LB583 LB583
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LEGISLATIVE BILL 583
Approved by the Governor May 5, 2021
Introduced by Murman, 38; Clements, 2; Dorn, 30; Gragert, 40; Hansen, B., 16;
Kolterman, 24.
A BILL FOR AN ACT relating to prescriptions; to amend sections 28-414,
28-414.01, 38-101, 38-2870, and 38-2891, Revised Statutes Cumulative Supplement, 2020; to define a term; to require electronic issuance of
prescriptions for controlled substances; to provide exceptions; to harmonize provisions; to provide an operative date; and to repeal the original sections.
Be it enacted by the people of the State of Nebraska,
Section 1. Section 28-414, Revised Statutes Cumulative Supplement, 2020,
is amended to read:
28-414 (1) Except as otherwise provided in this section or section 28-412
or when administered directly by a practitioner to an ultimate user, a controlled substance listed in Schedule II of section 28-405 shall not be
dispensed without a prescription from a practitioner authorized to prescribe.
Beginning January 1, 2022, all such prescriptions shall be subject to section 4
of this act, except that all such prescriptions issued by a practitioner who is
a dentist shall be subject to section 4 of this act beginning January 1, 2024.
No prescription for a controlled substance listed in Schedule II of section
28-405 shall be filled more than six months from the date of issuance. A
prescription for a controlled substance listed in Schedule II of section 28-405
shall not be refilled.
(2) A prescription for controlled substances listed in Schedule II of section 28-405 must contain the following information prior to being filled by
a pharmacist or dispensing practitioner: (a) Patient's name and address, (b)
name of the drug, device, or biological, (c) strength of the drug or
biological, if applicable, (d) dosage form of the drug or biological, (e)
quantity of the drug, device, or biological prescribed, (f) directions for use,
(g) date of issuance, (h) prescribing practitioner's name and address, and (i)
Drug Enforcement Administration number of the prescribing practitioner. If the prescription is a written paper prescription, the paper prescription must contain the prescribing practitioner's manual signature. If the prescription is
an electronic prescription, the electronic prescription must contain all of the elements in subdivisions (a) through (i) of this subsection, must be digitally signed, and must be transmitted to and received by the pharmacy electronically to meet all of the requirements of the Controlled Substances Act, 21 U.S.C. 801
et seq., as it existed on January 1, 2014, pertaining to electronic prescribing of controlled substances.
(3)(a) In emergency situations, a controlled substance listed in Schedule II of section 28-405 may be dispensed pursuant to an oral prescription reduced to writing in accordance with subsection (2) of this section, except for the prescribing practitioner's signature, and bearing the word "emergency".
(b) For purposes of this section, emergency situation means a situation in
which a prescribing practitioner determines that (i) immediate administration of the controlled substance is necessary for proper treatment of the patient,
(ii) no appropriate alternative treatment is available, including administration of a drug which is not a controlled substance listed in Schedule II of section 28-405, and (iii) it is not reasonably possible for the prescribing practitioner to provide a signed, written or electronic prescription to be presented to the person dispensing the controlled substance prior to dispensing.
(4)(a) In nonemergency situations:
(i) A controlled substance listed in Schedule II of section 28-405 may be
dispensed pursuant to a facsimile of a written, signed paper prescription if
the original written, signed paper prescription is presented to the pharmacist for review before the controlled substance is dispensed, except as provided in
subdivision (a)(ii) or (iii) of this subsection;
(ii) A narcotic drug listed in Schedule II of section 28-405 may be
dispensed pursuant to a facsimile of a written, signed paper prescription (A)
to be compounded for direct parenteral administration to a patient for the purpose of home infusion therapy or (B) for administration to a patient enrolled in a hospice care program and bearing the words "hospice patient"; and
(iii) A controlled substance listed in Schedule II of section 28-405 may be dispensed pursuant to a facsimile of a written, signed paper prescription for administration to a resident of a long-term care facility.
(b) For purposes of subdivisions (a)(ii) and (iii) of this subsection, a facsimile of a written, signed paper prescription shall serve as the original written prescription and shall be maintained in accordance with subsection (1)
of section 28-414.03.
(5)(a) A prescription for a controlled substance listed in Schedule II of section 28-405 may be partially filled if the pharmacist does not supply the full quantity prescribed and he or she makes a notation of the quantity supplied on the face of the prescription or in the electronic record. The
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remaining portion of the prescription may be filled no later than thirty days after the date on which the prescription is written. The pharmacist shall notify the prescribing practitioner if the remaining portion of the prescription is not or cannot be filled within such period. No further quantity may be supplied after such period without a new written, signed paper prescription or electronic prescription.
(b) A prescription for a controlled substance listed in Schedule II of section 28-405 written for a patient in a long-term care facility or for a patient with a medical diagnosis documenting a terminal illness may be
partially filled. Such prescription shall bear the words "terminally ill" or
"long-term care facility patient" on its face or in the electronic record. If there is any question whether a patient may be classified as having a terminal illness, the pharmacist shall contact the prescribing practitioner prior to
partially filling the prescription. Both the pharmacist and the prescribing practitioner have a corresponding responsibility to assure that the controlled substance is for a terminally ill patient. For each partial filling, the dispensing pharmacist shall record on the back of the prescription or on another appropriate record, uniformly maintained and readily retrievable, the date of the partial filling, quantity dispensed, remaining quantity authorized to be dispensed, and the identification of the dispensing pharmacist. The total quantity of controlled substances listed in Schedule II which is dispensed in
all partial fillings shall not exceed the total quantity prescribed. A
prescription for a Schedule II controlled substance for a patient in a long-
term care facility or a patient with a medical diagnosis documenting a terminal illness is valid for sixty days from the date of issuance or until discontinuance of the prescription, whichever occurs first.
Sec. 2. Section 28-414.01, Revised Statutes Cumulative Supplement, 2020,
is amended to read:
28-414.01 (1) Except as otherwise provided in this section or when administered directly by a practitioner to an ultimate user, a controlled substance listed in Schedule III, IV, or V of section 28-405 shall not be
dispensed without a written, oral, or electronic medical order. Such medical order is valid for six months after the date of issuance. Original prescription information for any controlled substance listed in Schedule III, IV, or V of section 28-405 may be transferred between pharmacies for purposes of refill dispensing pursuant to section 38-2871.
(2) A prescription for controlled substances listed in Schedule III, IV,
or V of section 28-405 must contain the following information prior to being filled by a pharmacist or dispensing practitioner: (a) Patient's name and address, (b) name of the drug, device, or biological, (c) strength of the drug or biological, if applicable, (d) dosage form of the drug or biological, (e)
quantity of the drug, device, or biological prescribed, (f) directions for use,
(g) date of issuance, (h) number of refills, including pro re nata or PRN
refills, not to exceed five refills within six months after the date of
issuance, (i) prescribing practitioner's name and address, and (j) Drug Enforcement Administration number of the prescribing practitioner. Beginning January 1, 2022, all such prescriptions shall be subject to section 4 of this act, except that all such prescriptions issued by a practitioner who is a dentist shall be subject to section 4 of this act beginning January 1, 2024. If the prescription is a written paper prescription, the paper prescription must contain the prescribing practitioner's manual signature. If the prescription is
an electronic prescription, the electronic prescription must contain all of the elements in subdivisions (a) through (j) of this subsection, must be digitally signed, and must be transmitted to and received by the pharmacy electronically to meet all of the requirements of 21 C.F.R. 1311, as the regulation existed on
January 1, 2014, pertaining to electronic prescribing of controlled substances.
(3)(a) A pharmacist who is exercising reasonable care and who has obtained patient consent may do the following:
(i) Change the quantity of a drug prescribed if:
(A) The prescribed quantity or package size is not commercially available;
or
(B) The change in quantity is related to a change in dosage form;
(ii) Change the dosage form of the prescription if it is in the best interest of the patient and if the directions for use are also modified to
equate to an equivalent amount of drug dispensed as prescribed;
(iii) Dispense multiple months' supply of a drug if a prescription is
written with sufficient refills; and
(iv) Substitute any chemically equivalent drug product for a prescribed drug to comply with a drug formulary which is covered by the patient's health insurance plan unless the prescribing practitioner specifies "no substitution",
"dispense as written", or "D.A.W." to indicate that substitution is not permitted. If a pharmacist substitutes any chemically equivalent drug product as permitted under this subdivision, the pharmacist shall provide notice to the prescribing practitioner or the prescribing practitioner's designee. If drug product selection occurs involving a generic substitution, the drug product selection shall comply with section 38-28,111.
(b) A pharmacist who adapts a prescription in accordance with this subsection shall document the adaptation in the patient's pharmacy record.
(4) A controlled substance listed in Schedule III, IV, or V of section
28-405 may be dispensed pursuant to a facsimile of a written, signed paper prescription. The facsimile of a written, signed paper prescription shall serve as the original written prescription for purposes of this subsection and shall be maintained in accordance with subsection (2) of section 28-414.03.
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(5) A prescription for a controlled substance listed in Schedule III, IV,
or V of section 28-405 may be partially filled if (a) each partial filling is
recorded in the same manner as a refilling, (b) the total quantity dispensed in
all partial fillings does not exceed the total quantity prescribed, and (c)
each partial filling is dispensed within six months after the prescription was issued.
Sec. 3. Section 38-101, Revised Statutes Cumulative Supplement, 2020, is amended to read:
38-101 Sections 38-101 to 38-1,145 and section 4 of this act and the following practice acts shall be known and may be cited as the Uniform Credentialing Act:
(1) The Advanced Practice Registered Nurse Practice Act;
(2) The Alcohol and Drug Counseling Practice Act;
(3) The Athletic Training Practice Act;
(4) The Audiology and Speech-Language Pathology Practice Act;
(5) The Certified Nurse Midwifery Practice Act;
(6) The Certified Registered Nurse Anesthetist Practice Act;
(7) The Chiropractic Practice Act;
(8) The Clinical Nurse Specialist Practice Act;
(9) The Cosmetology, Electrology, Esthetics, Nail Technology, and Body Art Practice Act;
(10) The Dentistry Practice Act;
(11) The Dialysis Patient Care Technician Registration Act;
(12) The Emergency Medical Services Practice Act;
(13) The Environmental Health Specialists Practice Act;
(14) The Funeral Directing and Embalming Practice Act;
(15) The Genetic Counseling Practice Act;
(16) The Hearing Instrument Specialists Practice Act;
(17) The Licensed Practical Nurse-Certified Practice Act until November 1,
2017;
(18) The Massage Therapy Practice Act;
(19) The Medical Nutrition Therapy Practice Act;
(20) The Medical Radiography Practice Act;
(21) The Medicine and Surgery Practice Act;
(22) The Mental Health Practice Act;
(23) The Nurse Practice Act;
(24) The Nurse Practitioner Practice Act;
(25) The Nursing Home Administrator Practice Act;
(26) The Occupational Therapy Practice Act;
(27) The Optometry Practice Act;
(28) The Perfusion Practice Act;
(29) The Pharmacy Practice Act;
(30) The Physical Therapy Practice Act;
(31) The Podiatry Practice Act;
(32) The Psychology Practice Act;
(33) The Respiratory Care Practice Act;
(34) The Surgical First Assistant Practice Act;
(35) The Veterinary Medicine and Surgery Practice Act; and
(36) The Water Well Standards and Contractors' Practice Act.
If there is any conflict between any provision of sections 38-101 to
38-1,145 and section 4 of this act and any provision of a practice act, the provision of the practice act shall prevail.
The Revisor of Statutes shall assign the Uniform Credentialing Act,
including the practice acts enumerated in subdivisions (1) through (35) of this section, to articles within Chapter 38.
Sec. 4. (1) For purposes of this section, prescriber means a health care practitioner authorized to prescribe controlled substances in the practice for which credentialed under the Uniform Credentialing Act.
(2) Except as otherwise provided in subsection (3) or (6) of this section,
no prescriber shall, in this state, issue any prescription as defined in
section 38-2840 for a controlled substance as defined in section 28-401 unless such prescription is issued (a) using electronic prescription technology, (b)
from the prescriber issuing the prescription to a pharmacy, and (c) in accordance with all requirements of state law and the rules and regulations adopted and promulgated pursuant to such state law.
(3) The requirements of subsection (2) of this section shall not apply to
prescriptions:
(a) Issued by veterinarians;
(b) Issued in circumstances where electronic prescribing is not available due to temporary technological or electrical failure;
(c) Issued when the prescriber and the dispenser are the same entity;
(d) Issued that include elements that are not supported by the Prescriber/
Pharmacist Interface SCRIPT Standard of the National Council for Prescription Drug Programs as such standard existed on January 1, 2021;
(e) Issued for a drug for which the federal Food and Drug Administration requires the prescription to contain certain elements that are not able to be accomplished with electronic prescribing;
(f) Issued for dispensing a non-patient-specific prescription which is (i)
an approved protocol for drug therapy or (ii) in response to a public health emergency;
(g) Issued for a drug for purposes of a research protocol;
(h) Issued under circumstances in which, notwithstanding the prescriber's ability to make an electronic prescription as required by this section, such
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prescriber reasonably determines (i) that it would be impractical for the patient to obtain substances prescribed by electronic prescription in a timely manner and (ii) that such delay would adversely impact the patient's medical condition; or
(i) Issued for drugs requiring compounding.
(4) A pharmacist who receives a written, oral, or faxed prescription is
not required to verify that the prescription falls under one of the exceptions listed in subsection (3) of this section. A pharmacist may continue to dispense medication from any otherwise valid written, oral, or faxed prescription consistent with the law and rules and regulations as they existed prior to
January 1, 2022.
(5) A violation of this section shall not be grounds for disciplinary action under the Uniform Credentialing Act.
(6) A dentist shall not be subject to this section until January 1, 2024.
Sec. 5. Section 38-2870, Revised Statutes Cumulative Supplement, 2020, is amended to read:
38-2870 (1) Beginning January 1, 2022, prescriptions for controlled substances listed in section 28-405 shall be subject to section 4 of this act,
except that all such prescriptions issued by a practitioner who is a dentist shall be subject to section 4 of this act beginning January 1, 2024.
(2) (1) All medical orders shall be written, oral, or electronic and shall be valid for the period stated in the medical order, except that (a) if the medical order is for a controlled substance listed in section 28-405, such period shall not exceed six months from the date of issuance at which time the medical order shall expire and (b) if the medical order is for a drug or device which is not a controlled substance listed in section 28-405 or is an order issued by a practitioner for pharmaceutical care, such period shall not exceed twelve months from the date of issuance at which time the medical order shall expire.
(3) (2) Prescription drugs or devices may only be dispensed by a pharmacist or pharmacist intern pursuant to a medical order, by an individual dispensing pursuant to a delegated dispensing permit, or as otherwise provided in section 38-2850. Notwithstanding any other provision of law to the contrary,
a pharmaci