Guide to Developing Prescription Practice Guidelines

Every physician assistant ("PA") who writes a prescription or medication order for a patient must comply with Board regulations at 263 Code of Massachusetts Regulations ("CMR") 5.07, Prescription Practices of a Physician Assistant. Board regulations at 263 CMR 5.07(4) require all PAs who engage in prescription practice to issue prescriptions or medication orders only in accordance "with written guidelines which are mutually developed and agreed upon by the physician assistant and his or her supervising physician(s)." Prescription Practice Guidelines consist of a written document that is separate and distinct from a PA's job description or listing of job duties and responsibilities, and is in addition to any other forms and documents that may required by the facility, institution or practice in which the PA is employed.

Every PA engaged in prescription practice and his/her supervising physician must review, sign, and date a written copy of the Prescription Practice Guidelines annually. In addition to the required PA and supervising physician signatures, the names of the PA and the supervising physician must be legibly printed on the Guidelines. Both the PA and the supervising physician must initial and date any changes made to the Guidelines either at the required annual review or at any other time during the year. If a PA is employed in more than one work setting and has more than one supervising physician, the PA and each supervising physician must develop written Prescription Practice Guidelines for each work setting and review, sign, and date a copy annually. A PA and her/his supervising physician must carefully review the document they develop to ensure that the Guidelines reflect the practice and work setting of the PA.

The following Checklist identifies the information that a PA and his/her supervising physician must provide in the Prescription Practices Guidelines. The Guidelines must be written as one document that includes all of the information on the Checklist. If any of the information identified on the Checklist does NOT apply to the PA's prescription practice, the PA must indicate that the required information does not apply in the Guidelines. For example, if a PA will not be initiating intravenous solutions, the PA must include in the Guidelines the statement, "The physician assistant will not initiate intravenous solutions."

Checklist

  • Identification of the supervising physician for that work setting (263 CMR 5.07(4)(a)1.).

Clearly print the names of the PA who will engage in prescription practice and his/her supervising physician, and a brief description of the work setting, e.g., name of the facility/hospital/practice and description of specialty/unit.

Example: These Prescription Practice Guidelines are mutually developed, and agreed on, by [PA's name] and [supervising physician's name]. [PA name] works in [description of work setting].

  • Describe the frequency of medication reviews by the PA and her/his supervising physician (263 CMR 5.07(4)(a)2.).

Example:The physician assistant and the supervising physician will conduct medication reviews weekly.

  • Describe the types and classes of medications to be prescribed by the physician assistant (263 CMR 5.07(4)(a)3.).

NOTE: It is not necessary to list every medication that the PA is authorized to prescribe. A general statement identifying the types and classes of medications the PA may or may not prescribe is sufficient.

Example: The physician assistant may prescribe all types and classes of medications.

OR

The physician assistant may prescribe all medications in Schedules II, III and IV, but may not prescribe any medications in Schedule V.

  • 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 (263 CMR 5.07(4)(a)4.).

Example: The physician assistant may initiate and/or renew prescriptions for medications that are not within the ordinary scope of practice for this practice/work setting, but which are needed to provide appropriate medical care.

A statement about any follow-up or review, or both, may be included.

Example: All such prescriptions shall be reviewed by the supervising physician within [XXX period of time].

  • The quantity of any medication to be prescribed by a physician assistant, including initial dosage limits and refills (263 CMR 5.07(4)(a)5.).

NOTE: It is not necessary to list every medication that the PA may prescribe.

Example: The physician assistant may prescribe initial dosages of all medications for up to 7 days; refills may be prescribed for up to 30 days.

  • 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 (263 CMR 5.07(4)(a)6.).

Example: The physician assistant may order all types and quantities of Schedule VI medications from a drug wholesaler, manufacturer, laboratory or distributor for use in the practice setting only.

OR

The physician assistant may not order any Schedule VI medications for this practice setting.

  • Review of initial prescriptions or changes in medication (263 CMR 5.07(4)(a)7.).

Example: All initial prescriptions and changes in medication written by the physician assistant shall be reviewed on a weekly basis.

OR

All initial prescriptions and changes in medication written by the physician assistant shall be reviewed by the supervising physician within [XXX period of time].

  • Procedures for initiating intravenous solutions(263 CMR 5.07(4)(a)8.).

Example: The physician assistant may initiate intravenous solutions as required/needed.

OR

The physician assistant may not initiate intravenous solutions in this practice/work setting.

  • In addition, 263 CMR 5.07(4)(c) requires that all Prescription Practice Guidelines must be:
    • in writing;
    • signed by both the PA and the supervising physician;
    • reviewed annually;
    • dated and initialed by the PA and the supervising physician at each annual review;
    • dated and initialed by the PA and the supervising physician whenever altered.

  • Finally, 263 CMR 5.07(1) requires all PAs engaged in prescription practice to also comply with all applicable state and federal laws and regulations governing such practice including, but not limited to:
    • Massachusetts General Laws ("MGL") Chapter 112, s. 9E;
    • MGL c. 94C, ss. 7, 9 and 20; and
    • 105 CMR 700.000.


This information is provided by the Division of Health Professions Licensure within the Department of Public Health.