CHAPTER 217

HB 1396-FN – FINAL VERSION

12Mar2008… 0745h

05/01/08 1470s

21May2008… 1877eba

2008 SESSION

08-2416

10/01

HOUSE BILL 1396-FN

AN ACT relative to requiring prescriptions to be ordered pursuant to a practitioner-patient relationship.

SPONSORS: Rep. Rosenwald, Hills 22; Rep. Case, Rock 1; Rep. Miller, Straf 7

COMMITTEE: Health, Human Services and Elderly Affairs

ANALYSIS

This bill requires that a prescription be ordered pursuant to a practitioner-patient relationship or under certain other limited circumstances.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

12Mar2008… 0745h

05/01/08 1470s

21May2008… 1877eba

08-2416

10/01

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Eight

AN ACT relative to requiring prescriptions to be ordered pursuant to a practitioner-patient relationship.

Be it Enacted by the Senate and House of Representatives in General Court convened:

217:1 Pharmacists; Definition of Prescription. Amend RSA 318:1, XVI to read as follows:

XVI. “Prescription” means a verbal, or written, or facsimile or electronically transmitted order for drugs, medicines and devices by a [licensed] practitioner licensed in the United States, to be compounded and dispensed by licensed pharmacists in a duly registered pharmacy, and to be kept on file for a period of 4 years. A written order shall include an electronic transmission prescription received and retained in a form complying with rules adopted pursuant to RSA 318:5-a, XV. Prescriptions may also apply to the finished products dispensed or administered by the licensed pharmacist in the registered pharmacy, on order of a licensed practitioner as defined in this section.

217:2 Pharmacy; Oral Prescriptions. Amend RSA 318:47-c, I(a) to read as follows:

(a) A prescription may be written, oral, or electronically transmitted. All oral prescriptions shall be immediately reduced to writing by the pharmacist or authorized technician receiving the oral prescription and shall indicate at least the name of the patient; the name, strength, and quantity of the drug prescribed; any directions specified by the prescriber; the name of the practitioner prescribing the medication; the date the prescription was ordered; a statement that the prescription was presented orally; and the name of the pharmacist who took the [verbal] oral order. The pharmacist who dispensed an original prescription shall indicate on the face of the prescription at least the assigned prescription identification number; the date of dispensing; the quantity actually dispensed; and his or her name or initials. The prescription shall be filed numerically by the assigned identification number for a period not less than 4 years. Such prescription files shall be open to inspection by the pharmacy board and its agents.

217:3 New Paragraph; Controlled Drugs; Definition; Practitioner-Patient Relationship. Amend RSA 318-B:1 by inserting after paragraph XXVI the following new paragraph:

XXVI-a. “Practitioner-patient relationship” means a medical connection between a licensed practitioner and a patient that includes an in-person exam, a history, a diagnosis, a treatment plan appropriate for the licensee’s scope of practice, and documentation of all prescription drugs including name and dosage. A licensee may prescribe for a patient whom the licensee does not have a practitioner-patient relationship under the following circumstances: for a patient of another licensee for whom the prescriber is taking call; for a patient examined by another New Hampshire licensed practitioner; or for medication on a short-term basis for a new patient prior to the patient’s first appointment. The definition of a practitioner-patient relationship shall not apply to a practitioner licensed in another state who is consulting to a New Hampshire licensed practitioner with whom the patient has a relationship.

217:4 Controlled Drug Act; Definition of Prescription. Amend RSA 318-B:1, XXVIII to read as follows:

XXVIII. “Prescription” means [a verbal] an oral, written, or facsimile or electronically transmitted order for any controlled drug or preparation [from] issued by a licensed practitioner to be compounded and dispensed by a pharmacist [for] and delivered to a patient for a medicinal or therapeutic purpose arising from a practitioner-patient relationship.

217:5 Controlled Drug Act; Acts Prohibited. Amend RSA 318-B:2, V(c) and (d) to read as follows:

(c) By the concealment of a material fact; [or]

(d) By the use of a false name or the giving of a false address[.] ; or

(e) By submission of an electronic or on-line medical history form that fails to establish a valid practitioner-patient relationship.

217:6 New Paragraphs; Controlled Drug Act; Acts Prohibited. Amend RSA 318-B:2 by inserting after paragraph XII-a the following new paragraphs:

XII-b. It shall be unlawful for any person to knowingly obtain, or attempt to obtain, or to assist a person in obtaining or attempting to obtain a prescription for a controlled substance without having formed a valid practitioner-patient relationship.

XII-c. It shall be unlawful for any person to, by written or electronic means, solicit, facilitate or enter into any agreement or contract to solicit or facilitate the dispensing of controlled substances pursuant to prescription orders that do not meet the federal and state requirements for a controlled drug prescription, and without an established valid practitioner-patient relationship.

XII-d. It shall be unlawful for any pharmacy to ship finished prescription products, containing controlled substances, to patients residing in the state of New Hampshire, pursuant to any oral, written or online prescription order that was generated based upon the patient’s submission of an electronic or online medical history form. Such electronic or online medical questionnaires, even if followed by telephonic communication between practitioner and patient, shall not be deemed to form the basis of a valid practitioner-patient relationship.

XII-e. It shall be unlawful for any pharmacist to knowingly dispense a controlled substance pursuant to any oral, written, or electronic prescription order, which he or she knows or should have known, was generated based upon the patient’s submission of an electronic or online medical history form. Such electronic or online medical questionnaires, even if followed by telephonic communication between practitioner and patient, shall not be deemed to form the basis of a valid practitioner-patient relationship.

217:7 New Section; Physicians and Surgeons; Definition of Physician-Patient Relationship. Amend RSA 329 by inserting after section 1-b the following new section:

329:1-c Physician-Patient Relationship. “Physician-patient relationship” means a medical connection between a licensed physician and a patient that includes an in-person exam, a history, a diagnosis, a treatment plan appropriate for the licensee’s medical specialty, and documentation of all prescription drugs including name and dosage. A licensee may prescribe for a patient whom the licensee does not have a physician-patient relationship under the following circumstances: writing admission orders for a newly hospitalized patient; for a patient of another licensee for whom the prescriber is taking call; for a patient examined by a physician assistant, nurse practitioner, or other licensed practitioner; or for medication on a short-term basis for a new patient prior to the patient’s first appointment or when providing limited treatment to a family member in accordance with the American Medical Association Code of Medical Ethics. Prescribing drugs to individuals without a physician-patient relationship shall be unprofessional conduct subject to discipline under RSA 329:17, VI. The definition of a physician-patient relationship shall not apply to a physician licensed in another state who is consulting to a New Hampshire licensed physician with whom the patient has a relationship.

217:8 New Subparagraph; Physicians and Surgeons; Disciplinary Proceedings. Amend RSA 329:17, VI by inserting after subparagraph (k) the following new subparagraph:

(l) Has knowingly obtained, attempted to obtain or assisted a person in obtaining or attempting to obtain a prescription for a controlled substance without having formed a valid physician-patient relationship pursuant to RSA 329:1-c.

217:9 Effective Date. This act shall take effect January 1, 2009.

Approved: June 16, 2008

Effective Date: January 1, 2009