Florida Senate - 2019                        COMMITTEE AMENDMENT
       Bill No. SB 1192
       
       
       
       
       
       
                                Ì113722zÎ113722                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/08/2019           .                                
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       The Committee on Health Policy (Bean) recommended 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, or who prescribes medicinal
   42  drugs as an owner, employee, or contractor of a licensed health
   43  care facility or practice that maintains such a system and who
   44  is prescribing in his or her capacity as such an owner,
   45  employee, or contractor, may only electronically transmit
   46  prescriptions for such drugs. This requirement applies to such a
   47  health care practitioner upon renewal of the health care
   48  practitioner’s license or by July 1, 2021, whichever is earlier,
   49  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 other
   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  
   74  The department, in consultation with the Board of Medicine and
   75  the Board of Osteopathic Medicine, may adopt rules to implement
   76  this subsection.
   77         Section 2. Section 456.43, Florida Statutes, is amended to
   78  read:
   79         456.43 Electronic prescribing for medicinal drugs.—
   80         (1) Electronic prescribing may shall not interfere with a
   81  patient’s freedom to choose a pharmacy.
   82         (2) Electronic prescribing software may shall not use any
   83  means or permit any other person to use any means to influence
   84  or attempt to influence, through economic incentives or
   85  otherwise, the prescribing decision of a prescribing
   86  practitioner or his or her agent at the point of care,
   87  including, but not limited to, means such as advertising,
   88  instant messaging, and pop-up ads, and similar means to
   89  influence or attempt to influence, through economic incentives
   90  or otherwise, the prescribing decision of a prescribing
   91  practitioner at the point of care. Such means shall not be
   92  triggered by or in specific response to the input, selection, or
   93  act of a prescribing practitioner or his or her agent in
   94  prescribing a certain medicinal drug pharmaceutical or directing
   95  a patient to a certain pharmacy. For purposes of this
   96  subsection, the term:
   97         (a) The term “Prescribing decision” means a prescribing
   98  practitioner’s or his or her agent’s decision to prescribe any
   99  medicinal drug a certain pharmaceutical.
  100         (b) The term “Point of care” means the time at which that a
  101  prescribing practitioner or his or her agent prescribes any
  102  medicinal drug is in the act of prescribing a certain
  103  pharmaceutical.
  104         (3) Electronic prescribing software may display show
  105  information regarding a payor’s formulary if as long as nothing
  106  is designed to preclude or make more difficult the selection of
  107  the act of a prescribing practitioner or patient selecting any
  108  particular pharmacy by a patient or the selection of a certain
  109  medicinal drug by a prescribing practitioner or his or her agent
  110  pharmaceutical.
  111         Section 3. Paragraph (a) of subsection (5) of section
  112  409.912, Florida Statutes, is amended to read:
  113         409.912 Cost-effective purchasing of health care.—The
  114  agency shall purchase goods and services for Medicaid recipients
  115  in the most cost-effective manner consistent with the delivery
  116  of quality medical care. To ensure that medical services are
  117  effectively utilized, the agency may, in any case, require a
  118  confirmation or second physician’s opinion of the correct
  119  diagnosis for purposes of authorizing future services under the
  120  Medicaid program. This section does not restrict access to
  121  emergency services or poststabilization care services as defined
  122  in 42 C.F.R. s. 438.114. Such confirmation or second opinion
  123  shall be rendered in a manner approved by the agency. The agency
  124  shall maximize the use of prepaid per capita and prepaid
  125  aggregate fixed-sum basis services when appropriate and other
  126  alternative service delivery and reimbursement methodologies,
  127  including competitive bidding pursuant to s. 287.057, designed
  128  to facilitate the cost-effective purchase of a case-managed
  129  continuum of care. The agency shall also require providers to
  130  minimize the exposure of recipients to the need for acute
  131  inpatient, custodial, and other institutional care and the
  132  inappropriate or unnecessary use of high-cost services. The
  133  agency shall contract with a vendor to monitor and evaluate the
  134  clinical practice patterns of providers in order to identify
  135  trends that are outside the normal practice patterns of a
  136  provider’s professional peers or the national guidelines of a
  137  provider’s professional association. The vendor must be able to
  138  provide information and counseling to a provider whose practice
  139  patterns are outside the norms, in consultation with the agency,
  140  to improve patient care and reduce inappropriate utilization.
  141  The agency may mandate prior authorization, drug therapy
  142  management, or disease management participation for certain
  143  populations of Medicaid beneficiaries, certain drug classes, or
  144  particular drugs to prevent fraud, abuse, overuse, and possible
  145  dangerous drug interactions. The Pharmaceutical and Therapeutics
  146  Committee shall make recommendations to the agency on drugs for
  147  which prior authorization is required. The agency shall inform
  148  the Pharmaceutical and Therapeutics Committee of its decisions
  149  regarding drugs subject to prior authorization. The agency is
  150  authorized to limit the entities it contracts with or enrolls as
  151  Medicaid providers by developing a provider network through
  152  provider credentialing. The agency may competitively bid single
  153  source-provider contracts if procurement of goods or services
  154  results in demonstrated cost savings to the state without
  155  limiting access to care. The agency may limit its network based
  156  on the assessment of beneficiary access to care, provider
  157  availability, provider quality standards, time and distance
  158  standards for access to care, the cultural competence of the
  159  provider network, demographic characteristics of Medicaid
  160  beneficiaries, practice and provider-to-beneficiary standards,
  161  appointment wait times, beneficiary use of services, provider
  162  turnover, provider profiling, provider licensure history,
  163  previous program integrity investigations and findings, peer
  164  review, provider Medicaid policy and billing compliance records,
  165  clinical and medical record audits, and other factors. Providers
  166  are not entitled to enrollment in the Medicaid provider network.
  167  The agency shall determine instances in which allowing Medicaid
  168  beneficiaries to purchase durable medical equipment and other
  169  goods is less expensive to the Medicaid program than long-term
  170  rental of the equipment or goods. The agency may establish rules
  171  to facilitate purchases in lieu of long-term rentals in order to
  172  protect against fraud and abuse in the Medicaid program as
  173  defined in s. 409.913. The agency may seek federal waivers
  174  necessary to administer these policies.
  175         (5)(a) The agency shall implement a Medicaid prescribed
  176  drug spending-control program that includes the following
  177  components:
  178         1. A Medicaid preferred drug list, which shall be a listing
  179  of cost-effective therapeutic options recommended by the
  180  Medicaid Pharmacy and Therapeutics Committee established
  181  pursuant to s. 409.91195 and adopted by the agency for each
  182  therapeutic class on the preferred drug list. At the discretion
  183  of the committee, and when feasible, the preferred drug list
  184  should include at least two products in a therapeutic class. The
  185  agency may post the preferred drug list and updates to the list
  186  on an Internet website without following the rulemaking
  187  procedures of chapter 120. Antiretroviral agents are excluded
  188  from the preferred drug list. The agency shall also limit the
  189  amount of a prescribed drug dispensed to no more than a 34-day
  190  supply unless the drug products’ smallest marketed package is
  191  greater than a 34-day supply, or the drug is determined by the
  192  agency to be a maintenance drug in which case a 100-day maximum
  193  supply may be authorized. The agency may seek any federal
  194  waivers necessary to implement these cost-control programs and
  195  to continue participation in the federal Medicaid rebate
  196  program, or alternatively to negotiate state-only manufacturer
  197  rebates. The agency may adopt rules to administer this
  198  subparagraph. The agency shall continue to provide unlimited
  199  contraceptive drugs and items. The agency must establish
  200  procedures to ensure that:
  201         a. There is a response to a request for prior consultation
  202  by telephone or other telecommunication device within 24 hours
  203  after receipt of a request for prior consultation; and
  204         b. A 72-hour supply of the drug prescribed is provided in
  205  an emergency or when the agency does not provide a response
  206  within 24 hours as required by sub-subparagraph a.
  207         2. Reimbursement to pharmacies for Medicaid prescribed
  208  drugs shall be set at the lowest of: the average wholesale price
  209  (AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
  210  plus 1.5 percent, the federal upper limit (FUL), the state
  211  maximum allowable cost (SMAC), or the usual and customary (UAC)
  212  charge billed by the provider.
  213         3. The agency shall develop and implement a process for
  214  managing the drug therapies of Medicaid recipients who are using
  215  significant numbers of prescribed drugs each month. The
  216  management process may include, but is not limited to,
  217  comprehensive, physician-directed medical-record reviews, claims
  218  analyses, and case evaluations to determine the medical
  219  necessity and appropriateness of a patient’s treatment plan and
  220  drug therapies. The agency may contract with a private
  221  organization to provide drug-program-management services. The
  222  Medicaid drug benefit management program shall include
  223  initiatives to manage drug therapies for HIV/AIDS patients,
  224  patients using 20 or more unique prescriptions in a 180-day
  225  period, and the top 1,000 patients in annual spending. The
  226  agency shall enroll any Medicaid recipient in the drug benefit
  227  management program if he or she meets the specifications of this
  228  provision and is not enrolled in a Medicaid health maintenance
  229  organization.
  230         4. The agency may limit the size of its pharmacy network
  231  based on need, competitive bidding, price negotiations,
  232  credentialing, or similar criteria. The agency shall give
  233  special consideration to rural areas in determining the size and
  234  location of pharmacies included in the Medicaid pharmacy
  235  network. A pharmacy credentialing process may include criteria
  236  such as a pharmacy’s full-service status, location, size,
  237  patient educational programs, patient consultation, disease
  238  management services, and other characteristics. The agency may
  239  impose a moratorium on Medicaid pharmacy enrollment if it is
  240  determined that it has a sufficient number of Medicaid
  241  participating providers. The agency must allow dispensing
  242  practitioners to participate as a part of the Medicaid pharmacy
  243  network regardless of the practitioner’s proximity to any other
  244  entity that is dispensing prescription drugs under the Medicaid
  245  program. A dispensing practitioner must meet all credentialing
  246  requirements applicable to his or her practice, as determined by
  247  the agency.
  248         5. The agency shall develop and implement a program that
  249  requires Medicaid practitioners who issue written prescriptions
  250  for medicinal prescribe drugs to use a counterfeit-proof
  251  prescription pad for Medicaid prescriptions. The agency shall
  252  require the use of standardized counterfeit-proof prescription
  253  pads by Medicaid-participating prescribers or prescribers who
  254  issue written write prescriptions for Medicaid recipients. The
  255  agency may implement the program in targeted geographic areas or
  256  statewide.
  257         6. The agency may enter into arrangements that require
  258  manufacturers of generic drugs prescribed to Medicaid recipients
  259  to provide rebates of at least 15.1 percent of the average
  260  manufacturer price for the manufacturer’s generic products.
  261  These arrangements shall require that if a generic-drug
  262  manufacturer pays federal rebates for Medicaid-reimbursed drugs
  263  at a level below 15.1 percent, the manufacturer must provide a
  264  supplemental rebate to the state in an amount necessary to
  265  achieve a 15.1-percent rebate level.
  266         7. The agency may establish a preferred drug list as
  267  described in this subsection, and, pursuant to the establishment
  268  of such preferred drug list, negotiate supplemental rebates from
  269  manufacturers that are in addition to those required by Title
  270  XIX of the Social Security Act and at no less than 14 percent of
  271  the average manufacturer price as defined in 42 U.S.C. s. 1936
  272  on the last day of a quarter unless the federal or supplemental
  273  rebate, or both, equals or exceeds 29 percent. There is no upper
  274  limit on the supplemental rebates the agency may negotiate. The
  275  agency may determine that specific products, brand-name or
  276  generic, are competitive at lower rebate percentages. Agreement
  277  to pay the minimum supplemental rebate percentage guarantees a
  278  manufacturer that the Medicaid Pharmaceutical and Therapeutics
  279  Committee will consider a product for inclusion on the preferred
  280  drug list. However, a pharmaceutical manufacturer is not
  281  guaranteed placement on the preferred drug list by simply paying
  282  the minimum supplemental rebate. Agency decisions will be made
  283  on the clinical efficacy of a drug and recommendations of the
  284  Medicaid Pharmaceutical and Therapeutics Committee, as well as
  285  the price of competing products minus federal and state rebates.
  286  The agency may contract with an outside agency or contractor to
  287  conduct negotiations for supplemental rebates. For the purposes
  288  of this section, the term “supplemental rebates” means cash
  289  rebates. Value-added programs as a substitution for supplemental
  290  rebates are prohibited. The agency may seek any federal waivers
  291  to implement this initiative.
  292         8. The agency shall expand home delivery of pharmacy
  293  products. The agency may amend the state plan and issue a
  294  procurement, as necessary, in order to implement this program.
  295  The procurements must include agreements with a pharmacy or
  296  pharmacies located in the state to provide mail order delivery
  297  services at no cost to the recipients who elect to receive home
  298  delivery of pharmacy products. The procurement must focus on
  299  serving recipients with chronic diseases for which pharmacy
  300  expenditures represent a significant portion of Medicaid
  301  pharmacy expenditures or which impact a significant portion of
  302  the Medicaid population. The agency may seek and implement any
  303  federal waivers necessary to implement this subparagraph.
  304         9. The agency shall limit to one dose per month any drug
  305  prescribed to treat erectile dysfunction.
  306         10.a. The agency may implement a Medicaid behavioral drug
  307  management system. The agency may contract with a vendor that
  308  has experience in operating behavioral drug management systems
  309  to implement this program. The agency may seek federal waivers
  310  to implement this program.
  311         b. The agency, in conjunction with the Department of
  312  Children and Families, may implement the Medicaid behavioral
  313  drug management system that is designed to improve the quality
  314  of care and behavioral health prescribing practices based on
  315  best practice guidelines, improve patient adherence to
  316  medication plans, reduce clinical risk, and lower prescribed
  317  drug costs and the rate of inappropriate spending on Medicaid
  318  behavioral drugs. The program may include the following
  319  elements:
  320         (I) Provide for the development and adoption of best
  321  practice guidelines for behavioral health-related drugs such as
  322  antipsychotics, antidepressants, and medications for treating
  323  bipolar disorders and other behavioral conditions; translate
  324  them into practice; review behavioral health prescribers and
  325  compare their prescribing patterns to a number of indicators
  326  that are based on national standards; and determine deviations
  327  from best practice guidelines.
  328         (II) Implement processes for providing feedback to and
  329  educating prescribers using best practice educational materials
  330  and peer-to-peer consultation.
  331         (III) Assess Medicaid beneficiaries who are outliers in
  332  their use of behavioral health drugs with regard to the numbers
  333  and types of drugs taken, drug dosages, combination drug
  334  therapies, and other indicators of improper use of behavioral
  335  health drugs.
  336         (IV) Alert prescribers to patients who fail to refill
  337  prescriptions in a timely fashion, are prescribed multiple same
  338  class behavioral health drugs, and may have other potential
  339  medication problems.
  340         (V) Track spending trends for behavioral health drugs and
  341  deviation from best practice guidelines.
  342         (VI) Use educational and technological approaches to
  343  promote best practices, educate consumers, and train prescribers
  344  in the use of practice guidelines.
  345         (VII) Disseminate electronic and published materials.
  346         (VIII) Hold statewide and regional conferences.
  347         (IX) Implement a disease management program with a model
  348  quality-based medication component for severely mentally ill
  349  individuals and emotionally disturbed children who are high
  350  users of care.
  351         11. The agency shall implement a Medicaid prescription drug
  352  management system.
  353         a. The agency may contract with a vendor that has
  354  experience in operating prescription drug management systems in
  355  order to implement this system. Any management system that is
  356  implemented in accordance with this subparagraph must rely on
  357  cooperation between physicians and pharmacists to determine
  358  appropriate practice patterns and clinical guidelines to improve
  359  the prescribing, dispensing, and use of drugs in the Medicaid
  360  program. The agency may seek federal waivers to implement this
  361  program.
  362         b. The drug management system must be designed to improve
  363  the quality of care and prescribing practices based on best
  364  practice guidelines, improve patient adherence to medication
  365  plans, reduce clinical risk, and lower prescribed drug costs and
  366  the rate of inappropriate spending on Medicaid prescription
  367  drugs. The program must:
  368         (I) Provide for the adoption of best practice guidelines
  369  for the prescribing and use of drugs in the Medicaid program,
  370  including translating best practice guidelines into practice;
  371  reviewing prescriber patterns and comparing them to indicators
  372  that are based on national standards and practice patterns of
  373  clinical peers in their community, statewide, and nationally;
  374  and determine deviations from best practice guidelines.
  375         (II) Implement processes for providing feedback to and
  376  educating prescribers using best practice educational materials
  377  and peer-to-peer consultation.
  378         (III) Assess Medicaid recipients who are outliers in their
  379  use of a single or multiple prescription drugs with regard to
  380  the numbers and types of drugs taken, drug dosages, combination
  381  drug therapies, and other indicators of improper use of
  382  prescription drugs.
  383         (IV) Alert prescribers to recipients who fail to refill
  384  prescriptions in a timely fashion, are prescribed multiple drugs
  385  that may be redundant or contraindicated, or may have other
  386  potential medication problems.
  387         12. The agency may contract for drug rebate administration,
  388  including, but not limited to, calculating rebate amounts,
  389  invoicing manufacturers, negotiating disputes with
  390  manufacturers, and maintaining a database of rebate collections.
  391         13. The agency may specify the preferred daily dosing form
  392  or strength for the purpose of promoting best practices with
  393  regard to the prescribing of certain drugs as specified in the
  394  General Appropriations Act and ensuring cost-effective
  395  prescribing practices.
  396         14. The agency may require prior authorization for
  397  Medicaid-covered prescribed drugs. The agency may prior
  398  authorize the use of a product:
  399         a. For an indication not approved in labeling;
  400         b. To comply with certain clinical guidelines; or
  401         c. If the product has the potential for overuse, misuse, or
  402  abuse.
  403  
  404  The agency may require the prescribing professional to provide
  405  information about the rationale and supporting medical evidence
  406  for the use of a drug. The agency shall post prior
  407  authorization, step-edit criteria and protocol, and updates to
  408  the list of drugs that are subject to prior authorization on the
  409  agency’s Internet website within 21 days after the prior
  410  authorization and step-edit criteria and protocol and updates
  411  are approved by the agency. For purposes of this subparagraph,
  412  the term “step-edit” means an automatic electronic review of
  413  certain medications subject to prior authorization.
  414         15. The agency, in conjunction with the Pharmaceutical and
  415  Therapeutics Committee, may require age-related prior
  416  authorizations for certain prescribed drugs. The agency may
  417  preauthorize the use of a drug for a recipient who may not meet
  418  the age requirement or may exceed the length of therapy for use
  419  of this product as recommended by the manufacturer and approved
  420  by the Food and Drug Administration. Prior authorization may
  421  require the prescribing professional to provide information
  422  about the rationale and supporting medical evidence for the use
  423  of a drug.
  424         16. The agency shall implement a step-therapy prior
  425  authorization approval process for medications excluded from the
  426  preferred drug list. Medications listed on the preferred drug
  427  list must be used within the previous 12 months before the
  428  alternative medications that are not listed. The step-therapy
  429  prior authorization may require the prescriber to use the
  430  medications of a similar drug class or for a similar medical
  431  indication unless contraindicated in the Food and Drug
  432  Administration labeling. The trial period between the specified
  433  steps may vary according to the medical indication. The step
  434  therapy approval process shall be developed in accordance with
  435  the committee as stated in s. 409.91195(7) and (8). A drug
  436  product may be approved without meeting the step-therapy prior
  437  authorization criteria if the prescribing physician provides the
  438  agency with additional written medical or clinical documentation
  439  that the product is medically necessary because:
  440         a. There is not a drug on the preferred drug list to treat
  441  the disease or medical condition which is an acceptable clinical
  442  alternative;
  443         b. The alternatives have been ineffective in the treatment
  444  of the beneficiary’s disease; or
  445         c. Based on historic evidence and known characteristics of
  446  the patient and the drug, the drug is likely to be ineffective,
  447  or the number of doses have been ineffective.
  448  
  449  The agency shall work with the physician to determine the best
  450  alternative for the patient. The agency may adopt rules waiving
  451  the requirements for written clinical documentation for specific
  452  drugs in limited clinical situations.
  453         17. The agency shall implement a return and reuse program
  454  for drugs dispensed by pharmacies to institutional recipients,
  455  which includes payment of a $5 restocking fee for the
  456  implementation and operation of the program. The return and
  457  reuse program shall be implemented electronically and in a
  458  manner that promotes efficiency. The program must permit a
  459  pharmacy to exclude drugs from the program if it is not
  460  practical or cost-effective for the drug to be included and must
  461  provide for the return to inventory of drugs that cannot be
  462  credited or returned in a cost-effective manner. The agency
  463  shall determine if the program has reduced the amount of
  464  Medicaid prescription drugs which are destroyed on an annual
  465  basis and if there are additional ways to ensure more
  466  prescription drugs are not destroyed which could safely be
  467  reused.
  468         Section 4. Section 456.0392, Florida Statutes, is amended
  469  to read:
  470         456.0392 Prescription labeling.—
  471         (1) A prescription issued written by a practitioner who is
  472  authorized under the laws of this state to prescribe write
  473  prescriptions for drugs that are not listed as controlled
  474  substances in chapter 893 but who is not eligible for a federal
  475  Drug Enforcement Administration number shall include that
  476  practitioner’s name and professional license number. The
  477  pharmacist or dispensing practitioner must include the
  478  practitioner’s name on the container of the drug that is
  479  dispensed. A pharmacist shall be permitted, upon verification by
  480  the prescriber, to document any information required by this
  481  section.
  482         (2) A prescription for a drug that is not listed as a
  483  controlled substance in chapter 893 which is issued written by
  484  an advanced practice registered nurse licensed under s. 464.012
  485  is presumed, subject to rebuttal, to be valid and within the
  486  parameters of the prescriptive authority delegated by a
  487  practitioner licensed under chapter 458, chapter 459, or chapter
  488  466.
  489         (3) A prescription for a drug that is not listed as a
  490  controlled substance in chapter 893 which is issued written by a
  491  physician assistant licensed under chapter 458 or chapter 459 is
  492  presumed, subject to rebuttal, to be valid and within the
  493  parameters of the prescriptive authority delegated by the
  494  physician assistant’s supervising physician.
  495         Section 5. Paragraph (d) of subsection (3) of section
  496  458.3265, Florida Statutes, is amended to read:
  497         458.3265 Pain-management clinics.—
  498         (3) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  499  apply to any physician who provides professional services in a
  500  pain-management clinic that is required to be registered in
  501  subsection (1).
  502         (d) A physician authorized to prescribe controlled
  503  substances who practices at a pain-management clinic is
  504  responsible for maintaining the control and security of his or
  505  her prescription blanks or electronic prescribing software and
  506  any other method used for prescribing controlled substance pain
  507  medication. A The physician who issues written prescriptions
  508  shall comply with the requirements for counterfeit-resistant
  509  prescription blanks in s. 893.065 and the rules adopted pursuant
  510  to that section. A The physician shall notify, in writing, the
  511  department within 24 hours after following any theft or loss of
  512  a prescription blank or breach of his or her electronic
  513  prescribing software used any other method for prescribing pain
  514  medication.
  515         Section 6. Paragraph (qq) of subsection (1) of section
  516  458.331, Florida Statutes, is amended to read:
  517         458.331 Grounds for disciplinary action; action by the
  518  board and department.—
  519         (1) The following acts constitute grounds for denial of a
  520  license or disciplinary action, as specified in s. 456.072(2):
  521         (qq) Failing to timely notify the department of the theft
  522  of prescription blanks from a pain-management clinic or a breach
  523  of a physician’s electronic prescribing software other methods
  524  for prescribing within 24 hours as required by s. 458.3265(3).
  525         Section 7. Paragraph (d) of subsection (3) of section
  526  459.0137, Florida Statutes, is amended to read:
  527         459.0137 Pain-management clinics.—
  528         (3) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  529  apply to any osteopathic physician who provides professional
  530  services in a pain-management clinic that is required to be
  531  registered in subsection (1).
  532         (d) An osteopathic physician authorized to prescribe
  533  controlled substances who practices at a pain-management clinic
  534  is responsible for maintaining the control and security of his
  535  or her prescription blanks or electronic prescribing software
  536  and any other method used for prescribing controlled substance
  537  pain medication. An The osteopathic physician who issues written
  538  prescriptions shall comply with the requirements for
  539  counterfeit-resistant prescription blanks in s. 893.065 and the
  540  rules adopted pursuant to that section. An The osteopathic
  541  physician shall notify, in writing, the department within 24
  542  hours after following any theft or loss of a prescription blank
  543  or breach of his or her electronic prescribing software used any
  544  other method for prescribing pain medication.
  545         Section 8. Paragraph (ss) of subsection (1) of section
  546  459.015, Florida Statutes, is amended to read:
  547         459.015 Grounds for disciplinary action; action by the
  548  board and department.—
  549         (1) The following acts constitute grounds for denial of a
  550  license or disciplinary action, as specified in s. 456.072(2):
  551         (ss) Failing to timely notify the department of the theft
  552  of prescription blanks from a pain-management clinic or a breach
  553  of an osteopathic physician’s electronic prescribing software
  554  other methods for prescribing within 24 hours as required by s.
  555  459.0137(3).
  556         Section 9. This act shall take effect January 1, 2020.
  557  
  558  
  559  ================= T I T L E  A M E N D M E N T ================
  560  And the title is amended as follows:
  561         Delete everything before the enacting clause
  562  and insert:
  563                        A bill to be entitled                      
  564         An act relating to electronic prescribing; amending s.
  565         456.42, F.S.; requiring certain health care
  566         practitioners to electronically generate and transmit
  567         prescriptions for medicinal drugs upon license renewal
  568         or by a specified date; providing exceptions;
  569         authorizing the Department of Health, in consultation
  570         with the Board of Medicine and the Board of
  571         Osteopathic Medicine, to adopt rules; amending s.
  572         456.43, F.S.; revising the definitions of the terms
  573         “prescribing decision” and “point of care”; revising
  574         the authority for electronic prescribing software to
  575         display information regarding a payor’s formulary
  576         under certain circumstances; amending ss. 409.912,
  577         456.0392, 458.3265, 458.331, 459.0137, and 459.015,
  578         F.S.; conforming provisions to changes made by the
  579         act; providing an effective date.