Physical Exam Prior to Prescribing

Description

A physical exam prior to prescribing requires healthcare providers, under state law, to obtain a patient history, perform a patient evaluation, and/or document the existence of a bona fide physician-patient relationship prior to prescribing controlled substances.

Objective(s)

To limit unnecessary access to controlled substances

Typical Elements

The exact requirements vary by and within states, depending on the type of prescription (Centers for Disease Control and Prevention [CDC], 2015):

  • States can include a patient examination as part of their prescribing regulations, forbid pharmacists from filling prescriptions if they suspect that an examination did not occur, or both. 
    • Note: Forty-one states and the District of Columbia require prescribers or dispensers to ensure that prescriptions are the result of a patient examination.
  • State provisions regarding the type of exams required vary (CDC, 2015):
    • Physical exams are required in Alabama, Alaska, Arizona, Arkansas, Connecticut, Delaware, Florida, Georgia, Hawaii, Indiana, Iowa, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, and the District of Columbia.
    • An “appropriate” or “sufficient” examination, instead of or in addition to a physical exam, is required in California, Connecticut, Idaho, Iowa, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, Texas, Vermont, and the District of Columbia.
    • An unspecified examination (meaning there are no specific standards for that examination) is required in California, Idaho, Iowa, Kentucky, Montana, Nebraska, Nevada, New Jersey, Oregon, and South Carolina.
  • State provisions regarding the types of prescriptions that require exams likewise vary (CDC, 2015):
    • Exams are for required for all drug types, including controlled substances, in Alabama, Alaska, Arizona, Arkansas, California, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, and the District of Columbia.
    • Pain management prescriptions require an exam in Alabama, Florida, Iowa, Kentucky, Louisiana, Maine, New Jersey, New Mexico, Ohio, Oklahoma, Tennessee, Texas, Washington, and the District of Columbia.
    • Specific controlled substances, specific schedules of controlled substances, and/or drugs for the treatment of specific disorders require exams in Arkansas, Iowa, Kentucky, Louisiana, Minnesota, Mississippi, Nevada, New Jersey, Ohio, Oklahoma, Rhode Island, South Carolina, Utah, and Washington State.
  • States vary in the penalties imposed for prescribing without an exam (CDC, 2015):
    • Failure to conduct a required exam is considered unprofessional conduct and punishable by the licensing board in Alabama, Arizona, California, Delaware, Michigan, Nevada, New Hampshire, Ohio, Oklahoma, Oregon, South Carolina, Tennessee, and Wisconsin.
    • Failure to conduct a required exam can lead to license or application revocation or rejection in Florida and Tennessee.
    • Failure to conduct a required exam leads to criminal liability in Kentucky, Louisiana, and Virginia.
    • Licensing boards will report failure to conduct an exam to the attorney general in Arkansas.

Populations

Prescribers, pharmacists

Outcomes

No outcome data have been found regarding the role of physical exams prior to prescribing in preventing the nonmedical use of prescription drugs and/or its consequences.

Guidelines

Prescription Drug Physical Examination Requirements. 

Acknowledged by

No acknowledgements have been found regarding physical exams prior to prescribing in preventing the nonmedical use of prescription drugs and/or its consequences

References

Centers for Disease Control and Prevention. (2015). Prescription drug physical examination requirements. Retrieved from https://www.cdc.gov/phlp/docs/pdpe-requirements.pdf