Prescription Practices of a Physician Assistant

(1) Any physician assistant who holds a full license, issued by the Board pursuant to 263 CMR 3.02: Requirements for Full Licensure, may issue written or oral prescriptions or medication orders for a patient, provided that he or she does so in accordance with all applicable state and federal laws and regulations including, but not limited to, M.G.L. c. 112, § 9E; c. 94C, §§ 7, 9 and 20; 105 CMR 700.000: Implementation of M.G.L. c. 94C; and 263 CMR 5.06(1). (2) A physician assistant who holds a temporarylicense, issued by the Board pursuant to 263 CMR 3.04: Temporary License, may prepare a written or oral prescription or medication order for a patient, provided that: (a) Any such written prescription or medication order is signed by his or her supervising physician, or by another licensed physician who has been designated to assume temporary supervisory responsibilities with respect to that physician assistant pursuant to 263 CMR 5.04(3)(g), prior to the issuance of said prescription or medication order to the patient; (b) Any such oral prescription or medication order is approved, in writing, by his or her supervising physician, or by another licensed physician who has been designated to assume temporary supervisory responsibilities with respect to that physician assistant pursuant to 263 CMR 5.04(3)(g), prior to the issuance of that oral prescription or medication order; and (c) All such oral or written prescriptions or medication orders are issued in the name of the supervising physician, and are otherwise issued in accordance with all applicable state and federal laws and regulations, including but not limited to, M.G.L. c. 112, § 9E; c. 94C, §§ 7, 9 and 20; 105 CMR 700.000: Implementation of M.G.L. c. 94C; and 263 CMR 5.06(2). (3) Any prescription or medication order issued by a physician assistant for a Schedule II controlled substance, as defined in 105 CMR 700.002: Schedules of Controlled Substances, shall be reviewed by his or her supervising physician, or by a temporary supervising physician designated pursuant to 263 CMR 5.04(3)(g), within 96 hours after its issuance. (4) All physician assistants shall issue prescriptions or medication orders in accordance with written guidelines governing the prescription of medication which are mutually developed and agreed upon by the physician assistant and his or her supervising physician. (a) Such guidelines shall address, but need not be limited to, the following issues: 1. Identification of the supervising physician for that work setting; 2. Frequency of medication reviews by the physician assistant and his or her supervising physician; 3. Types and classes of medications to be prescribed by the physician assistant; 4. The initiation and/or renewal of prescriptions for medications which are not within the ordinary scope of practice for the specific work setting in question, but which may be needed to provide appropriate medical care; 5. The quantity of any medication to be prescribed by a physician assistant, including initial dosage limits and refills; 6. The types and quantities of Schedule VI medications which may be ordered by the physician assistant from a drug wholesaler, manufacturer, laboratory or distributor for use in the practice setting in question; 7. Review of initial prescriptions or changes in medication; and 8. Procedures for initiating intravenous solutions. (b) Such guidelines shall be available for review by the Board or its designee, the Massachusetts Board of Registration in Medicine or its designee, the Massachusetts Department of Public Health or its designee, and such other state or federal government agencies as may be reasonably necessary and appropriate to ensure compliance with all applicable state or federal laws and regulations. Copies of such guidelines, however, need not be filed with those agencies. (c) All such guidelines must be in writing and must be signed by both the supervising physician and the physician assistant. Such guidelines shall be reviewed annually and dated and initialed by both the supervising physician and the physician assistant at the time of each such review. The physician assistant and his or her supervising physician may alter such guidelines at any time and any such changes shall be initialed by both parties and dated. (5) All prescriptions or medication orders issued by a physician assistant shall be issued in a manner which is consistent with the scope of practice of the physician assistant, the guidelines developed pursuant to 263 CMR 5.06(4), and accepted standards of good medical practice for licensed physicians with respect to prescription practices. (6) At least four hours of the continuing medical education which a physician assistant is required to obtain pursuant to 263 CMR 3.05(3) as a condition for license renewal shall be in the field of pharmacology and/or pharmacokinetics. (7) All prescriptions written by a physician assistant shall be written in accordance with 105 CMR 721.000: Standards for Prescription Format and Security in Massachusetts. (8) A physician assistant may order only Schedule VI controlled substances from a drug wholesaler, manufacturer, distributor or laboratory, and only in accordance with the written guidelines developed with his or her supervising physician pursuant to 263 CMR 5.06(4). A physician assistant may sign only for sample Schedule VI controlled substances received by or sent to the practice setting by a pharmaceutical representative. (9) The use of pre-signed prescription blanks or forms is prohibited. (10) A physician assistant shall not prescribe controlled substances in Schedules II, III and IV for his or her own use. A physician assistant shall not prescribe Schedule II controlled substances for a member of his or her immediate family, including a parent, spouse or equivalent, child, sibling, parent-in-law, son/daughter-in-law, brother/sister-in-law, step-parent, step-child, step-sibling, or other relative permanently residing in the same residence as the physician assistant. (11) The physician assistant and the supervising physician for that work setting shall be jointly responsible for all prescriptions or medication orders issued by the physician assistant in that work setting.