporting of additional
   38  information.
   39         (3) A health care practitioner licensed by law to prescribe
   40  a medicinal drug who maintains a system of electronic health
   41  records as defined in s. 408.051(2)(a), or who prescribes
   42  medicinal drugs as an owner, an employee, or a contractor of a
   43  licensed health care facility or practice that maintains such a
   44  system and who is prescribing in his or her capacity as such an
   45  owner, an employee, or a contractor, may only electronically
   46  transmit prescriptions for such drugs. This requirement applies
   47  to such a health care practitioner upon renewal of the health
   48  care practitioner’s license or by July 1, 2021, whichever is
   49  earlier, but does not apply if:
   50         (a) The practitioner and the dispenser are the same entity;
   51         (b) The prescription cannot be transmitted electronically
   52  under the most recently implemented version of the National
   53  Council for Prescription Drug Programs SCRIPT Standard;
   54         (c) The practitioner has been issued a waiver by the
   55  department, not to exceed 1 year in duration, from the
   56  requirement to use electronic prescribing due to demonstrated
   57  economic hardship, technological limitations that are not
   58  reasonably within the control of the practitioner, or another
   59  exceptional circumstance demonstrated by the practitioner;
   60         (d) The practitioner reasonably determines that it would be
   61  impractical for the patient in question to obtain a medicinal
   62  drug prescribed by electronic prescription in a timely manner
   63  and such delay would adversely impact the patient’s medical
   64  condition;
   65         (e) The practitioner is prescribing a drug under a research
   66  protocol;
   67         (f) The prescription is for a drug for which the federal
   68  Food and Drug Administration requires the prescription to
   69  contain elements that may not be included in electronic
   70  prescribing; or
   71         (g) The prescription is issued to an individual receiving
   72  hospice care or who is a resident of a nursing home facility.
   73         (h) The practitioner determines that it is in the best
   74  interest of the patient, or the patient determines that it is in
   75  his or her own best interest, to compare prescription drug
   76  prices among area pharmacies. The practitioner must document
   77  such determination in the patient’s medical record.
   78  
   79  The department, in consultation with the Board of Medicine, the
   80  Board of Osteopathic Medicine, the Board of Podiatric Medicine,
   81  the Board of Dentistry, the Board of Nursing, and the Board of
   82  Optometry, may adopt rules to implement this subsection.
   83         Section 2. Section 456.43, Florida Statutes, is amended to
   84  read:
   85         456.43 Electronic prescribing for medicinal drugs.—
   86         (1) Electronic prescribing may shall not interfere with a
   87  patient’s freedom to choose a pharmacy.
   88         (2) Electronic prescribing software may shall not use any
   89  means or permit any other person to use any means to influence
   90  or attempt to influence, through economic incentives or
   91  otherwise, the prescribing decision of a prescribing
   92  practitioner or his or her agent at the point of care,
   93  including, but not limited to, means such as advertising,
   94  instant messaging, and pop-up ads, and similar means to
   95  influence or attempt to influence, through economic incentives
   96  or otherwise, the prescribing decision of a prescribing
   97  practitioner at the point of care. Such means shall not be
   98  triggered by or in specific response to the input, selection, or
   99  act of a prescribing practitioner or his or her agent in
  100  prescribing a certain medicinal drug pharmaceutical or directing
  101  a patient to a certain pharmacy. For purposes of this
  102  subsection, the term:
  103         (a) The term “Prescribing decision” means a prescribing
  104  practitioner’s or his or her agent’s decision to prescribe any
  105  medicinal drug a certain pharmaceutical.
  106         (b) The term “Point of care” means the time at which that a
  107  prescribing practitioner or his or her agent prescribes any
  108  medicinal drug is in the act of prescribing a certain
  109  pharmaceutical.
  110         (3) Electronic prescribing software may display show
  111  information regarding a payor’s formulary if as long as nothing
  112  is designed to preclude or make more difficult the selection of
  113  the act of a prescribing practitioner or patient selecting any
  114  particular pharmacy by a patient or the selection of a certain
  115  medicinal drug by a prescribing practitioner or his or her agent
  116  pharmaceutical.
  117         Section 3. Paragraph (a) of subsection (5) of section
  118  409.912, Florida Statutes, is amended to read:
  119         409.912 Cost-effective purchasing of health care.—The
  120  agency shall purchase goods and services for Medicaid recipients
  121  in the most cost-effective manner consistent with the delivery
  122  of quality medical care. To ensure that medical services are
  123  effectively utilized, the agency may, in any case, require a
  124  confirmation or second physician’s opinion of the correct
  125  diagnosis for purposes of authorizing future services under the
  126  Medicaid program. This section does not restrict access to
  127  emergency services or poststabilization care services as defined
  128  in 42 C.F.R. s. 438.114. Such confirmation or second opinion
  129  shall be rendered in a manner approved by the agency. The agency
  130  shall maximize the use of prepaid per capita and prepaid
  131  aggregate fixed-sum basis services when appropriate and other
  132  alternative service delivery and reimbursement methodologies,
  133  including competitive bidding pursuant to s. 287.057, designed
  134  to facilitate the cost-effective purchase of a case-managed
  135  continuum of care. The agency shall also require providers to
  136  minimize the exposure of recipients to the need for acute
  137  inpatient, custodial, and other institutional care and the
  138  inappropriate or unnecessary use of high-cost services. The
  139  agency shall contract with a vendor to monitor and evaluate the
  140  clinical practice patterns of providers in order to identify
  141  trends that are outside the normal practice patterns of a
  142  provider’s professional peers or the national guidelines of a
  143  provider’s professional association. The vendor must be able to
  144  provide information and counseling to a provider whose practice
  145  patterns are outside the norms, in consultation with the agency,
  146  to improve patient care and reduce inappropriate utilization.
  147  The agency may mandate prior authorization, drug therapy
  148  management, or disease management participation for certain
  149  populations of Medicaid beneficiaries, certain drug classes, or
  150  particular drugs to prevent fraud, abuse, overuse, and possible
  151  dangerous drug interactions. The Pharmaceutical and Therapeutics
  152  Committee shall make recommendations to the agency on drugs for
  153  which prior authorization is required. The agency shall inform
  154  the Pharmaceutical and Therapeutics Committee of its decisions
  155  regarding drugs subject to prior authorization. The agency is
  156  authorized to limit the entities it contracts with or enrolls as
  157  Medicaid providers by developing a provider network through
  158  provider credentialing. The agency may competitively bid single
  159  source-provider contracts if procurement of goods or services
  160  results in demonstrated cost savings to the state without
  161  limiting access to care. The agency may limit its network based
  162  on the assessment of beneficiary access to care, provider
  163  availability, provider quality standards, time and distance
  164  standards for access to care, the cultural competence of the
  165  provider network, demographic characteristics of Medicaid
  166  beneficiaries, practice and provider-to-beneficiary standards,
  167  appointment wait times, beneficiary use of services, provider
  168  turnover, provider profiling, provider licensure history,
  169  previous program integrity investigations and findings, peer
  170  review, provider Medicaid policy and billing compliance records,
  171  clinical and medical record audits, and other factors. Providers
  172  are not entitled to enrollment in the Medicaid provider network.
  173  The agency shall determine instances in which allowing Medicaid
  174  beneficiaries to purchase durable medical equipment and other
  175  goods is less expensive to the Medicaid program than long-term
  176  rental of the equipment or goods. The agency may establish rules
  177  to facilitate purchases in lieu of long-term rentals in order to
  178  protect against fraud and abuse in the Medicaid program as
  179  defined in s. 409.913. The agency may seek federal waivers
  180  necessary to administer these policies.
  181         (5)(a) The agency shall implement a Medicaid prescribed
  182  drug spending-control program that includes the following
  183  components:
  184         1. A Medicaid preferred drug list, which shall be a listing
  185  of cost-effective therapeutic options recommended by the
  186  Medicaid Pharmacy and Therapeutics Committee established
  187  pursuant to s. 409.91195 and adopted by the agency for each
  188  therapeutic class on the preferred drug list. At the discretion
  189  of the committee, and when feasible, the preferred drug list
  190  should include at least two products in a therapeutic class. The
  191  agency may post the preferred drug list and updates to the list
  192  on an Internet website without following the rulemaking
  193  procedures of chapter 120. Antiretroviral agents are excluded
  194  from the preferred drug list. The agency shall also limit the
  195  amount of a prescribed drug dispensed to no more than a 34-day
  196  supply unless the drug products’ smallest marketed package is
  197  greater than a 34-day supply, or the drug is determined by the
  198  agency to be a maintenance drug in which case a 100-day maximum
  199  supply may be authorized. The agency may seek any federal
  200  waivers necessary to implement these cost-control programs and
  201  to continue participation in the federal Medicaid rebate
  202  program, or alternatively to negotiate state-only manufacturer
  203  rebates. The agency may adopt rules to administer this
  204  subparagraph. The agency shall continue to provide unlimited
  205  contraceptive drugs and items. The agency must establish
  206  procedures to ensure that:
  207         a. There is a response to a request for prior consultation
  208  by telephone or other telecommunication device within 24 hours
  209  after receipt of a request for prior consultation; and
  210         b. A 72-hour supply of the drug prescribed is provided in
  211  an emergency or when the agency does not provide a response
  212  within 24 hours as required by sub-subparagraph a.
  213         2. Reimbursement to pharmacies for Medicaid prescribed
  214  drugs shall be set at the lowest of: the average wholesale price
  215  (AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
  216  plus 1.5 percent, the federal upper limit (FUL), the state
  217  maximum allowable cost (SMAC), or the usual and customary (UAC)
  218  charge billed by the provider.
  219         3. The agency shall develop and implement a process for
  220  managing the drug therapies of Medicaid recipients who are using
  221  significant numbers of prescribed drugs each month. The
  222  management process may include, but is not limited to,
  223  comprehensive, physician-directed medical-record reviews, claims
  224  analyses, and case evaluations to determine the medical
  225  necessity and appropriateness of a patient’s treatment plan and
  226  drug therapies. The agency may contract with a private
  227  organization to provide drug-program-management services. The
  228  Medicaid drug benefit management program shall include
  229  initiatives to manage drug therapies for HIV/AIDS patients,
  230  patients using 20 or more unique prescriptions in a 180-day
  231  period, and the top 1,000 patients in annual spending. The
  232  agency shall enroll any Medicaid recipient in the drug benefit
  233  management program if he or she meets the specifications of this
  234  provision and is not enrolled in a Medicaid health maintenance
  235  organization.
  236         4. The agency may limit the size of its pharmacy network
  237  based on need, competitive bidding, price negotiations,
  238  credentialing, or similar criteria. The agency shall give
  239  special consideration to rural areas in determining the size and
  240  location of pharmacies included in the Medicaid pharmacy
  241  network. A pharmacy credentialing process may include criteria
  242  such as a pharmacy’s full-service status, location, size,
  243  patient educational programs, patient consultation, disease
  244  management services, and other characteristics. The agency may
  245  impose a moratorium on Medicaid pharmacy enrollment if it is
  246  determined that it has a sufficient number of Medicaid
  247  participating providers. The agency must allow dispensing
  248  practitioners to participate as a part of the Medicaid pharmacy
  249  network regardless of the practitioner’s proximity to any other
  250  entity that is dispensing prescription drugs under the Medicaid
  251  program. A dispensing practitioner must meet all credentialing
  252  requirements applicable to his or her practice, as determined by
  253  the agency.
  254         5. The agency shall develop and implement a program that
  255  requires Medicaid practitioners who issue written prescriptions
  256  for medicinal prescribe drugs to use a counterfeit-proof
  257  prescription pad for Medicaid prescriptions. The agency shall
  258  require the use of standardized counterfeit-proof prescription
  259  pads by Medicaid-participating prescribers or prescribers who
  260  issue written write prescriptions for Medicaid recipients. The
  261  agency may implement the program in targeted geographic areas or
  262  statewide.
  263         6. The agency may enter into arrangements that require
  264  manufacturers of generic drugs prescribed to Medicaid recipients
  265  to provide rebates of at least 15.1 percent of the average
  266  manufacturer price for the manufacturer’s generic products.
  267  These arrangements shall require that if a generic-drug
  268  manufacturer pays federal rebates for Medicaid-reimbursed drugs
  269  at a level below 15.1 percent, the manufacturer must provide a
  270  supplemental rebate to the state in an amount necessary to
  271  achieve a 15.1-percent rebate level.
  272         7. The agency may establish a preferred drug list as
  273  described in this subsection, and, pursuant to the establishment
  274  of such preferred drug list, negotiate supplemental rebates from
  275  manufacturers that are in addition to those required by Title
  276  XIX of the Social Security Act and at no less than 14 percent of
  277  the average manufacturer price as defined in 42 U.S.C. s. 1936
  278  on the last day of a quarter unless the federal or supplemental
  279  rebate, or both, equals or exceeds 29 percent. There is no upper
  280  limit on the supplemental rebates the agency may negotiate. The
  281  agency may determine that specific products, brand-name or
  282  generic, are competitive at lower rebate percentages. Agreement
  283  to pay the minimum supplemental rebate percentage guarantees a
  284  manufacturer that the Medicaid Pharmaceutical and Therapeutics
  285  Committee will consider a product for inclusion on the preferred
  286  drug list. However, a pharmaceutical manufacturer is not
  287  guaranteed placement on the preferred drug list by simply paying
  288  the minimum supplemental rebate. Agency decisions will be made
  289  on the clinical efficacy of a drug and recommendations of the
  290  Medicaid Pharmaceutical and Therapeutics Committee, as well as
  291  the price of competing products minus federal and state rebates.
  292  The agency may contract with an outside agency or contractor to
  293  conduct negotiations for supplemental rebates. For the purposes
  294  of this section, the term “supplemental rebates” means cash
  295  rebates. Value-added programs as a substitution for supplemental
  296  rebates are prohibited. The agency may seek any federal waivers
  297  to implement this initiative.
  298         8. The agency shall expand home delivery of pharmacy
  299  products. The agency may amend the state plan and issue a
  300  procurement, as necessary, in order to implement this program.
  301  The procurements must include agreements with a pharmacy or
  302  pharmacies located in the state to provide mail order delivery
  303  services at no cost to the recipients who elect to receive home
  304  delivery of pharmacy products. The procurement must focus on
  305  serving recipients with chronic diseases for which pharmacy
  306  expenditures represent a significant portion of Medicaid
  307  pharmacy expenditures or which impact a significant portion of
  308  the Medicaid population. The agency may seek and implement any
  309  federal waivers necessary to implement this subparagraph.
  310         9. The agency shall limit to one dose per month any drug
  311  prescribed to treat erectile dysfunction.
  312         10.a. The agency may implement a Medicaid behavioral drug
  313  management system. The agency may contract with a vendor that
  314  has experience in operating behavioral drug management systems
  315  to implement this program. The agency may seek federal waivers
  316  to implement this program.
  317         b. The agency, in conjunction with the Department of
  318  Children and Families, may implement the Medicaid behavioral
  319  drug management system that is designed to improve the quality
  320  of care and behavioral health prescribing practices based on
  321  best practice guidelines, improve patient adherence to
  322  medication plans, reduce clinical risk, and lower prescribed
  323  drug costs and the rate of inappropriate spending on Medicaid
  324  behavioral drugs. The program may include the following
  325  elements:
  326         (I) Provide for the development and adoption of best
  327  practice guidelines for behavioral health-related drugs such as
  328  antipsychotics, antidepressants, and medications for treating
  329  bipolar disorders and other behavioral conditions; translate
  330  them into practice; review behavioral health prescribers and
  331  compare their prescribing patterns to a number of indicators
  332  that are based on national standards; and determine deviations
  333  from best practice guidelines.
  334         (II) Implement processes for providing feedback to and
  335  educating prescribers using best practice educational materials
  336  and peer-to-peer consultation.
  337         (III) Assess Medicaid beneficiaries who are outliers in
  338  their use of behavioral health drugs with regard to the numbers
  339  and types of drugs taken, drug dosages, combination drug
  340  therapies, and other indicators of improper use of behavioral
  341  health drugs.
  342         (IV) Alert prescribers to patients who fail to refill
  343  prescriptions in a timely fashion, are prescribed multiple same
  344  class behavioral health drugs, and may have other potential
  345  medication problems.
  346         (V) Track spending trends for behavioral health drugs and
  347  deviation from best practice guidelines.
  348         (VI) Use educational and technological approaches to
  349  promote best practices, educate consumers, and train prescribers
  350  in the use of practice guidelines.
  351         (VII) Disseminate electronic and published materials.
  352         (VIII) Hold statewide and regional conferences.
  353         (IX) Implement a disease management program with a model
  354  quality-based medication component for severely mentally ill
  355  individuals and emotionally disturbed children who are high
  356  users of care.
  357         11. The agency shall implement a Medicaid prescription drug
  358  management system.
  359         a. The agency may contract with a vendor that has
  360  experience in operating prescription drug management systems in
  361  order to implement this system. Any management system that is
  362  implemented in accordance with this subparagraph must rely on
  363  cooperation between physicians and pharmacists to determine
  364  appropriate practice patterns and clinical guidelines to improve
  365  the prescribing, dispensing, and use of drugs in the Medicaid
  366  program. The agency may seek federal waivers to implement this
  367  program.
  368         b. The drug management system must be designed to improve
  369  the quality of care and prescribing practices based on best
  370  practice guidelines, improve patient adherence to medication
  371  plans, reduce clinical risk, and lower prescribed drug costs and
  372  the rate of inappropriate spending on Medicaid prescription
  373  drugs. The program must:
  374         (I) Provide for the adoption of best practice guidelines
  375  for the prescribing and use of drugs in the Medicaid program,
  376  including translating best practice guidelines into practice;
  377  reviewing prescriber patterns and comparing them to indicators
  378  that are based on national standards and practice patterns of
  379  clinical peers in their community, statewide, and nationally;
  380  and determine deviations from best practice guidelines.
  381         (II) Implement processes for providing feedback to and
  382  educating prescribers using best practice educational materials
  383  and peer-to-peer consultation.
  384         (III) Assess Medicaid recipients who are outliers in their
  385  use of a single or multiple prescription drugs with regard to
  386  the numbers and types of drugs taken, drug dosages, combination
  387  drug therapies, and other indicators of improper use of
  388  prescription drugs.
  389         (IV) Alert prescribers to recipients who fail to refill
  390  prescriptions in a timely fashion, are prescribed multiple drugs
  391  that may be redundant or contraindicated, or may have other
  392  potential medication problems.
  393         12. The agency may contract for drug rebate administration,
  394  including, but not limited to, calculating rebate amounts,
  395  invoicing manufacturers, negotiating disputes with
  396  manufacturers, and maintaining a database of rebate collections.
  397         13. The agency may specify the preferred daily dosing form
  398  or strength for the purpose of promoting best practices with
  399  regard to the prescribing of certain drugs as specified in the
  400  General Appropriations Act and ensuring cost-effective
  401  prescribing practices.
  402         14. The agency may require prior authorization for
  403  Medicaid-covered prescribed drugs. The agency may prior
  404  authorize the use of a product:
  405         a. For an indication not approved in labeling;
  406         b. To comply with certain clinical guidelines; or
  407         c. If the product has the potential for overuse, misuse, or
  408  abuse.
  409  
  410  The agency may require the prescribing professional to provide
  411  information about the rationale and supporting medical evidence
  412  for the use of a drug. The agency shall post prior
  413  authorization, step-edit criteria and protocol, and updates to
  414  the list of drugs that are subject to prior authorization on the
  415  agency’s Internet website within 21 days after the prior
  416  authorization and step-edit criteria and protocol and updates
  417  are approved by the agency. For purposes of this subparagraph,
  418  the term “step-edit” means an automatic electronic review of
  419  certain medications subject to prior authorization.
  420         15. The agency, in conjunction with the Pharmaceutical and
  421  Therapeutics Committee, may require age-related prior
  422  authorizations for certain prescribed drugs. The agency may
  423  preauthorize the use of a drug for a recipient who may not meet
  424  the age requirement or may exceed the length of therapy for use
  425  of this product as recommended by the manufacturer and approved
  426  by the Food and Drug Administration. Prior authorization may
  427  require the prescribing professional to provide information
  428  about the rationale and supporting medical evidence for the use
  429  of a drug.
  430         16. The agency shall implement a step-therapy prior
  431  authorization approval process for medications excluded from the
  432  preferred drug list. Medications listed on the preferred drug
  433  list must be used within the previous 12 months before the
  434  alternative medications that are not listed. The step-therapy
  435  prior authorization may require the prescriber to use the
  436  medications of a similar drug class or for a similar medical
  437  indication unless contraindicated in the Food and Drug
  438  Administration labeling. The trial period between the specified
  439  steps may vary according to the medical indication. The step
  440  therapy approval process shall be developed in accordance with
  441  the committee as stated in s. 409.91195(7) and (8). A drug
  442  product may be approved without meeting the step-therapy prior
  443  authorization criteria if the prescribing physician provides the
  444  agency with additional written medical or clinical documentation
  445  that the product is medically necessary because:
  446         a. There is not a drug on the preferred drug list to treat
  447  the disease or medical condition which is an acceptable clinical
  448  alternative;
  449         b. The alternatives have been ineffective in the treatment
  450  of the beneficiary’s disease; or
  451         c. Based on historic evidence and known characteristics of
  452  the patient and the drug, the drug is likely to be ineffective,
  453  or the number of doses have been ineffective.
  454  
  455  The agency shall work with the physician to determine the best
  456  alternative for the patient. The agency may adopt rules waiving
  457  the requirements for written clinical documentation for specific
  458  drugs in limited clinical situations.
  459         17. The agency shall implement a return and reuse program
  460  for drugs dispensed by pharmacies to institutional recipients,
  461  which includes payment of a $5 restocking fee for the
  462  implementation and operation of the program. The return and
  463  reuse program shall be implemented electronically and in a
  464  manner that promotes efficiency. The program must permit a
  465  pharmacy to exclude drugs from the program if it is not
  466  practical or cost-effective for the drug to be included and must
  467  provide for the return to inventory of drugs that cannot be
  468  credited or returned in a cost-effective manner. The agency
  469  shall determine if the program has reduced the amount of
  470  Medicaid prescription drugs which are destroyed on an annual
  471  basis and if there are additional ways to ensure more
  472  prescription drugs are not destroyed which could safely be
  473  reused.
  474         Section 4. Section 456.0392, Florida Statutes, is amended
  475  to read:
  476         456.0392 Prescription labeling.—
  477         (1) A prescription issued written by a practitioner who is
  478  authorized under the laws of this state to prescribe write
  479  prescriptions for drugs that are not listed as controlled
  480  substances in chapter 893 but who is not eligible for a federal
  481  Drug Enforcement Administration number shall include that
  482  practitioner’s name and professional license number. The
  483  pharmacist or dispensing practitioner must include the
  484  practitioner’s name on the container of the drug that is
  485  dispensed. A pharmacist shall be permitted, upon verification by
  486  the prescriber, to document any information required by this
  487  section.
  488         (2) A prescription for a drug that is not listed as a
  489  controlled substance in chapter 893 which is issued written by
  490  an advanced practice registered nurse licensed under s. 464.012
  491  is presumed, subject to rebuttal, to be valid and within the
  492  parameters of the prescriptive authority delegated by a
  493  practitioner licensed under chapter 458, chapter 459, or chapter
  494  466.
  495         (3) A prescription for a drug that is not listed as a
  496  controlled substance in chapter 893 which is issued written by a
  497  physician assistant licensed under chapter 458 or chapter 459 is
  498  presumed, subject to rebuttal, to be valid and within the
  499  parameters of the prescriptive authority delegated by the
  500  physician assistant’s supervising physician.
  501         Section 5. Paragraph (d) of subsection (3) of section
  502  458.3265, Florida Statutes, is amended to read:
  503         458.3265 Pain-management clinics.—
  504         (3) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  505  apply to any physician who provides professional services in a
  506  pain-management clinic that is required to be registered in
  507  subsection (1).
  508         (d) A physician authorized to prescribe controlled
  509  substances who practices at a pain-management clinic is
  510  responsible for maintaining the control and security of his or
  511  her prescription blanks or electronic prescribing software and
  512  any other method used for prescribing controlled substance pain
  513  medication. A The physician who issues written prescriptions
  514  shall comply with the requirements for counterfeit-resistant
  515  prescription blanks in s. 893.065 and the rules adopted pursuant
  516  to that section. A The physician shall notify, in writing, the
  517  department within 24 hours after following any theft or loss of
  518  a prescription blank or breach of his or her electronic
  519  prescribing software used any other method for prescribing pain
  520  medication.
  521         Section 6. Paragraph (qq) of subsection (1) of section
  522  458.331, Florida Statutes, is amended to read:
  523         458.331 Grounds for disciplinary action; action by the
  524  board and department.—
  525         (1) The following acts constitute grounds for denial of a
  526  license or disciplinary action, as specified in s. 456.072(2):
  527         (qq) Failing to timely notify the department of the theft
  528  of prescription blanks from a pain-management clinic or a breach
  529  of a physician’s electronic prescribing software other methods
  530  for prescribing within 24 hours as required by s. 458.3265(3).
  531         Section 7. Paragraph (d) of subsection (3) of section
  532  459.0137, Florida Statutes, is amended to read:
  533         459.0137 Pain-management clinics.—
  534         (3) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  535  apply to any osteopathic physician who provides professional
  536  services in a pain-management clinic that is required to be
  537  registered in subsection (1).
  538         (d) An osteopathic physician authorized to prescribe
  539  controlled substances who practices at a pain-management clinic
  540  is responsible for maintaining the control and security of his
  541  or her prescription blanks or electronic prescribing software
  542  and any other method used for prescribing controlled substance
  543  pain medication. An The osteopathic physician who issues written
  544  prescriptions shall comply with the requirements for
  545  counterfeit-resistant prescription blanks in s. 893.065 and the
  546  rules adopted pursuant to that section. An The osteopathic
  547  physician shall notify, in writing, the department within 24
  548  hours after following any theft or loss of a prescription blank
  549  or breach of his or her electronic prescribing software used any
  550  other method for prescribing pain medication.
  551         Section 8. Paragraph (ss) of subsection (1) of section
  552  459.015, Florida Statutes, is amended to read:
  553         459.015 Grounds for disciplinary action; action by the
  554  board and department.—
  555         (1) The following acts constitute grounds for denial of a
  556  license or disciplinary action, as specified in s. 456.072(2):
  557         (ss) Failing to timely notify the department of the theft
  558  of prescription blanks from a pain-management clinic or a breach
  559  of an osteopathic physician’s electronic prescribing software
  560  other methods for prescribing within 24 hours as required by s.
  561  459.0137(3).
  562         Section 9. This act shall take effect January 1, 2020.
  563  
  564  ================= T I T L E  A M E N D M E N T ================
  565  And the title is amended as follows:
  566         Delete everything before the enacting clause
  567  and insert:
  568                        A bill to be entitled                      
  569         An act relating to electronic prescribing; amending s.
  570         456.42, F.S.; requiring certain health care
  571         practitioners to electronically generate and transmit
  572         prescriptions for medicinal drugs upon license renewal
  573         or by a specified date; providing exceptions;
  574         authorizing the Department of Health, in consultation
  575         with the Board of Medicine, the Board of Osteopathic
  576         Medicine, the Board of Podiatric Medicine, the Board
  577         of Dentistry, the Board of Nursing, and the Board of
  578         Optometry, to adopt rules; amending s. 456.43, F.S.;
  579         revising the definitions of the terms “prescribing
  580         decision” and “point of care”; revising the authority
  581         for electronic prescribing software to display
  582         information regarding a payor’s formulary under
  583         certain circumstances; amending ss. 409.912, 456.0392,
  584         458.3265, 458.331, 459.0137, and 459.015, F.S.;
  585         conforming provisions to changes made by the act;
  586         providing an effective date.