Amendments	Fiscal Memos
HA0927	Amendment 1-0 to HB1993
HA0928	Amendment 2-0 to HB1993
HA1105	Amendment 3-0 to HB1993

	Amendments	Fiscal Memos
SA0721	Amendment 1-1 to SB2191
SA1023	Amendment 2-1 to SB2191
SA1024	Amendment 3-2 to SB2191

NOTE: Each fiscal memorandum applies only to the amendment(s) identified in the memorandum. The fiscal memorandum must be matched to any amendments that have been adopted.

Fiscal Summary

NOT SIGNIFICANT

Bill Summary

ON APRIL 9, 2018, THE HOUSE ADOPTED AMENDMENT #1, #2, AND #3 AND PASSED HOUSE BILL 1993, AS AMENDED.

AMENDMENT #1 rewrites this bill and bill requires health care prescribers to issue all prescriptions for Schedule II controlled substances electronically by July 1, 2020, with some exceptions, as described below.

This amendment requires an authorized health care prescriber to legibly print, enter, or type, as a separate prescription order, any written, printed, or electronic prescription order for a Schedule II controlled substance. The written, printed, or electronic prescription order must contain all information otherwise required by law, and it must be signed by the prescriber on the day it is issued. An "electronic prescription" is a written prescription generated on an electronic application and transmitted as an electronic data file as set out in federal regulations.

Under this bill, any prescription for a Schedule II controlled substance on or after July 1, 2020, must be issued as an electronic prescription from the person issuing the prescription to a pharmacy, with the name, address, and telephone number of the collaborating physician of an advanced practice registered nurse or physician assistant included on the electronic prescription. This requirement will not apply to prescriptions:

(1) Issued by veterinarians;
(2) Issued in circumstances where electronic prescribing is not available due to technological or electrical failure, as set forth in rule;
(3) Issued by a health care prescriber to be dispensed by a pharmacy located outside the state, as set forth in rule;
(4) Issued when the health care prescriber and dispenser are the same entity;
(5) Issued while including elements that are not supported by the most recently implemented version of the National Council for Prescription Drug Programs Prescriber/Pharmacist Interface SCRIPT Standard;
(6) Issued by a health care prescriber for a drug that the federal food and drug administration (FDA) requires the prescription to contain certain elements that are not able to be accomplished with electronic prescribing;
(7) Issued by a health care prescriber allowing for the dispensing of a non-patient-specific prescription pursuant to a standing order, approved protocol for drug therapy, collaborative pharmacy practice agreement in response to a public health emergency, or in other circumstances where the health care prescriber may issue a non-patient-specific prescription;
(8) Issued by a health care prescriber prescribing a drug under a research protocol;
(9) Issued by a health care prescriber who has received a waiver or a renewed waiver for a specified period determined by the commissioner of health, not to exceed one year without renewal by the commissioner, from the requirement to use electronic prescribing, pursuant to a process established in rule by the commissioner, due to economic hardship, technological limitations that are not reasonably within the control of the health care prescriber, or other exceptional circumstance demonstrated by the health care prescriber; or
(10) Issued by a health care prescriber under circumstances where, notwithstanding the health care prescriber's present ability to make an electronic prescription, the health care prescriber reasonably determines that it would be impractical for the patient to obtain substances prescribed by electronic prescription in a timely manner, and such delay would adversely impact the patient's medical condition.

Under this amendment, a pharmacist who receives a written, oral, or faxed prescription is not required to verify with the health care prescriber that the prescription properly falls under one of the exceptions from the requirement to electronically prescribe.

The commissioner of health will refer individual health care prescribers who violate this amendment to the health care prescriber's licensing board, and for such violation, the health care prescriber is subject to a civil penalty of $1,000 for each violation. Any health-related board that is affected by this amendment must report to the general assembly by January 1, 2019, on issues related to the implementation of amendment.

Under present law, except when dispensed directly by a practitioner other than a pharmacy to an ultimate user, no controlled substance in Schedule II may be dispensed without the written prescription of a practitioner. This amendment revises this provision to instead provide that except when dispensed directly by a health care prescriber other than a pharmacy to an ultimate user, no controlled substance in Schedule II may be dispensed without the electronic prescription of a health care prescriber, unless authorized by the above-described provisions of this amendment. To the extent federal law does not permit an electronic prescription, a written prescription from a health care prescriber is required. This amendment specifies that pharmacists may continue to dispense medications from otherwise valid written, oral, or fax prescriptions that are consistent with these present law requirements, as amended by this amendment.

AMENDMENT #2 makes technical, nonsubstantive changes to this bill, by correcting a citation to a federal regulation; clarifying that any prescription for a Schedule II controlled substance must be issued as an electronic prescription from the person issuing the prescription to a pharmacy, not just prescriptions "in this state"; and referencing the provision of this bill in the present law provisions governing pharmacists, pharmacy interns, and pharmacy technicians transferring prescriptions to another form.

AMENDMENT #3 specifies that prescriptions issued by a health care prescriber who issues 50 or fewer prescriptions for Schedule II controlled substances per year are exempt from this bill's requirement that any prescription for a Schedule II controlled substance in this state must be issued as an electronic prescription from the person issuing the prescription to a pharmacy.