Senate Bill sb0666e1

    SB 666                                   First Engrossed (ntc)



  1                      A bill to be entitled

  2         An act relating to physician assistants;

  3         amending ss. 458.347 and 459.022, F.S.;

  4         allowing authorized physician assistants to

  5         prescribe any medication not listed on a

  6         formulary established by the Council on

  7         Physician Assistants; allowing authorized

  8         physician assistants to dispense drug samples

  9         pursuant to proper prescription; eliminating

10         the formulary committee and revising provisions

11         relating to creation and amendment of the

12         formulary, to conform; providing an effective

13         date.

14

15  Be It Enacted by the Legislature of the State of Florida:

16

17         Section 1.  Paragraphs (e) and (f) of subsection (4) of

18  section 458.347, Florida Statutes, are amended to read:

19         458.347  Physician assistants.--

20         (4)  PERFORMANCE OF PHYSICIAN ASSISTANTS.--

21         (e)  A supervisory physician may delegate to a fully

22  licensed physician assistant the authority to prescribe any

23  medication used in the supervisory physician's practice unless

24  if such medication is listed on the formulary created pursuant

25  to paragraph (f).  A fully licensed physician assistant may

26  only prescribe such medication under the following

27  circumstances:

28         1.  A physician assistant must clearly identify to the

29  patient that he or she is a physician assistant.  Furthermore,

30  the physician assistant must inform the patient that the

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    SB 666                                   First Engrossed (ntc)



  1  patient has the right to see the physician prior to any

  2  prescription being prescribed by the physician assistant.

  3         2.  The supervisory physician must notify the

  4  department of his or her intent to delegate, on a

  5  department-approved form, before delegating such authority and

  6  notify the department of any change in prescriptive privileges

  7  of the physician assistant.

  8         3.  The physician assistant must file with the

  9  department, before commencing to prescribe, evidence that he

10  or she has completed a continuing medical education course of

11  at least 3 classroom hours in prescriptive practice, conducted

12  by an accredited program approved by the boards, which course

13  covers the limitations, responsibilities, and privileges

14  involved in prescribing medicinal drugs, or evidence that he

15  or she has received education comparable to the continuing

16  education course as part of an accredited physician assistant

17  training program.

18         4.  The physician assistant must file with the

19  department, before commencing to prescribe, evidence that the

20  physician assistant has a minimum of 3 months of clinical

21  experience in the specialty area of the supervising physician.

22         5.  The physician assistant must file with the

23  department a signed affidavit that he or she has completed a

24  minimum of 10 continuing medical education hours in the

25  specialty practice in which the physician assistant has

26  prescriptive privileges with each licensure renewal

27  application.

28         6.  The department shall issue a license and a

29  prescriber number to the physician assistant granting

30  authority for the prescribing of medicinal drugs authorized

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    SB 666                                   First Engrossed (ntc)



  1  within this paragraph upon completion of the foregoing

  2  requirements.

  3         7.  The prescription must be written in a form that

  4  complies with chapter 499 and must contain, in addition to the

  5  supervisory physician's name, address, and telephone number,

  6  the physician assistant's prescriber number. Unless it is a

  7  drug sample dispensed by the physician assistant, the

  8  prescription must be filled in a pharmacy permitted under

  9  chapter 465 and must be dispensed in that pharmacy by a

10  pharmacist licensed under chapter 465. The appearance of the

11  prescriber number creates a presumption that the physician

12  assistant is authorized to prescribe the medicinal drug and

13  the prescription is valid.

14         8.  The physician assistant must note the prescription

15  in the appropriate medical record, and the supervisory

16  physician must review and sign each notation.  For dispensing

17  purposes only, the failure of the supervisory physician to

18  comply with these requirements does not affect the validity of

19  the prescription.

20         9.  This paragraph does not prohibit a supervisory

21  physician from delegating to a physician assistant the

22  authority to order medication for a hospitalized patient of

23  the supervisory physician.

24

25  This paragraph does not apply to facilities licensed pursuant

26  to chapter 395.

27         (f)1.  There is created a five-member committee

28  appointed by the Secretary of Health.  The committee must be

29  composed of one fully licensed physician assistant licensed

30  pursuant to this section or s. 459.022, two physicians

31  licensed pursuant to this chapter, one of whom supervises a


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    SB 666                                   First Engrossed (ntc)



  1  fully licensed physician assistant, one osteopathic physician

  2  licensed pursuant to chapter 459, and one pharmacist licensed

  3  pursuant to chapter 465 who is not licensed pursuant to this

  4  chapter or chapter 459.  The council committee shall establish

  5  a formulary of medicinal drugs that for which a fully licensed

  6  physician assistant, licensed under this section or s.

  7  459.022, may not prescribe. The formulary must may not include

  8  controlled substances as defined in chapter 893,

  9  antineoplastics, antipsychotics, radiopharmaceuticals, general

10  anesthetics and or radiographic contrast materials, and all or

11  any parenteral preparations except insulin and epinephrine.

12         2.  In establishing the formulary, the council shall

13  consult with a pharmacist licensed under chapter 465, but not

14  licensed under this chapter or chapter 459, who shall be

15  selected by the Secretary of Health.

16         3.2.  Only the council committee shall add to, delete

17  from, or modify the formulary.  Any person who requests an

18  addition, deletion, or modification of a medicinal drug listed

19  on such formulary has the burden of proof to show cause why

20  such addition, deletion, or modification should be made.

21         4.3.  The boards shall adopt the formulary required by

22  this paragraph, and each addition, deletion, or modification

23  to the formulary, by rule. Notwithstanding any provision of

24  chapter 120 to the contrary, the formulary rule shall be

25  effective 60 days after the date it is filed with the

26  Secretary of State.  Upon adoption of the formulary, the

27  department shall mail a copy of such formulary to each fully

28  licensed physician assistant, licensed under this section or

29  s. 459.022, and to each pharmacy licensed by the state.  The

30  boards shall establish, by rule, a fee not to exceed $200 to

31  fund the provisions of this paragraph and paragraph (e).


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    SB 666                                   First Engrossed (ntc)



  1         Section 2.  Subsection (4) and paragraph (c) of

  2  subsection (9) of section 459.022, Florida Statutes, are

  3  amended to read:

  4         459.022  Physician assistants.--

  5         (4)  PERFORMANCE OF PHYSICIAN ASSISTANTS.--

  6         (a)  The boards shall adopt, by rule, the general

  7  principles that supervising physicians must use in developing

  8  the scope of practice of a physician assistant under direct

  9  supervision and under indirect supervision. These principles

10  shall recognize the diversity of both specialty and practice

11  settings in which physician assistants are used.

12         (b)  This chapter does not prevent third-party payors

13  from reimbursing employers of physician assistants for covered

14  services rendered by licensed physician assistants.

15         (c)  Licensed physician assistants may not be denied

16  clinical hospital privileges, except for cause, so long as the

17  supervising physician is a staff member in good standing.

18         (d)  A supervisory physician may delegate to a licensed

19  physician assistant, pursuant to a written protocol, the

20  authority to act according to s. 154.04(1)(c).  Such delegated

21  authority is limited to the supervising physician's practice

22  in connection with a county health department as defined and

23  established pursuant to chapter 154.  The boards shall adopt

24  rules governing the supervision of physician assistants by

25  physicians in county health departments.

26         (e)  A supervisory physician may delegate to a fully

27  licensed physician assistant the authority to prescribe any

28  medication used in the supervisory physician's practice unless

29  if such medication is listed on the formulary created pursuant

30  to s. 458.347.  A fully licensed physician assistant may only

31  prescribe such medication under the following circumstances:


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    SB 666                                   First Engrossed (ntc)



  1         1.  A physician assistant must clearly identify to the

  2  patient that she or he is a physician assistant. Furthermore,

  3  the physician assistant must inform the patient that the

  4  patient has the right to see the physician prior to any

  5  prescription being prescribed by the physician assistant.

  6         2.  The supervisory physician must notify the

  7  department of her or his intent to delegate, on a

  8  department-approved form, before delegating such authority and

  9  notify the department of any change in prescriptive privileges

10  of the physician assistant.

11         3.  The physician assistant must file with the

12  department, before commencing to prescribe, evidence that she

13  or he has completed a continuing medical education course of

14  at least 3 classroom hours in prescriptive practice, conducted

15  by an accredited program approved by the boards, which course

16  covers the limitations, responsibilities, and privileges

17  involved in prescribing medicinal drugs, or evidence that she

18  or he has received education comparable to the continuing

19  education course as part of an accredited physician assistant

20  training program.

21         4.  The physician assistant must file with the

22  department, before commencing to prescribe, evidence that the

23  physician assistant has a minimum of 3 months of clinical

24  experience in the specialty area of the supervising physician.

25         5.  The physician assistant must file with the

26  department a signed affidavit that she or he has completed a

27  minimum of 10 continuing medical education hours in the

28  specialty practice in which the physician assistant has

29  prescriptive privileges with each licensure renewal

30  application.

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    SB 666                                   First Engrossed (ntc)



  1         6.  The department shall issue a license and a

  2  prescriber number to the physician assistant granting

  3  authority for the prescribing of medicinal drugs authorized

  4  within this paragraph upon completion of the foregoing

  5  requirements.

  6         7.  The prescription must be written in a form that

  7  complies with chapter 499 and must contain, in addition to the

  8  supervisory physician's name, address, and telephone number,

  9  the physician assistant's prescriber number. Unless it is a

10  drug sample dispensed by the physician assistant, the

11  prescription must be filled in a pharmacy permitted under

12  chapter 465, and must be dispensed in that pharmacy by a

13  pharmacist licensed under chapter 465. The appearance of the

14  prescriber number creates a presumption that the physician

15  assistant is authorized to prescribe the medicinal drug and

16  the prescription is valid.

17         8.  The physician assistant must note the prescription

18  in the appropriate medical record, and the supervisory

19  physician must review and sign each notation.  For dispensing

20  purposes only, the failure of the supervisory physician to

21  comply with these requirements does not affect the validity of

22  the prescription.

23         9.  This paragraph does not prohibit a supervisory

24  physician from delegating to a physician assistant the

25  authority to order medication for a hospitalized patient of

26  the supervisory physician.

27

28  This paragraph does not apply to facilities licensed pursuant

29  to chapter 395.

30         (f)1.  There is created a five-member committee

31  appointed by the Secretary of Health.  The committee must be


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    SB 666                                   First Engrossed (ntc)



  1  composed of one fully licensed physician assistant licensed

  2  pursuant to this section or s. 458.347, two physicians

  3  licensed pursuant to chapter 458, one of whom supervises a

  4  fully licensed physician assistant, one osteopathic physician

  5  licensed pursuant to this chapter, and one pharmacist licensed

  6  pursuant to chapter 465 who is not licensed pursuant to this

  7  chapter or chapter 458.  The committee shall establish a

  8  formulary of medicinal drugs for which a fully licensed

  9  physician assistant may prescribe. The formulary may not

10  include controlled substances as defined in chapter 893,

11  antineoplastics, antipsychotics, radiopharmaceuticals, general

12  anesthetics or radiographic contrast materials, or any

13  parenteral preparations except insulin and epinephrine.

14         2.  Only the committee shall add to, delete from, or

15  modify the formulary.  Any person who requests an addition,

16  deletion, or modification of a medicinal drug listed on such

17  formulary has the burden of proof to show cause why such

18  addition, deletion, or modification should be made.

19         3.  The boards shall adopt the formulary required by

20  this paragraph, and each addition, deletion, or modification

21  to the formulary, by rule. Notwithstanding any provision of

22  chapter 120 to the contrary, the formulary rule shall be

23  effective 60 days after the date it is filed with the

24  Secretary of State.  Upon adoption of the formulary, the

25  department shall mail a copy of such formulary to each fully

26  licensed physician assistant and to each pharmacy licensed by

27  the state.  The boards shall establish, by rule, a fee not to

28  exceed $200 to fund the provisions of this paragraph and

29  paragraph (e).

30         (9)  COUNCIL ON PHYSICIAN ASSISTANTS.--The Council on

31  Physician Assistants is created within the department.


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    SB 666                                   First Engrossed (ntc)



  1         (c)  The council shall:

  2         1.  Recommend to the department the licensure of

  3  physician assistants.

  4         2.  Develop all rules regulating the use of physician

  5  assistants by physicians under chapter 458 and this chapter,

  6  except for rules relating to the formulary developed under s.

  7  458.347(4)(f). The council shall also develop rules to ensure

  8  that the continuity of supervision is maintained in each

  9  practice setting. The boards shall consider adopting a

10  proposed rule developed by the council at the regularly

11  scheduled meeting immediately following the submission of the

12  proposed rule by the council.  A proposed rule submitted by

13  the council may not be adopted by either board unless both

14  boards have accepted and approved the identical language

15  contained in the proposed rule. The language of all proposed

16  rules submitted by the council must be approved by both boards

17  pursuant to each respective board's guidelines and standards

18  regarding the adoption of proposed rules.  If either board

19  rejects the council's proposed rule, that board must specify

20  its objection to the council with particularity and include

21  any recommendations it may have for the modification of the

22  proposed rule.

23         3.  Make recommendations to the boards regarding all

24  matters relating to physician assistants.

25         4.  Address concerns and problems of practicing

26  physician assistants in order to improve safety in the

27  clinical practices of licensed physician assistants.

28         Section 3.  This act shall take effect October 1, 2001.

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30

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