                                 CODE OF VIRGINIA

PRESCRIPTIONS TO BE ISSUED AND DRUGS TO BE DISPENSED FOR MEDICAL OR THERAPEUTIC
PURPOSES ONLY (§ 54.1-3303)

A. A prescription for a controlled substance may be issued only by a
practitioner of medicine, osteopathy, podiatry, dentistry or veterinary medicine
who is authorized to prescribe controlled substances, a licensed advanced
practice registered nurse pursuant to &#xA7; 54.1-2957.01, a licensed certified
midwife pursuant to &#xA7; 54.1-2957.04, a licensed physician assistant pursuant
to &#xA7; 54.1-2952.1, or a TPA-certified optometrist pursuant to Article 5
(&#xA7; 54.1-3222 et seq.) of Chapter 32.

B. A prescription shall be issued only to persons or animals with whom the
practitioner has a bona fide practitioner-patient relationship or
veterinarian-client-patient relationship. If a practitioner is providing
expedited partner therapy consistent with the recommendations of the Centers for
Disease Control and Prevention, then a bona fide practitioner-patient
relationship shall not be required.
			A bona fide practitioner-patient relationship shall exist if the practitioner
has (i) obtained or caused to be obtained a medical or drug history of the
patient; (ii) provided information to the patient about the benefits and risks
of the drug being prescribed; (iii) performed or caused to be performed an
appropriate examination of the patient, either physically or by the use of
instrumentation and diagnostic equipment through which images and medical
records may be transmitted electronically; and (iv) initiated additional
interventions and follow-up care, if necessary, especially if a prescribed drug
may have serious side effects. Except in cases involving a medical emergency,
the examination required pursuant to clause (iii) shall be performed by the
practitioner prescribing the controlled substance, a practitioner who practices
in the same group as the practitioner prescribing the controlled substance, or a
consulting practitioner.
			A practitioner who has established a bona fide practitioner-patient
relationship with a patient in accordance with the provisions of this subsection
may prescribe Schedule II through VI controlled substances to that patient.
			A practitioner who has established a bona fide practitioner-patient
relationship with a patient in accordance with the provisions of this subsection
may prescribe Schedule II through VI controlled substances to that patient via
telemedicine if such prescribing is in compliance with federal requirements for
the practice of telemedicine and, in the case of the prescribing of a Schedule
II through V controlled substance, the prescriber maintains a practice at a
physical location in the Commonwealth or is able to make appropriate referral of
patients to a licensed practitioner located in the Commonwealth in order to
ensure an in-person examination of the patient when required by the standard of
care.
			A prescriber may establish a bona fide practitioner-patient relationship for
the purpose of prescribing Schedule II through VI controlled substances by an
examination through face-to-face interactive, two-way, real-time communications
services or store-and-forward technologies when all of the following conditions
are met: (a) the patient has provided a medical history that is available for
review by the prescriber; (b) the prescriber obtains an updated medical history
at the time of prescribing; (c) the prescriber makes a diagnosis at the time of
prescribing; (d) the prescriber conforms to the standard of care expected of
in-person care as appropriate to the patient&#8217;s age and presenting
condition, including when the standard of care requires the use of diagnostic
testing and performance of a physical examination, which may be carried out
through the use of peripheral devices appropriate to the patient&#8217;s
condition; (e) the prescriber is actively licensed in the Commonwealth and
authorized to prescribe; (f) if the patient is a member or enrollee of a health
plan or carrier, the prescriber has been credentialed by the health plan or
carrier as a participating provider and the diagnosing and prescribing meets the
qualifications for reimbursement by the health plan or carrier pursuant to
&#xA7; 38.2-3418.16; (g) upon request, the prescriber provides patient records
in a timely manner in accordance with the provisions of &#xA7; 32.1-127.1:03 and
all other state and federal laws and regulations; (h) the establishment of a
bona fide practitioner-patient relationship via telemedicine is consistent with
the standard of care, and the standard of care does not require an in-person
examination for the purpose of diagnosis; and (i) the establishment of a bona
fide practitioner patient relationship via telemedicine is consistent with
federal law and regulations and any waiver thereof. Nothing in this paragraph
shall apply to (1) a prescriber providing on-call coverage per an agreement with
another prescriber or his prescriber&#8217;s professional entity or employer;
(2) a prescriber consulting with another prescriber regarding a patient&#8217;s
care; or (3) orders of prescribers for hospital out-patients or in-patients.
			For purposes of this section, a bona fide veterinarian-client-patient
relationship is one in which a veterinarian, another veterinarian within the
group in which he practices, or a veterinarian with whom he is consulting has
assumed the responsibility for making medical judgments regarding the health of
and providing medical treatment to an animal as defined in &#xA7; 3.2-6500,
other than an equine as defined in &#xA7; 3.2-6200, a group of agricultural
animals as defined in &#xA7; 3.2-6500, or bees as defined in &#xA7; 3.2-4400,
and a client who is the owner or other caretaker of the animal, group of
agricultural animals, or bees has consented to such treatment and agreed to
follow the instructions of the veterinarian. Evidence that a veterinarian has
assumed responsibility for making medical judgments regarding the health of and
providing medical treatment to an animal, group of agricultural animals, or bees
shall include evidence that the veterinarian (A) has sufficient knowledge of the
animal, group of agricultural animals, or bees to provide a general or
preliminary diagnosis of the medical condition of the animal, group of
agricultural animals, or bees; (B) has made an examination of the animal, group
of agricultural animals, or bees, either physically or by the use of
instrumentation and diagnostic equipment through which images and medical
records may be transmitted electronically or has become familiar with the care
and keeping of that species of animal or bee on the premises of the client,
including other premises within the same operation or production system of the
client, through medically appropriate and timely visits to the premises at which
the animal, group of agricultural animals, or bees are kept; and (C) is
available to provide follow-up care.

C. A prescription shall only be issued for a medicinal or therapeutic purpose in
the usual course of treatment or for authorized research. A prescription not
issued in the usual course of treatment or for authorized research is not a
valid prescription. A practitioner who prescribes any controlled substance with
the knowledge that the controlled substance will be used otherwise than for
medicinal or therapeutic purposes shall be subject to the criminal penalties
provided in &#xA7; 18.2-248 for violations of the provisions of law relating to
the distribution or possession of controlled substances.

D. No prescription shall be filled unless a bona fide
practitioner-patient-pharmacist relationship exists. A bona fide
practitioner-patient-pharmacist relationship shall exist in cases in which a
practitioner prescribes, and a pharmacist dispenses, controlled substances in
good faith to a patient for a medicinal or therapeutic purpose within the course
of his professional practice.
			In cases in which it is not clear to a pharmacist that a bona fide
practitioner-patient relationship exists between a prescriber and a patient, a
pharmacist shall contact the prescribing practitioner or his agent and verify
the identity of the patient and name and quantity of the drug prescribed.
			Any person knowingly filling an invalid prescription shall be subject to the
criminal penalties provided in &#xA7; 18.2-248 for violations of the provisions
of law relating to the sale, distribution or possession of controlled
substances.

E. Notwithstanding any provision of law to the contrary and consistent with
recommendations of the Centers for Disease Control and Prevention or the
Department of Health, a practitioner may prescribe Schedule VI antibiotics and
antiviral agents to other persons in close contact with a diagnosed patient when
(i) the practitioner meets all requirements of a bona fide practitioner-patient
relationship, as defined in subsection B, with the diagnosed patient and (ii) in
the practitioner&#8217;s professional judgment, the practitioner deems there is
urgency to begin treatment to prevent the transmission of a communicable
disease. In cases in which the practitioner is an employee of or contracted by
the Department of Health or a local health department, the bona fide
practitioner-patient relationship with the diagnosed patient, as required by
clause (i), shall not be required.

F. A pharmacist may dispense a controlled substance pursuant to a prescription
of an out-of-state practitioner of medicine, osteopathy, podiatry, dentistry,
optometry, or veterinary medicine, an advanced practice registered nurse, or a
physician assistant authorized to issue such prescription if the prescription
complies with the requirements of this chapter and the Drug Control Act (&#xA7;
54.1-3400 et seq.).

G. A licensed advanced practice registered nurse who is authorized to prescribe
controlled substances pursuant to &#xA7; 54.1-2957.01 may issue prescriptions or
provide manufacturers&#8217; professional samples for controlled substances and
devices as set forth in the Drug Control Act (&#xA7; 54.1-3400 et seq.) in good
faith to his patient for a medicinal or therapeutic purpose within the scope of
his professional practice.

H. A licensed physician assistant who is authorized to prescribe controlled
substances pursuant to &#xA7; 54.1-2952.1 may issue prescriptions or provide
manufacturers&#8217; professional samples for controlled substances and devices
as set forth in the Drug Control Act (&#xA7; 54.1-3400 et seq.) in good faith to
his patient for a medicinal or therapeutic purpose within the scope of his
professional practice.

I. A TPA-certified optometrist who is authorized to prescribe controlled
substances pursuant to Article 5 (&#xA7; 54.1-3222 et seq.) of Chapter 32 may
issue prescriptions in good faith or provide manufacturers&#8217; professional
samples to his patients for medicinal or therapeutic purposes within the scope
of his professional practice pursuant to &#xA7; 54.1-3223, which shall be
limited to (i) analgesics included on Schedule II controlled substances as
defined in &#xA7; 54.1-3448 of the Drug Control Act (&#xA7; 54.1-3400 et seq.)
consisting of hydrocodone in combination with acetaminophen; (ii) oral
analgesics included in Schedules III through VI, as defined in &#xA7;&#xA7;
54.1-3450 and 54.1-3455 of the Drug Control Act (&#xA7; 54.1-3400 et seq.),
which are appropriate to relieve ocular pain; (iii) other oral Schedule VI
controlled substances, as defined in &#xA7; 54.1-3455 of the Drug Control Act,
appropriate to treat diseases and abnormal conditions of the human eye and its
adnexa; (iv) topically applied Schedule VI drugs, as defined in &#xA7; 54.1-3455
of the Drug Control Act; and (v) intramuscular administration of epinephrine for
treatment of emergency cases of anaphylactic shock.

J. The requirement for a bona fide practitioner-patient relationship shall be
deemed to be satisfied by a member or committee of a hospital&#8217;s medical
staff when approving a standing order or protocol for the administration of
influenza vaccinations and pneumococcal vaccinations in a hospital in compliance
with &#xA7; 32.1-126.4.

K. Notwithstanding any other provision of law, a prescriber may authorize a
registered nurse or licensed practical nurse to approve additional refills of a
prescribed drug for no more than 90 consecutive days, provided that (i) the drug
is classified as a Schedule VI drug; (ii) there are no changes in the prescribed
drug, strength, or dosage; (iii) the prescriber has a current written protocol,
accessible by the nurse, that identifies the conditions under which the nurse
may approve additional refills; and (iv) the nurse documents in the
patient&#8217;s chart any refills authorized for a specific patient pursuant to
the protocol and the additional refills are transmitted to a pharmacist in
accordance with the allowances for an authorized agent to transmit a
prescription orally or by facsimile pursuant to subsection C of &#xA7;
54.1-3408.01 and regulations of the Board.

HISTORY: 1983, c. 528, § 54-524.50:1; 1985, c. 336; 1988, c. 765; 1991, cc.
519, 524; 1992, c. 793; 1996, cc. 152, 158, 408; 1997, c. 806; 1998, c. 101;
1999, c. 745; 2000, cc. 882, 924; 2001, c. 465; 2003, c. 639; 2004, c. 744;
2006, c. 432; 2010, c. 74; 2015, cc. 32, 115; 2016, c. 86; 2017, cc. 58, 110;
2018, cc. 373, 380, 790; 2019, c. 335; 2020, c. 464; 2021, Sp. Sess. I, cc. 200,
201, 301, 302; 2023, c. 183; 2025, cc. 391, 408.