Alabama News: Prescribing of Controlled Substances by Physician Assistants

Topics: Controlled substances and Prescribing authority

Published in the November 2009 Alabama State Board of Pharmacy Newsletter

A new law authorizes qualified, approved physician assistants (PAs) to prescribe controlled substances in Schedules III, IV, and V. The Alabama Board of Medical Examiners is in the process of developing administrative rules that will specify the application procedures, fees, fines, punishments, and conduct of disciplinary hearings concerning the Qualified Alabama Controlled Substances Certificates (QACSC).

Pursuant to the new law (Act 2009-489), the Medical Board may grant a QACSC to a PA who:

  • Is practicing with appropriate physician supervision
  • Submits proof of successful completion of certain courses to include advanced pharmacology and controlled substances prescribing trends (the Medical Board is in the process of determining approved courses and number of hours required)
  • Provides documentation of a minimum of 12 months of active, clinical employment with physician supervision following National Commission on Certification of Physician Assistants certification

PAs who are issued a QACSC by the Medical Board and a valid registration number from Drug Enforcement Administration (DEA) may prescribe, administer, authorize for administration, or dispense only those controlled substances in Schedules III, IV, and V in accordance with protocols and formularies approved by the supervising physician and the Medical Board. These protocols and formularies will specify which schedules and/or specific drugs the PA may prescribe. PAs may not use their QACSCs for purchasing, obtaining, maintaining, or ordering any stock supply or inventory of any controlled substance in any form. The law also states that a PA shall not prescribe, administer, or dispense any controlled substance to his or her own self, spouse, child, or parent.

The law sets out the grounds upon which the Medical Board may deny an initial or renewal QACSC application or initiate a disciplinary action. These grounds include the following:

  • Fraud or deceit in applying for a QACSC
  • Conviction of a crime relating to controlled substances
  • Conviction of a crime or offense that affects the ability of the PA to practice with due regard for the health or safety of his or her patients
  • Prescribing a drug or utilizing a QACSC in such a manner as to endanger the health of the patient
  • Suspension or revocation of the PA’s DEA registration number
  • Excessive dispensing or prescribing of any drug to any person or patient of the PA
  • Unfitness or incompetence due to the use of or dependence on alcohol, chemicals, or any mood altering drug to such an extent as to render the PA unsafe or unreliable to prescribe drugs or hold a QACSC

At this writing, the Medical Board has not yet established the application and renewal fees for QACSCs. This information, along with the administrative rules when they are published for public comment, will be available at the Medical Board’s Web site. The Medical Board will commence accepting applications and issuing QACSCs in January 2010.

The law also amends provisions concerning the Department of Public Health’s Prescription Drug Monitoring Program (PDMP) database. PAs with QACSCs will be authorized to query the database, limited to information concerning a current or prospective patient, and physicians will be authorized to query the database concerning PAs under their supervision. As with the physicians’ QACSCs, the Medical Board will be required to collect $10 per year on each QACSC to be remitted to the health department for the operation and maintenance of the PDMP database.

On the Net:

  • Act 2009-489: http://arc-sos.state.al.us/PAC/SOSACPDF.001/A0007123.pdf
  • PDMP: www.adph.org/PDMP/